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      Asymptomatic infection in family contacts of patients with human visceral leishmaniasis in Três Lagoas, Mato Grosso do Sul State, Brazil Translated title: Infecção assintomática em contactantes de pacientes com leishmaniose visceral humana em Três Lagoas, Mato Grosso do Sul, Brasil

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          Abstract

          The Brazilian city of Três Lagoas, Mato Grosso do Sul State, has experienced an urban outbreak of visceral leishmaniasis since 2000. In 2002, due to the increase in the number of cases, 46 families with cases of visceral leishmaniasis were studied to verify the prevalence of asymptomatic infection in household contacts. Indirect immunofluorescence and ELISA showed a 36.4% positive infection rate. There were no cases of symptomatic disease among these contacts. There was no statistically significant difference in gender or age. Median age was 21 years, and the 10-19-year age bracket was the most heavily affected (23%). As for family characteristics, no differences were observed in schooling or family income; most families (58.7%) owned their homes, which were built of masonry (97.8%) and had adequate infrastructure. All the families reported what were probably phlebotomine sand flies in the peridomicile. In conclusion, asymptomatic visceral leishmaniasis infection is frequent and occurs in both males and females, regardless of age.

          Translated abstract

          O Município de Três Lagoas, Mato Grosso do Sul, Brasil, foi alvo de uma epidemia de leishmaniose visceral a partir de 2000. Em 2002, devido ao incremento de casos, estudou-se 46 famílias que apresentavam um caso de doença para verificar-se o percentual de positividade de infecção assintomática por leishmaniose visceral em contactantes. Encontrou-se 36,4% de positividade pelos testes sorológicos Reação de Imunofluorescência Indireta e/ou imunoenzimático ELISA, sem diferença estatisticamente significativa quanto ao sexo e faixa etária. A mediana de idade foi de 21 anos, sendo a faixa etária mais acometida de 10 a 19 anos (23%). Quanto às características familiares não observaram-se diferenças quanto ao nível de instrução e renda familiar; a moradia, em sua maioria, era própria (58,7%), em alvenaria (97,8%), com infra-estrutura adequada. Todas as famílias relataram a presença de provável flebotomíneo no peridomicílio. Conclui-se que a infecção assintomática por leishmaniose visceral é freqüente, ocorrendo em homens e mulheres, independente de faixa etária.

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          Most cited references64

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          Manual de vigilância e controle da leishmaniose visceral

          MS Brasil (2006)
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            Leishmaniasis. Public health aspects and control.

            P Desjeux (2015)
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              Leishmania and human immunodeficiency virus coinfection: the first 10 years.

              Over 850 Leishmania-human immunodeficiency virus (HIV) coinfection cases have been recorded, the majority in Europe, where 7 to 17% of HIV-positive individuals with fever have amastigotes, suggesting that Leishmania-infected individuals without symptoms will express symptoms of leishmaniasis if they become immunosuppressed. However, there are indirect reasons and statistical data demonstrating that intravenous drug addiction plays a specific role in Leishmania infantum transmission: an anthroponotic cycle complementary to the zoonotic one has been suggested. Due to anergy in patients with coinfection, L. infantum dermotropic zymodemes are isolated from patient viscera and a higher L. infantum phenotypic variability is seen. Moreover, insect trypanosomatids that are currently considered nonpathogenic have been isolated from coinfected patients. HIV infection and Leishmania infection each induce important analogous immunological changes whose effects are multiplied if they occur concomitantly, such as a Th1-to-Th2 response switch; however, the consequences of the viral infection predominate. In fact, a large proportion of coinfected patients have no detectable anti-Leishmania antibodies. The microorganisms share target cells, and it has been demonstrated in vitro how L. infantum induces the expression of latent HIV-1. Bone marrow culture is the most useful diagnostic technique, but it is invasive. Blood smears and culture are good alternatives. PCR, xenodiagnosis, and circulating-antigen detection are available only in specialized laboratories. The relationship with low levels of CD4+ cells conditions the clinical presentation and evolution of disease. Most patients have visceral leishmaniasis, but asymptomatic, cutaneous, mucocutaneous, diffuse cutaneous, and post-kala-azar dermal leishmaniasis can be produced by L. infantum. The digestive and respiratory tracts are frequently parasitized. The course of coinfection is marked by a high relapse rate. There is a lack of randomized prospective treatment trials; therefore, coinfected patients are treated by conventional regimens. Prophylactic therapy is suggested to be helpful in preventing relapses.
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                Author and article information

                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                0102-311X
                1678-4464
                December 2008
                : 24
                : 12
                : 2827-2833
                Affiliations
                [02] Rio de Janeiro orgnameFundação Oswaldo Cruz orgdiv1Instituto Oswaldo Cruz Brasil
                [05] Rio de Janeiro Rio de Janeiro orgnameUniversidade do Estado do Rio de Janeiro orgdiv1Faculdade de Ciências Médicas Brazil
                [01] Campo Grande Mato Grosso do Sul orgnameUniversidade Federal de Mato Grosso do Sul orgdiv1Faculdade de Medicina Brazil
                [04] Campo Grande Mato Grosso do Sul orgnameUniversidade Federal de Mato Grosso do Sul orgdiv1Faculdade de Medicina Veterinária e Zootecnia Brazil
                [03] Campo Grande Mato Grosso do Sul orgnameUniversidade Federal de Mato Grosso do Sul orgdiv1Centro de Ciências Biológicas e da Saúde Brazil
                Article
                S0102-311X2008001200011 S0102-311X(08)02401211
                10.1590/S0102-311X2008001200011
                dfe69453-1b41-4bb8-a500-d97a3a3bae26

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

                History
                : 11 June 2007
                : 22 November 2007
                : 05 December 2007
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 7
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                SciELO Public Health

                Self URI: Full text available only in PDF format (EN)
                Categories
                Article

                Doenças Transmissíveis,Visceral Leishmaniasis,Infecção,Surtos de Doenças,Infection,Leishmaniose Visceral,Disease Outbreaks,Communicable Diseases

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