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      Visceral leishmaniasis in a Brazilian endemic area: an overview of occurrence, HIV coinfection and lethality

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          ABSTRACT

          The Brazilian municipality of Rondonópolis, Mato Grosso State, represents an important visceral leishmaniasis (VL) endemic area. This study described epidemiological and clinical aspects of the occurrence, VL/HIV coinfection and lethality related to VL in Rondonópolis. Data from autochthonous cases reported between 2011 and 2016 were obtained from official information systems. During this period, 81 autochthonous cases were reported, with decreasing incidence through 2016. Contrastingly, the lethality rate was 8.6% overall, but varied widely, reaching a peak (20%) in 2016. Almost 10% of patients had VL/HIVcoinfection. The occurrence of VL prevailed among men (56.8%), brown-skinned (49.4%), urban residents (92.6%), aged 0-4 years (33.3%). Housewives or retired (29.6%) were the most affected occupational groups. Lower age was the main difference among the total VL cases and those who were coinfected or died. Clinically, fever, weakness and splenomegaly were more frequent among all VL cases and VL/HIV coinfected individuals. Bacterial infections (p=0.001) and bleeding (p<0.001) were associated with death due to VL. Pentavalent antimonial and liposomal amphotericin B were the first choices for treatment among all VL cases (71.6%) and those who died (71.4%), respectively. VL/HIV patients were equally treated with both drugs. These findings may support control measures and demonstrate the need for further investigations.

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          Global distribution maps of the leishmaniases

          The leishmaniases are vector-borne diseases that have a broad global distribution throughout much of the Americas, Africa, and Asia. Despite representing a significant public health burden, our understanding of the global distribution of the leishmaniases remains vague, reliant upon expert opinion and limited to poor spatial resolution. A global assessment of the consensus of evidence for leishmaniasis was performed at a sub-national level by aggregating information from a variety of sources. A database of records of cutaneous and visceral leishmaniasis occurrence was compiled from published literature, online reports, strain archives, and GenBank accessions. These, with a suite of biologically relevant environmental covariates, were used in a boosted regression tree modelling framework to generate global environmental risk maps for the leishmaniases. These high-resolution evidence-based maps can help direct future surveillance activities, identify areas to target for disease control and inform future burden estimation efforts. DOI: http://dx.doi.org/10.7554/eLife.02851.001
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            Visceral leishmaniasis treatment: What do we have, what do we need and how to deliver it?

            Leishmaniasis is one of the most neglected tropical disease in terms of drug discovery and development. Most antileishmanial drugs are highly toxic, present resistance issues or require hospitalization, being therefore not adequate to the field. Recently improvements have been achieved by combination therapy, reducing the time and cost of treatment. Nonetheless, new drugs are still urgently needed. In this review, we describe the current visceral leishmaniasis (VL) treatments and their limitations. We also discuss the new strategies in the drug discovery field including the development and implementation of high-throughput screening (HTS) assays and the joint efforts of international teams to deliver clinical candidates.
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              An update on pharmacotherapy for leishmaniasis.

              Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis. The treatment of leishmaniasis is challenging and the armamentarium of drugs is small, duration of treatment is long, and most drugs are toxic.
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                Author and article information

                Journal
                Rev Inst Med Trop Sao Paulo
                Rev. Inst. Med. Trop. Sao Paulo
                rimtsp
                Revista do Instituto de Medicina Tropical de São Paulo
                Instituto de Medicina Tropical
                0036-4665
                1678-9946
                08 March 2018
                2018
                : 60
                Affiliations
                [1 ]Universidade Federal de Mato Grosso, Instituto de Ciências Exatas e Naturais, Curso de Medicina, Rondonópolis, Mato Grosso, Brazil
                [2 ]Universidade Federal de Mato Grosso, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Cuiabá, Mato Grosso, Brazil
                [3 ]Secretaria Municipal de Saúde de Rondonópolis, Gerência de Vigilância Epidemiológica, Rondonópolis, Mato Grosso, Brazil
                [4 ]Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Medicina do Mucuri, Teófilo Otoni, Minas Gerais, Brazil
                [5 ]Universidade Federal de Mato Grosso, Hospital Júlio Müller, Cuiabá, Mato Grosso, Brazil
                Author notes
                Correspondence to: João Gabriel Guimarães Luz Universidade Federal de Mato Grosso, Instituto de Ciências Exatas e Naturais, Curso de Medicina, Campus Rondonópolis, Av. dos Estudantes, 5055, CEP 78735-901, Rondonópolis, MT, Brazil. E-mail: joaogabrielgl@ 123456hotmail.com

                ETHICAL APPROVAL

                This study was approved by the Ethical Committee for Human Research of Júlio Müller University Hospital (CAAE Nº 52023215.5.0000.5541).

                Article
                00205
                10.1590/S1678-9946201860012
                5962093
                29538509

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 60, Pages: 1
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