Geographic Clustering of Leishmaniasis in Northeastern Brazil1

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Abstract

Different forms of this disease are spreading rapidly in distinct geographic clusters in this region.

Abstract

To determine whether disease outcomes and clades of Leishmania braziliensis genotypes are associated, we studied geographic clustering of clades and most severe disease outcomes for leishmaniasis during 1999–2003 in Corte de Pedra in northeastern Brazil. Highly significant differences were observed in distribution of mucosal leishmaniasis versus disseminated leishmaniasis (DL) (p<0.0001). Concordance was observed between distribution of these disease forms and clades of L. braziliensis genotypes shown to be associated with these disease forms. We also detected spread of DL over this region and an inverse correlation between frequency of recent DL diagnoses and distance to a previous DL case. These findings indicate that leishmaniasis outcomes are distributed differently within transmission foci and show that DL is rapidly spreading in northeastern Brazil.

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Most cited references 22

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The trypanosomiases.

Juan Cazzulo, Sanjeev Krishna, August Stich … (2003)

The trypanosomiases consist of a group of important animal and human diseases caused by parasitic protozoa of the genus Trypanosoma. In sub-Saharan Africa, the final decade of the 20th century witnessed an alarming resurgence in sleeping sickness (human African trypanosomiasis). In South and Central America, Chagas' disease (American trypanosomiasis) remains one of the most prevalent infectious diseases. Arthropod vectors transmit African and American trypanosomiases, and disease containment through insect control programmes is an achievable goal. Chemotherapy is available for both diseases, but existing drugs are far from ideal. The trypanosomes are some of the earliest diverging members of the Eukaryotae and share several biochemical peculiarities that have stimulated research into new drug targets. However, differences in the ways in which trypanosome species interact with their hosts have frustrated efforts to design drugs effective against both species. Growth in recognition of these neglected diseases might result in progress towards control through increased funding for drug development and vector elimination.

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Immunopathogenesis of infection with the visceralizing Leishmania species.

S M Jeronimo, D. Pearson, C. A. M. E. Wilson (2005)

Human leishmaniasis is a spectral disease that includes asymptomatic self-resolving infection, localized skin lesions, and progressive visceral leishmaniasis. With some overlap, visceral and cutaneous leishmaniasis are usually caused by different species of Leishmania. This review focuses on host responses to infection with the species that cause visceral leishmaniasis, as they contrast with species causing localized cutaneous leishmaniasis. Data from experimental models document significant differences between host responses to organisms causing these diverse syndromes. The visceralizing Leishmania spp. cause localized organ-specific immune responses that are important determinants of disease outcome. Both the Leishmania species causing cutaneous and those causing visceral leishmaniasis require a Type 1 immune response to undergo cure in mouse models. However, during progressive murine infection with the visceralizing Leishmania sp., the Type 1 response is suppressed at least in part by TGF-beta and IL-10 without type 2 cytokine production. This contrasts with the cutaneous species L. major, in which a Type 2 response suppresses type 1 cytokines and leads to murine disease progression. Population and family studies are beginning to elucidate human genetic determinants predisposing to different outcomes of Leishmania infection. These studies should eventually result in a better understanding of the immunopathogenesis and the spectrum of human leishmaniasis.

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Second-generation vaccines against leishmaniasis.

Rhea N Coler, Steven Reed (2005)

Several species of Leishmania cause human diseases that range from self-healing cutaneous lesions to fatal visceral leishmaniasis, mucosal leishmaniasis and diffuse cutaneous leishmaniasis. Drug resistance and toxicities associated with chemotherapy emphasize the need for a safe, effective vaccine. Studies of the immunopathogenesis and mechanisms of protective immunity define several features that should be met by an effective vaccine. The leishmaniases are unique among parasitic diseases because a single vaccine has the potential to protect against more than one species (disease) and be successful at both treating and preventing disease. In addition, several antigens have been identified and characterized that might be potential vaccine candidates. In this article, we focus on advances made with second-generation vaccines against leishmaniasis.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Infect Dis

Journal ID (publisher-id): EID

Title: Emerging Infectious Diseases

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 1080-6040

ISSN (Electronic): 1080-6059

Publication date (Print): June 2009

Volume: 15

Issue: 6

Pages: 871-876

Affiliations

[1]Universidade Federal da Bahia, Salvador, Brazil (A. Schriefer, L.H. Guimarães, P.R.L. Machado, M. Lessa, H.A. Lessa, E. Lago, G. Ritt, A.L.F. Schriefer, E.M. Carvalho)

[2]Universidade Estadual de Feira de Santana, Feira de Santana, Brazil (A. Góes-Neto)

[3]University of California School of Public Health, Berkeley, California, USA (L.W. Riley)

Author notes

Address for correspondence: Albert Schriefer, Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Rua João das Botas s/n, 5° Andar, Canela 40.110-160, Salvador, Bahia, Brazil; email: aschriefer@ 123456globo.com

Article

Publisher ID: 08-0406

DOI: 10.3201/eid1506.080406

PMC ID: 2727348

PubMed ID: 19523284

SO-VID: 3ee59fbd-7f86-4b2c-8639-60409ebca98e

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