2 nd Brazilian Consensus on Chagas Disease, 2015

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research

Epidemiologic aspects and evaluation of the control methods American visceral leishmaniasis in São Paulo State, Brazil

O controle da leishmaniose visceral americana (LVA) tem encerrado controvérsias quanto à efetividade das diferentes medidas empregadas, e sua manutenção apresenta custos elevados. Dada a essa problemática, esse estudo teve como objetivo avaliar as intervenções do Programa de Controle da LVA no Estado de São Paulo. Foram selecionadas três áreas no município de Araçatuba onde a LVA canina vinha ocorrendo: área Testemunha, onde se realizou somente a eliminação de cães soropositivos; área Tratada, onde foram realizadas a aplicação de cipermetrina nos imóveis e anexos, e a eliminação de cães soropositivos; área Calagem, onde foram realizados o manejo ambiental pela remoção de matéria orgânica e aplicação de calcário dolomítico no peridomicílio e terrenos baldios e a eliminação de cães soropositivos. As capturas mensais de flebotomíneos foram realizadas numa amostra de 123 residências, de 1999 a 2001. Para conhecer a preferência alimentar de L. longipalpis foi utilizado o teste de precipitação com antisoros de humano e de animais domésticos. Durante as capturas foram realizadas as medidas de temperatura e umidade relativa do ar. Quanto ao cão, uma coorte dinâmica foi acompanhada em cada área. A infecção canina foi detectada pela técnica de imunofluorescência indireta e calculadas as taxas de prevalência e incidência. A eliminação ocorreu quando os títulos foram iguais a 1/40. Para comparar as médias de L. longipalpis no intra e peridomicílio das áreas Tratadas e Calagem com a Testemunha foi utilizado o teste H de Kruskall-Wallis. A análise dos fatores associados com a presença do vetor foi feita pelo método de regressão logística múltipla. A probabilidade do cão de adquirir a infecção foi realizada pela técnica de regressão complementar loglog. Também, foi analisada a relação custo-efetividade das atividades do Programa. A análise da freqüência de L. longipalpis revelou maior densidade nos meses de janeiro a abril e de setembro a dezembro. A maior chance da presença do vetor no peridomicílio foi observada no horário das 20h00 às 21h00, temperaturas médias entre 20 a 29°C, e umidade relativa do ar inferior a 80%. O vetor apresentou hábito alimentar eclético, porém com elevado grau de cinofilia. Os tratamentos químicos dos imóveis e o manejo ambiental mostraram eficácia na redução do vetor no intradomicílio. Verificou-se que a chance x de presença do vetor foi mais elevada na área sem nenhuma intervenção contra o vetor (OR=6,13), enquanto a área Calagem mostrou metade dessa chance (OR=3,08) quando comparada à área com intervenção química. Em relação ao cão, observou-se que a infecção foi maior em cães sem raça definida do que entre os cães de raça. Entre os cães e raça, as maiores positividades ocorreram entre cães de tamanho grande, do tipo Dogue, onde a chance de infecção foi mais 2,5 vezes do que nos demais do grupo; os cães de pêlo liso tiveram 2,06 vezes mais chance de infecção do que os de pêlo crespo; cães com hábito de dormir no intradomicílio demonstraram menor participação na manutenção na doença. A comparação entre as prevalências inicial e final não mostrou diferença significativa nas três áreas estudadas, bem como, não houve diferença no comportamento da incidência acumulada canina nas três áreas. Considerando os períodos de maior densidade vetorial e maior prevalência da infecção canina, o período pré-patente para a detecção de títulos IFA no cão pode ser considerado de 4 a 5 meses. Com o controle vetorial houve a redução da densidade de L. longipalpis. Entretanto, não houve diferença significativa na incidência da LVA canina entre as áreas, levando a concluir que a redução da população do vetor não teve efeito sobre a doença canina, no entanto nenhum caso humano ocorreu nas três áreas, embora tenham ocorrido nas áreas vizinhas do município. Isto sugere que as medidas de controle foram eficientes e a eliminação de cães infectados reduziu a chance de infecção humana. Para a diminuição da incidência humana, a eliminação de cão foi a medida de melhor relação custo-efetividade. Em relação ao vetor, o manejo ambiental foi a medida mais custo-efetiva atingindo 80 a 100% de efetividade para o intradomicílio. No peridomicílio, as duas medidas de controle foram inefetivas para redução da população do vetor. Recomenda-se que o manejo ambiental seja empregado em todo o município como medida de prevenção em área urbana, e o controle químico passe a ser empregado em situações epidêmicas envolvendo a população humana.Controversy surrounds the effectiveness of the control methods used for American visceral leishmaniasis (AVL) and their maintenance is very expensive. With these points in mind it was decided to evaluate São Paulo State\'s AVL Control Program. Three areas in Araçatuba city were chosen. Canine AVL in all of them and in the Control area the only method employed was the elimination of seropositive dogs. In the 2nd area, which is called the Treated area, the houses and outhouses were sprayed with cypermethrin and seropositive dogs were eliminated, In the third area, which is called the Environmental area, surplus organic material was removed and soil of the gardens and abandoned plots was treated with dolomitic lime and seropositive dogs were eliminated. Monthly sand fly captures were performed in a 123 residences situated in these 3 areas between 1999 and 2001. Lutzomyia longipalpis blood meals were tested by the precipitin test human and domestic animal antisera. During the captures temperature and relative humidity levels were recorded. The canine infections were determined in cohorts in each area using the indirect immune-fluorescent test (IFAT) and from these the prevalence and incidences rates were calculated. Dogs whose titres were 1/40 were sacrificed. The means of the extra and intra-domiciliary populations of L. longipalpis were compared using the Kruskall-Wallis H test. The factors with the presence of the vector were compared using multiple logistic regressions. The complementary loglog regression estimated the probability of a dog acquiring the infection. The cost-effectiveness of the Program\'s activities was also analyzed. L. longipalpis population densities were highest between January and April and September and December. The greatest chance of the vector\'s presence extra domiciliary habitat was between 8 and 9 pm, when the average temperature was between 20°C and 29°C and relative humidity was below 80%. The vector presented eclectic feeding habits, but there was a preference for dogs (cinophilic). Insecticide spraying of the domiciliary habitats and environmental management resulted in the reduction of the vector indoors. The XIII chance of the vector\'s presence was higher in the Control area where no vector control measures had been applied (OR=6,13). In the Environmental area the chance of the vector\'s presence was half (OR=3,08) of that Treated area. Infections rates were higher in mongrels than in dogs with defined breeds. In the larger dog breeds the chance of infection was 2,5 times more than in the others. In breeds with straight hair the chance of infection was 2,06 times more than those with curly hair. Dogs who slept indoors also played a less significant role in the enzootic cycle. There was no difference in the initial and final prevalences and canine cumulative incidences between the three areas. Based on the periods with higher vectorial density and higher prevalence of canine infection the pre-patent period for the appearance of IFAT was 4 to 5. Vectorial control reduced the L. longipalpis populations. However, since there was no significant difference in the incidence of canine VL in any of the areas it is concluded that even though the vector population was reduced it had no effect. No human cases occurred in any of the three areas but they continued to occur in neighboring areas. This suggests that the control measures were efficient and that the elimination of infected dogs reduces the chances of human infections. For the reduction of human incidence the elimination of dogs was the most cost-effective measure. For vector control environmental management was the most cost/effective measure and was 80% to 100% effective in the indoor environment. In the peridomiciliary environment neither insecticide application nor environmental management reduced the vector population. It is recommended that the environmental intervention should be applied, as a preventive measure, in all municipal area. Insecticides should be applied only when there is an epidemic outbreak in the human population

Estratégia e perspectivas de controle da leishmaniose tegumentar no Estado de São Paulo

A multiplicidade de fatores que envolve a transmissão da leishmaniose tegumentar americana resulta em dificuldades para se formular estratégia eficiente de controle da doença. O Estado de São Paulo, considerando o número de casos notificados por localidade, estabelece aplicação de DDT em área com ocorrência de dois ou mais casos. Com isto, parte do programa fica afetado, pois em 40% dos municípios tem-se registrado apenas um caso humano. Esses e outros fatores são analisados diante de um crescimento de distribuição da incidência no Estado e da evolução da doença em ambiente extraflorestal. Procedimentos administrativos com retardamento na tomada de decisão afetam a eficácia do programa. Daí, a necessidade de uma revisão na estratégia

Leishmania infantum Genetic Diversity and Lutzomyia longipalpis Mitochondrial Haplotypes in Brazil

Leishmania infantum is the etiological agent of visceral leishmaniasis (VL) in the Americas with domestic dogs being its major reservoir hosts. The main VL vector is the sandfly Lutzomyia longipalpis, while other Lutzomyia species may play a role in disease transmission. Although the genetic structure of L. infantum populations has been widely evaluated, only a few studies have addressed this subject coupled to the genetic structure of the respective sandfly vectors. In this study, we analyzed the population structure of L. infantum in three major VL endemic areas in Brazil and associated it with Lutzomyia longipalpis geographic structure

Núcleos de Ensino da Unesp: artigos 2007

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora