Influence of anthropic changes and environmental characteristics on the occurrence of Tegumentary Leishmaniasis in Montes Claros, Minas Gerais, Brazil, between 2012 and 2019

This is an ecological study that investigated the influence of environmental, socioeconomic characteristics and changes in land use and cover on the occurrence of Tegumentary Leishmaniasis (TL) in the city of Montes Claros.The relationships between the number of cases of TL, which occurred between 2012 and 2019, in each census sector and the standardized covariates (Number of properties, altitude, Brazilian Deprivation Index, Normalized Difference Vegetation Index (NDVI), proportion of sector (PS) deforested, PS that underwent other anthropic alterations and unaltered PS) were evaluated with ecological Bayesian Models. Four multivariate models were constructed, with similar quality of adjustments, but Model 1 was the most parsimonious. Model 1 revealed that for each one-unit increase of standard deviation (SD) in the log of the number of properties, at the altitude and root of the deforested PS, corresponds to an increase of 44%, 34% and 24.5% in the number of cases of TL, respectively. The variable NDVI, included in models 3 and 4, was positively associated with the increase in the number of TL cases, being that for each one-unit increase in the NDVI was verified an increase of 21.3% and 20.2% respectively in the models. This study showed that the spatial distribution of TL cases in the city of Montes Claros occurs in a heterogeneous way and our findings support the hypothesis that socio-environmental char­acteristics and deforestation influence the occurrence of this disease in the studied area. Thus, these factors must be considered for the development of disease control strategies.Fil: Luiz Ursine, Renata. Universidade Federal de Montes Claros; BrasilFil: Fonseca Rocha, Marília. Universidade Federal de Montes Claros; BrasilFil: Chiaravalloti Neto, Francisco. Universidade de Sao Paulo; BrasilFil: Esdras Leite, Marcos. Universidade Federal de Montes Claros; BrasilFil: Dolabela Falcão, Luiz. Universidade Federal de Montes Claros; BrasilFil: Gorla, David Eladio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Diversidad y Ecología Animal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Diversidad y Ecología Animal; ArgentinaFil: Guimarães de Carvalho, Sílvio Fernando. Universidade Federal de Montes Claros; BrasilFil: Vieira, Thallyta Maria. Universidade Federal de Montes Claros; Brasi

Perfil dos acidentes ofídicos no norte do Estado de Minas Gerais, Brasil Profile of snakebite accidents in the north of the State of Minas Gerais, Brazil

O objetivo deste estudo foi descrever o perfil epidemiológico dos acidentes ofídicos da macrorregião de saúde do Norte do Estado de Minas Gerais, Brasil. Foram analisadas informações sobre os acidentes ofídicos relativos ao período compreendido entre janeiro de 2002 a dezembro de 2006, por meio de bancos de dados. Os resultados demonstraram 10.553 casos notificados, com ênfase para a maior casuística em meses de tempo quente e chuvoso, em áreas urbanas (54,1%), faixa etária menor de 20 anos (39,7%), acometendo mais homens e estudantes (53,1% e 29,1%) respectivamente. Os membros inferiores (pé, dedo do pé, perna e coxa) foram os locais mais afetados (35,9%), as serpentes prevalentes foram do gênero Bothrops (82,9%) e a gravidade da maioria dos acidentes foi leve (66,2%). Observou-se nesse estudo um importante impacto da sazonalidade, urbanização, subnotificação das espécies envolvidas nesses acidentes e busca rápida pelo pronto atendimento. Espera-se que os dados inéditos da casuística obtida possam servir de substrato para o planejamento e execução de medidas voltadas para vigilância em saúde e atendimento.The aim of this study was to describe the epidemiological profile of snakebite accidents in the healthcare macroregion of the north of the State of Minas Gerais, Brazil. Database information on snakebite accidents covering the period from January 2002 to December 2006 was analyzed. It was found that 10,553 cases were notified, and that the samples were noticeably larger in the months of hot and rainy weather, in urban areas (54.1%), at ages less then 20 years (39.7%) and among men and students (53.1% and 29.1%) respectively. The lower limbs (feet, toes, legs and thighs) were the locations most affected (35.9%). The most prevalent snakes were in the genus Bothrops (82.9%) and most of the accidents were mild (66.2%). In this study, it was seen that the seasonality, urbanization and undernotification of the species involved in these accidents had a notable impact, along with seeking walk-in care. It is expected that the new data obtained from this sample may serve as the substrate for planning and implementing measures for healthcare surveillance

Socio-environmental factors associated with the occurrence of triatomines (Hemiptera: Reduviidae) in an endemic municipality in northern Minas Gerais, Brazil

Triatomines are the vectors of Trypanosoma cruzi, the etiological agent of Chagas dis-ease. The study aimed to evaluate the association between sociodemographic andenvironmental factors, and changes in land use and cover, with the occurrence andabundance of triatomines by census sectors in an endemic municipality of northernMinas Gerais, Brazil. The study was conducted in Montes Claros, located in the northof Minas Gerais, Brazil. The entomological data used in the study were collected byactive surveillance in the rural area from 2015 to 2019 and by passive surveillancein the urban area from 2009 to 2019. Data on sociodemographic and environmentalfactors and changes in land use and land cover were obtained from the urban andrural census sectors. A total of 1404 triatomines, belonging to eight species, werecaptured in domiciles in the rural area (2015–­2019) and 277 triatomines in domicilesin the urban area (2009–­2019) of the municipality of Montes Claros. The variables thenumber of domiciles, household economic income, pavement, NDVI, deforestation,unchanged, and anthropic proved to be positively associated with the occurrenceand/or number of triatomines in census sectors, within the models. The occurrence oftriatomines in the domestic environment of the municipality of Montes Claros shouldbe considered a public health problem, as it suggests a potential risk of establishmentand transmission of T. cruzi to domestic animals, farm animals, and humans.Fil: Goncalvez, Thainara. Universidade Federal de Montes Claros; BrasilFil: Ursine, Renata. Universidade Federal de Montes Claros; BrasilFil: Cardozo, Miriam. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones Biológicas y Tecnológicas. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto de Investigaciones Biológicas y Tecnológicas; ArgentinaFil: Lorrane Francisco dos Reis Matos, Rosanna. Universidade Federal de Montes Claros; BrasilFil: de Cássia Moreira de Souza, Rita. Fundación Oswaldo Cruz; BrasilFil: Gonçalves Diotaiuti, Liléia. Fundación Oswaldo Cruz; BrasilFil: Gorla, David Eladio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Diversidad y Ecología Animal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Diversidad y Ecología Animal; ArgentinaFil: Guimarães de Carvalho, Sílvio Fernando. Universidade Federal de Montes Claros; BrasilFil: Vieira, Thallyta Maria. Universidade Federal de Montes Claros; Brasi

Genetic diversity of Leishmania infantum field populations from Brazil

Leishmania infantum (syn. Leishmania chagasi) is the etiological agent of visceral leishmaniasis (VL) in Brazil. The epidemiology of VL is poorly understood. Therefore, a more detailed molecular characterization at an intraspecific level is certainly needed. Herein, three independent molecular methods, multilocus microsatellite typing (MLMT), random amplification of polymorphic DNA (RAPD) and simple sequence repeats-polymerase chain reaction (SSR-PCR), were used to evaluate the genetic diversity of 53 L. infantum isolates from five different endemic areas in Brazil. Population structures were inferred by distance-based and Bayesian-based approaches. Eighteen very similar genotypes were detected by MLMT, most of them differed in only one locus and no correlation was found between MLMT profiles, geographical origin or the estimated population structure. However, complex profiles composed of 182 bands obtained by both RAPD and SSR-PCR assays gave different results. Unweighted pair group method with arithmetic mean trees built from these data revealed a high degree of homogeneity within isolates of L. infantum. Interestingly, despite this genetic homogeneity, most of the isolates clustered according to their geographical origin

Efficacy and safety of available treatments for visceral leishmaniasis in Brazil: A multicenter, randomized, open label trial

<div><p>Background</p><p>There is insufficient evidence to support visceral leishmaniasis (VL) treatment recommendations in Brazil and an urgent need to improve current treatments. Drug combinations may be an option.</p><p>Methods</p><p>A multicenter, randomized, open label, controlled trial was conducted in five sites in Brazil to evaluate efficacy and safety of (i) amphotericin B deoxycholate (AmphoB) (1 mg/kg/day for 14 days), (ii) liposomal amphotericin B (LAMB) (3 mg/kg/day for 7 days) and (iii) a combination of LAMB (10 mg/kg single dose) plus meglumine antimoniate (MA) (20 mg Sb⁺⁵/kg/day for 10 days), compared to (iv) standard treatment with MA (20 mg Sb⁺⁵/kg/day for 20 days). Patients, aged 6 months to 50 years, with confirmed VL and without HIV infection were enrolled in the study. Primary efficacy endpoint was clinical cure at 6 months. A planned efficacy and safety interim analysis led to trial interruption.</p><p>Results</p><p>378 patients were randomized to the four treatment arms<b>:</b> MA (n = 112), AmphoB (n = 45), LAMB (n = 109), or LAMB plus MA (n = 112). A high toxicity of AmphoB prompted an unplanned interim safety analysis and this treatment arm was dropped. Per intention-to-treat protocol final analyses of the remaining 332 patients show cure rates at 6 months of 77.5% for MA, 87.2% for LAMB, and 83.9% for LAMB plus MA, without statistically significant differences between the experimental arms and comparator (LAMB: 9.7%; CI95% -0.28 to 19.68, p = 0.06; LAMB plus MA: 6.4%; CI95% -3.93 to 16.73; p = 0.222). LAMB monotherapy was safer than MA regarding frequency of treatment-related adverse events (AE) (p = 0.045), proportion of patients presenting at least one severe AE (p = 0.029), and the proportion of AEs resulting in definitive treatment discontinuation (p = 0.003).</p><p>Conclusions</p><p>Due to lower toxicity and acceptable efficacy, LAMB would be a more suitable first line treatment for VL than standard treatment. ClinicalTrials.gov identification number: NCT01310738.</p><p>Trial registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT01310738" target="_blank">NCT01310738</a></p></div

Early withdrawal rate due to the occurrence of AE/SAE during treatment as per ITT.

<p>Early withdrawal rate due to the occurrence of AE/SAE during treatment as per ITT.</p

CONSORT patient flowchart.

<p>Flow diagram of the progress through the phases of the trial. AmphoB = amphotericin B deoxycholate; MA = meglumine antimoniate; LAMB = Liposomal amphotericin B.</p

Treatment efficacy at six months follow-up as PP approach.

<p>Treatment efficacy at six months follow-up as PP approach.</p