Fatores associados à ocorrência da leishmaniose visceral humana durante epidemias urbanas no Brasil e estudo da distribuição espaço-temporal e do perfil clínico-epidemiológico dos casos em Araçuaí, Minas Gerais

Abstract

Introduction: Human visceral leishmaniasis (HVL) is a zoonosis typical of tropical areas and is present on the five continents. It is a neglected disease with a wide geographic distribution and high morbimortality rate, thereby constituting a public health problem in various regions around the world. Objective: to review the factors associated with HVL in Brazil in the context of an epidemic and to analyze the spatiotemporal distribution and clinical-epidemiological profile of HVL cases in the municipality of Araçuaí, Minas Gerais. Methods: 1) A Systematic Review of the factors associated with HVL during urban epidemics in Brazil. The Review was registered with the International Prospective Register of Systematic Reviews under number CRD42019128998. 2) A study of HVL in the municipality of Araçuaí, Minas Gerais, from 2012 to 2014 (endemic period) and from 2015 to 2017 (epidemic period). 2a) A descriptive study of HVL cases. 2b) An case series study with spatiotemporal analysis of the endemic and epidemic patterns in the occurrence of HVL. 2c) Case series study, clinical aspects of HVL in a small municipality in Minas Gerais. Results: Chapter 1: Climatic, environmental factors and indicators of urban social structure were described as influencing epidemics in the North and Northeast regions. Gender and age characteristics were related to a greater chance of developing HVL in the country’s Central-West, Northeast and Southeast regions. Vector indicators showed a positive correlation with the incidence of HVL in studies in the Northeast region. Chapter 2: The results showed an HVL epidemic in the years 2015 to 2017 in the municipality of Araçuaí. The highest percentage of HVL cases occurred in brown-skinned males aged 30 to 69 years. As for signs and symptoms, the highest percentages found in both periods were for fever, weakness, weight loss, pallor, and hepatomegaly. The highest incidence of LVH occurred in the rural area of the municipality, with the highest concentration of cases in the urban area. Chapter 3: Spatial analysis detected a high-risk cluster for HVL in the rural area. There was a positive correlation between HVL cases and temperature during the endemic period. Chapter 4: Bivariate analysis showed differences between confirmed and discarded cases for fever, pallor, splenomegaly and hepatomegaly. Multivariate analysis showed that HVL was associated with fever and hepatomegaly when compared to discarded cases. Conclusion: The identification of factors associated with HVL can contribute to the surveillance, detection, treatment, and better management of patients. The understanding of clinical-epidemiological differences and factors associated with confirmed and discarded HVL cases, as well as spatial analysis allow to outline the epidemiological scenario of human cases of HVL and they can also contribute to the surveillance, detection, treatment and better management of patients with LVH.