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      Tegumentary and visceral leishmaniases in Brazil: emerging anthropozoonosis and possibilities for their control Translated title: Leishmanioses tegumentar e visceral no Brasil: antropozoonoses emergentes e perspectivas de controle

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          Abstract

          The existence of a number of different species of Leishmania, the persistent increase in the infection rate of diseases caused by this parasite (tegumentary and visceral forms), the different epidemiological situations found in regions of both recent and older colonization, and the trend towards urbanization have led to the adoption of different strategies to control leishmaniases in Brazil. The control measures involve studies related to the parasite, vectors, sources of infection (animal and human), clinical aspects, geographical distribution, historical and socioeconomic factors, integration of health services, and adequate technologies for diagnosis, treatment, and immunoprophylaxis. Finally, successful control requires work with human communities, involving education, provision of information, health promotion, and participation of these communities in the planning, development, and maintenance of control programs.

          Translated abstract

          A ocorrência de várias espécies de Leishmania, o contínuo aumento das afecções causadas por esses parasitas (formas tegumentares e visceral) e as diferentes situações epidemiológicas encontradas, tanto em regiões de colonização recente quanto de colonização antiga, com tendência a urbanização, vem requerendo a adoção de diferentes estratégias para o controle dessas endemias no Brasil. Essas medidas demandam estudos relacionados aos parasitas, insetos vetores, fontes de infecção, aspectos clínicos, distribuição geográfica, fatores históricos e sócio-econômicos, integração dos serviços de saúde, tecnologias apropriadas de diagnóstico, tratamento e imunoprofilaxia. Finalmente, para o sucesso do controle, são requeridos esforços junto as comunidades humanas, envolvendo educação, provisão de informação, promoção da saúde e participação dessas comunidades no planejamento, desenvolvimento e manutenção dos programas adotados.

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          Most cited references83

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          Mucosal leishmaniasis ("espundia" Escomel, 1911).

          S. Marsden (1985)
          One of the more serious clinical forms of leishmaniasis occurs in espundia when the mucosae of the upper respiratory passages are inflamed. This complication is a metastasis from a skin lesion caused by Leishmania braziliensis braziliensis (Lbb) although cases have been described associated with other leishmanial species. Epidemiological data suggest that a detectable mucosal metastasis occurs in fewer than 5% of patients infected with Lbb in our study area. The determinants of this complication are still largely obscure. The granuloma usually commences on the nasal septum. In about two-thirds of our patients the lesion remained restricted to the nose. In the rest the pharynx, palate, larynx and lips were involved, in this order. It is often difficult to isolate the parasite and for routine diagnosis the leishmanin skin reaction and serological tests are helpful. Although a serious condition, with possible mutilation and even death as subsequent complications, treatment is still mainly with pentavalent antimonials, introduced 40 years ago. These are most unsatisfactory for field use, being given parenterally and relatively toxic. In mucosal leishmaniasis, if sufficient antimony can be administered in a regular daily dose, the relapse rate is small (3 of 42 patients followed for a mean of 5 years). Also, antimony treatment of the initial skin ulcer due to Lbb followed for a mean of 4 years of 83 patients resulted in subsequent mucosal metastasis in only 2. Since espundia is relatively rare, specific treatment targeted to this specific problem is the efficient short term solution. At present there is no satisfactory alternative drug to those in current use.
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            Visceral leishmaniasis in Brazil: geographical distribution and trnsmission.

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              A field trial of a vaccine against American dermal leishmaniasis.

              A field trial was carried out in the eastern part of the State of Minas Gerais (Brazil) of a vaccine containing killed promastigotes of five stocks of Leishmania. Tests with Montenegro antigen showed that a high proportion of the vaccinated persons became positive within three months, but circulating antibodies were not detected. A proportion of those vaccinated continued to give positive Montenegro reactions for up to three years. Lymphocyte sensitivity tests carried out, on a small sample, three years after vaccination were positive and gave no evidence of immunological depression. No cases of cutaneous or mucocutaneous leishmaniasis occurred in the trial area during the three years of observations.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro )
                1678-4464
                July 1994
                : 10
                : suppl 2
                : S359-S375
                Affiliations
                [1 ] Fundação Oswaldo Cruz Brazil
                Article
                S0102-311X1994000800014
                10.1590/S0102-311X1994000800014
                3a13b03b-06b0-442c-a348-0c06f4bfbdfe

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0102-311X&lng=en
                Categories
                Health Policy & Services

                Public health
                Leishmaniases,Clinical Classification,Vector Control,Lutzomyia sp.,Community Participation,Leishmanioses,Classificação Clínica,Controle de Vetores,Lutzmoyia sp.,Participação Comunitária

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