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      Saúde, ciência e desenvolvimento: a emergência da leishmaniose tegumentar americana como desafio médico-sanitário no Amazonas Translated title: Health, science and development: the emergence of American cutaneous leishmaniasis as a medical and public health challenge in Amazonas state, Brazil

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          Abstract

          Resumo O artigo faz análise histórica da emergência da leishmaniose tegumentar americana como objeto do conhecimento e desafio médico-sanitário no Amazonas desde a década de 1970. Fornece visão geral dessa época, as medidas sanitárias e os estudos científicos realizados no contexto de implantação dos principais projetos de desenvolvimento regionais executados em nome da política de integração nacional do governo federal. Utiliza como metodologia a análise documental de leis, produção científica, relatórios de pesquisa, boletins epidemiológicos e jornais. Os resultados da pesquisa mostram que a doença surgiu no Amazonas associando o grande problema de saúde com mudanças político-econômicas e alterações socioambientais.

          Translated abstract

          Abstract The history of the emergence of American cutaneous leishmaniasis in the Brazilian state of Amazonas since the 1970s is analyzed as an object of knowledge and a medical and public health challenge. An overview of the period is provided, including the public health measures and scientific studies undertaken in the context of the execution of large-scale regional developments pursued in the name of national integration by the federal government. The methodology uses documental analysis of laws, the scientific literature, research reports, epidemiological bulletins, and newspapers. The results show that American cutaneous leishmaniasis emerged as a major health problem in Amazonas in close association with the political, economic, and socioenvironmental changes seen in the period.

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          Most cited references28

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          Effects of environmental change on emerging parasitic diseases.

          Ecological disturbances exert an influence on the emergence and proliferation of malaria and zoonotic parasitic diseases, including, Leishmaniasis, cryptosporidiosis, giardiasis, trypanosomiasis, schistosomiasis, filariasis, onchocerciasis, and loiasis. Each environmental change, whether occurring as a natural phenomenon or through human intervention, changes the ecological balance and context within which disease hosts or vectors and parasites breed, develop, and transmit disease. Each species occupies a particular ecological niche and vector species sub-populations are distinct behaviourally and genetically as they adapt to man-made environments. Most zoonotic parasites display three distinct life cycles: sylvatic, zoonotic, and anthroponotic. In adapting to changed environmental conditions, including reduced non-human population and increased human population, some vectors display conversion from a primarily zoophyllic to primarily anthrophyllic orientation. Deforestation and ensuing changes in landuse, human settlement, commercial development, road construction, water control systems (dams, canals, irrigation systems, reservoirs), and climate, singly, and in combination have been accompanied by global increases in morbidity and mortality from emergent parasitic disease. The replacement of forests with crop farming, ranching, and raising small animals can create supportive habitats for parasites and their host vectors. When the land use of deforested areas changes, the pattern of human settlement is altered and habitat fragmentation may provide opportunities for exchange and transmission of parasites to the heretofore uninfected humans. Construction of water control projects can lead to shifts in such vector populations as snails and mosquitoes and their parasites. Construction of roads in previously inaccessible forested areas can lead to erosion, and stagnant ponds by blocking the flow of streams when the water rises during the rainy season. The combined effects of environmentally detrimental changes in local land use and alterations in global climate disrupt the natural ecosystem and can increase the risk of transmission of parasitic diseases to the human population.
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            The Neotropical Leishmania species: a brief historical review of their discovery, ecology and taxonomy

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              Tegumentary leishmaniasis in the State of Amazonas: what have we learned and what do we need?

              This study evaluated the occurrence of American tegumentary leishmaniasis (ATL) in the State of Amazonas, Brazil, in the last 30 years with emphasis on the last 10 years (2001 to 2010). The disease was predominantly observed in males (76.2%), in the 21- to 30-year-old age group (26.6%) and in extractive workers (43.7%); 3.3% of the cases were the mucosal form. The endemic channel shows the disease seasonality, with a predominance of cases at the beginning and end of each year. The number of cases by municipality in the period of 2001-2010 shows the maintenance of the endemic in the localities where the highest numbers of cases have always been registered, namely, Manaus, Rio Preto da Eva, Itacoatiara and Presidente Figueiredo. The comparison of data from 2001 to 2005 and from 2006 to 2010 showed the emergence of this disease in municipalities that had been previously unaffected. In the last years, there has been a significant increase in the activities of control, diagnosis and treatment of leishmaniasis in the State of Amazonas. In conclusion, the historical series of ATL analyzed in this study suggests that the transmission foci remain and are even expanding, though without continuous transmission in the intra- or peridomicile settings. Moreover, the disease will persist in the Amazon while the factors associated with infection acquisition relative to forest exploitation continue to have economic appeal. There is a real expectation of wide variations in disease incidence that can be influenced by climate and economic aspects.
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                Author and article information

                Journal
                hcsm
                História, Ciências, Saúde-Manguinhos
                Hist. cienc. saude-Manguinhos
                Casa de Oswaldo Cruz, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                0104-5970
                1678-4758
                September 2020
                : 27
                : 3
                : 741-761
                Affiliations
                [1] Manaus AM orgnameFiocruz orgdiv1Instituto Leônidas e Maria Deane Brasil claudio.peixoto@ 123456fiocruz.br
                Article
                S0104-59702020000300741 S0104-5970(20)02700300741
                10.1590/s0104-59702020000400003
                7e777542-6e33-483a-abde-c7a425baee9c

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 11 April 2019
                : 29 November 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 50, Pages: 21
                Product

                SciELO Brazil

                Categories
                Análise

                projetos de desenvolvimento,leishmaniose tegumentar americana,história das leishmanioses,leishmanioses,políticas públicas de saúde,American cutaneous leishmaniasis,history of leishmaniasis,leishmaniasis,public health policies,development projects

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