Leishmaniose visceral na região Centro-Oeste do Brasil: aspectos epidemiológicos, padrões espaço-temporais e fatores associados ao óbito

Abstract

Visceral leishmaniasis (VL) is a neglected tropical disease (NTD) that is widely distributed in Brazil, with the country being responsible for 93.5% of cases in the Americas. The Brazilian Central-West region has characteristics related to the host, vector, climate and reservoir, which allow the transmission of VL in the region. The objectives of the present study were to understand the factors related to the occurrence of VL, the clinical-epidemiological profile of the parasitosis and the prognostic factors associated with death from VL, in addition to the spatio-temporal distribution in the Central-West region of Brazil. Regarding the factors related to the occurrence of VL in this region, a systematic review was conducted based on studies published in the scientific electronic databases of the Portal Regional da BVS, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), U.S. National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO), in addition to gray literature through access to Google Scholar. This systematic review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The systematic review included 20 studies that demonstrated that the presence of Lutzomyia longipalpis, Lu. cruzi and the canine reservoir are mainly responsible for the occurrence and spread of VL in the region. Furthermore, men and children have been the most exposed to the infection, and the elderly over 60 have had the highest risk of death. In order to understand the clinical-epidemiological profile of patients with VL and the prognostic factors associated with death from VL in the Central-West region, a case series study was carried out with notifications from the Sistema de Informação de Agravos de Notificação (SINAN), referring to the years 2010 to 2019. Mato Grosso do Sul had the highest number of VL cases, as well as the highest incidence rates. Furthermore, men, children aged less than or equal to 5 years, mixed race and those with low education were the groups most affected by the disease in this region. The factors associated with death from VL were age groups ≥20 and <60, and ≥60, edema, pallor, infectious condition and hemorrhagic phenomena. Finally, to understand the spatio-temporal distribution in the region, an ecological study was carried out with cases reported on SINAN, between 2010 and 2019. Mato Grosso do Sul presented the highest incidence rates, obtaining the majority of municipalities classified as high-high in all biennia analyzed. A heterogeneous distribution of VL was also observed in the Central-West region of Brazil, with spatial clustering in the state of Mato Grosso do Sul, a state that should be prioritized in VL surveillance and control activities in the region. Therefore, it is observed that few studies have been published on the dynamics of VL transmission in the Central-West region of Brazil, highlighting the importance of studying the disease in this Brazilian region, as it presents important spatial aggregates of VL occurrence, in addition that the results were unprecedented in the present study.