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Risk Factors Associated with Human Visceral Leishmaniasis in an Urban Area of Bahia, Brazil.
Vector Borne Zoonotic Dis. 2016 06; 16(6):368-76.VB

Abstract

BACKGROUND

The early diagnosis of asymptomatic, acute, and subclinical Leishmania infections remains a challenge for controlling visceral leishmaniasis (VL). Individuals with acute VL represent <1% of Leishmania infections occurring in active transmission endemic areas. In this cross-sectional study with a prospective follow-up, we explored the risk factors associated with acquisition of Leishmania infection in an area with newly identified endemic VL.

MATERIALS AND METHODS

Ninety-four households were randomly selected from the study area, which included a population of 213 individuals (10% of the total population of Pé de Areia, Bahia, Brazil). Clinical and epidemiological surveys were prospectively performed to detect cases of asymptomatic infections, acute VL, and subclinical VL, using the leishmanin skin test (LST), and serological response to two Leishmania-specific antigens: rK39 and rK26.

RESULTS

Within the 92 households included in the study, the prevalence of Leishmania infection in individuals detected by positive serology was 91/197 (46.2%; 95% CI: 0.3937-0.5316) and by LST was 29/114 (25.4%; 95% CI: 0.1834-0.3414). Reactivity to both antigens was detected in 64/197 individuals (32.5%; 95% CI: 0.2634-0.3931). Among 89 individuals diagnosed with leishmaniasis, we found acute VL in one (1%), subclinical VL in 20 (22.5%), and asymptomatic Leishmania infection in 68 (76.4%) subjects. Use of repellents and bed nets showed no significant protection (prevalence ratio [PR] = 1.01, p = 1.0). Interestingly, individuals residing in houses with a sand backyard had significant protection against Leishmania infection (PR = 1.24, p = 0.049) compared to those with a different type or no backyard. Moreover, the presence of cat or dog at home was also not a risk factor (dog: PR = 1.14, 95% CI: 0.80-1.64; and cat: PR = 1.19, 95% CI: 0.78-1.81). We conclude that in newly discovered areas of transmission of L. infantum infection with sylvatic reservoirs, periodic surveys may be helpful in identifying risk factors for infection and optimizing prevention guidelines.

Authors+Show Affiliations

1 Department of Medicine, Federal University of Bahia , Salvador, Brazil .1 Department of Medicine, Federal University of Bahia , Salvador, Brazil .1 Department of Medicine, Federal University of Bahia , Salvador, Brazil .1 Department of Medicine, Federal University of Bahia , Salvador, Brazil .2 Health Science Institute, Federal University of Bahia , Salvador, Brazil .3 Division of Infectious Diseases, University of California , San Diego, California.1 Department of Medicine, Federal University of Bahia , Salvador, Brazil .

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27074100

Citation

Maia, Zuinara, et al. "Risk Factors Associated With Human Visceral Leishmaniasis in an Urban Area of Bahia, Brazil." Vector Borne and Zoonotic Diseases (Larchmont, N.Y.), vol. 16, no. 6, 2016, pp. 368-76.
Maia Z, Viana V, Muniz E, et al. Risk Factors Associated with Human Visceral Leishmaniasis in an Urban Area of Bahia, Brazil. Vector Borne Zoonotic Dis. 2016;16(6):368-76.
Maia, Z., Viana, V., Muniz, E., Gonçalves, L. O., Mendes, C. M., Mehta, S. R., & Badaro, R. (2016). Risk Factors Associated with Human Visceral Leishmaniasis in an Urban Area of Bahia, Brazil. Vector Borne and Zoonotic Diseases (Larchmont, N.Y.), 16(6), 368-76. https://doi.org/10.1089/vbz.2015.1880
Maia Z, et al. Risk Factors Associated With Human Visceral Leishmaniasis in an Urban Area of Bahia, Brazil. Vector Borne Zoonotic Dis. 2016;16(6):368-76. PubMed PMID: 27074100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk Factors Associated with Human Visceral Leishmaniasis in an Urban Area of Bahia, Brazil. AU - Maia,Zuinara, AU - Viana,Vivian, AU - Muniz,Eduardo, AU - Gonçalves,Larissa Oliveira, AU - Mendes,Carlos Maurício Cardeal, AU - Mehta,Sanjay R, AU - Badaro,Roberto, Y1 - 2016/04/13/ PY - 2016/4/14/entrez PY - 2016/4/14/pubmed PY - 2017/7/14/medline KW - Reservoir host KW - Sand fly KW - Transmission KW - Visceral leishmaniasis SP - 368 EP - 76 JF - Vector borne and zoonotic diseases (Larchmont, N.Y.) JO - Vector Borne Zoonotic Dis VL - 16 IS - 6 N2 - BACKGROUND: The early diagnosis of asymptomatic, acute, and subclinical Leishmania infections remains a challenge for controlling visceral leishmaniasis (VL). Individuals with acute VL represent <1% of Leishmania infections occurring in active transmission endemic areas. In this cross-sectional study with a prospective follow-up, we explored the risk factors associated with acquisition of Leishmania infection in an area with newly identified endemic VL. MATERIALS AND METHODS: Ninety-four households were randomly selected from the study area, which included a population of 213 individuals (10% of the total population of Pé de Areia, Bahia, Brazil). Clinical and epidemiological surveys were prospectively performed to detect cases of asymptomatic infections, acute VL, and subclinical VL, using the leishmanin skin test (LST), and serological response to two Leishmania-specific antigens: rK39 and rK26. RESULTS: Within the 92 households included in the study, the prevalence of Leishmania infection in individuals detected by positive serology was 91/197 (46.2%; 95% CI: 0.3937-0.5316) and by LST was 29/114 (25.4%; 95% CI: 0.1834-0.3414). Reactivity to both antigens was detected in 64/197 individuals (32.5%; 95% CI: 0.2634-0.3931). Among 89 individuals diagnosed with leishmaniasis, we found acute VL in one (1%), subclinical VL in 20 (22.5%), and asymptomatic Leishmania infection in 68 (76.4%) subjects. Use of repellents and bed nets showed no significant protection (prevalence ratio [PR] = 1.01, p = 1.0). Interestingly, individuals residing in houses with a sand backyard had significant protection against Leishmania infection (PR = 1.24, p = 0.049) compared to those with a different type or no backyard. Moreover, the presence of cat or dog at home was also not a risk factor (dog: PR = 1.14, 95% CI: 0.80-1.64; and cat: PR = 1.19, 95% CI: 0.78-1.81). We conclude that in newly discovered areas of transmission of L. infantum infection with sylvatic reservoirs, periodic surveys may be helpful in identifying risk factors for infection and optimizing prevention guidelines. SN - 1557-7759 UR - https://www.unboundmedicine.com/medline/citation/27074100/Risk_Factors_Associated_with_Human_Visceral_Leishmaniasis_in_an_Urban_Area_of_Bahia_Brazil_ L2 - https://www.liebertpub.com/doi/10.1089/vbz.2015.1880?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -