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      Leishmaniasis cutánea americana en Venezuela: un análisis clínico epidemiológico a nivel nacional y por entidad federal, 1988-2007 Translated title: American cutaneous leishmaniasis in Venezuela: a clinical and epidemiological analysis at a national level and by federal entity, 1988-2007

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          Abstract

          Se describen las características epidemiológicas generales, junto a algunos aspectos clínico-inmunológicos, de las diferentes formas clínicas de leishmaniasis cutánea en Venezuela. Esto se logró a través de un estudio descriptivo retrospectivo de la base de datos del registro nacional de leishmaniasis en el Instituto de Biomedicina. La información fue analizada con EpiInfo 3.5.1, SPSS 11.0 y Excel. 47.762 casos de las diferentes formas clínicas de leishmaniasis cutánea fueron diagnosticados en el periodo 1988-2007, esto es 2.388 casos por año, con una tasa promedio anual de 10,5 por 100.000 habitantes. Predomina en sexo masculino con una razón de masculinidad que oscila entre 1,2 y 1,8. Casos en todas las edades, con predominio en el grupo de 15 a 24 años, edad promedio de 28 años. En cuanto a la ocupación 24,58 % corresponde a personas del sector agropecuario, seguido de estudiantes (21,40%) y Oficios del Hogar (18,47%). Se han registrado casos en todas las entidades federales, observándose regiones como los estados andinos (Trujillo y Mérida) con tasas superiores a 30 por 100.000 habitantes. La distribución según forma clínica fue: 97,94% (46.778) leishmaniasis cutánea localizada; 0,72% (346) leishmaniasis cutánea intermedia; 1,11% (531) leishmaniasis cutánea mucosa y 0,22% (107) leishmaniasis cutánea difusa. Las características clínicas e inmunológicas estudiadas variaron de acuerdo con las diferentes formas clínicas descritas. En conclusión, se hace una descripción clínico-epidemiológica de la leishmaniasis cutánea americana en Venezuela en base a los datos del registro de casos del Programa Nacional de Control de la Leishmaniasis. Esto sirve de apoyo al desarrollo de futuras investigaciones y para la mejora del propio registro con los consecuentes beneficios que ello puede traer al programa de control.

          Translated abstract

          The general epidemiological characteristics are described, together with some clinical and immunological aspects of the different clinical forms of cutaneous leishmaniasis in Venezuela. This was accomplished through a descriptive retrospective study of the leishmaniasis national registry database of the Institute of Biomedicine. The information was analyzed with EpiInfo 3.5.1, SPSS 11.0 and Excel. 47,762 cases of different clinical forms of cutaneous leishmaniasis were diagnosed during the period 1988-2007, i.e. 2,388 cases per year, with an average annual rate of 10.5 per 100,000 inhabitants. It is predominant in males, with a sex ratio of between 1.2 and 1.8. There are cases in all ages, with predominance in the 15 to 24 years group, average age 28 years. In terms of occupation, 24.58% are people of the agricultural sector, followed by students (21.40%) and housewives (18.47%). Cases have been registered in all the federal entities, observing regions such as the Andean States (Trujillo and Merida) with rates above 30 per 100,000 inhabitants. Distribution according to clinical form was: 97.94% (46,778) localized cutaneous leishmaniasis; 0.72% (346) intermediate cutaneous leishmaniasis, 1.11% (531) mucocutaneous leishmaniasis and 0.22% (107) diffused cutaneous leishmaniasis. The clinical and immunological characteristics examined varied according to the different clinical forms described. In conclusion, a clinical and epidemiological description is made of the American cutaneous leishmaniasis in Venezuela, based on the data of the register of cases of the Leishmaniasis Control National Program. This serves to support the development of future research and improve the register with the consequent benefits is can bring to the control program.

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          Most cited references47

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          Control of the Leishmaniasis

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            Immunotherapy of localized, intermediate, and diffuse forms of American cutaneous leishmaniasis.

            The clinical efficacy of immunotherapy for localized American cutaneous leishmaniasis with a combination of heat-killed Leishmania mexicana amazonensis promastigotes and viable BCG (bacille Calmette Guérin) has been compared with meglumine antimoniate chemotherapy and with BCG alone in a controlled clinical study in 217 patients. The results in the first two groups were comparable, with greater than 90% clinical cures with an average time of 16-18 w required for healing. The cure rate was considerably lower (42%) and more prolonged in the group receiving BCG alone. Secondary effects were observed in less than 5% of the patients receiving combined immunotherapy or BCG alone. In contrast, 49% of the patients receiving chemotherapy showed side effects. High therapeutic efficacy was also observed using combined immunotherapy in patients with intermediate and diffuse cutaneous leishmaniasis who were previously unresponsive to chemotherapy. Cure or clinical improvement was seen in all 11 patients with intermediate forms of the disease, and marked clinical improvement was observed in 9 of 10 patients with diffuse disease. The results on the efficacy of the combined vaccine in immunotherapy for American cutaneous leishmaniasis provide a strong rationale for studying its effectiveness in prophylactic trials.
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              Cutaneous leishmaniasis due to Leishmania chagasi/Le. infantum in an endemic area of Guarico State, Venezuela.

              This study reports cutaneous leishmaniasis (CL) caused by Leishmania chagasi/Le. infantum in Venezuela, with some atypical characteristics. Out of 63 cases of CL in the suburbs of Altagracia de Orituco, Guarico State, Venezuela, 30 presented clinical, parasitological, immunological and epidemiological features different from those of the classical CL known in the country. The initial lesion was small and nodular, which, if not treated, might progress to a superficial ulcer. No secondary infection was observed. The identification of the isolates was carried out by molecular techniques. Twelve species of phlebotomine sandflies were caught, the most abundant being Lutzomyia evansi and Lu. longipalpis s.l., known vectors of Le. chagasi/Le. infantum. The existence of Le. chagasi/Le. infantum and its vectors in an endemic area of CL has implications and we suggest that epidemiological studies should be carried out to obtain a clearer picture of the extent of this CL form in Venezuela.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                bmsa
                Boletín de Malariología y Salud Ambiental
                Bol Mal Salud Amb
                Instituto de Altos Estudios en Salud Pública Dr. Arnoldo Gabaldon (Maracay )
                1690-4648
                December 2010
                : 50
                : 2
                : 283-300
                Affiliations
                [1 ] Instituto de Biomedicina Venezuela
                Article
                S1690-46482010000200012
                4f9ea77d-54a2-43d2-8729-d4a165adf895

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

                History
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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=1690-4648&lng=en
                Categories
                INFECTIOUS DISEASES
                PARASITOLOGY

                Parasitology,Infectious disease & Microbiology
                Cutaneous leishmaniasis,statistical distributions,epidemiology,register,Venezuela,Leishmaniasis cutánea,distribuciones estadísticas,epidemiología,sistema de registros

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