Lima Ádila L M, de Lima Iraci D, Coutinho José F V, de Sousa Úrsula P S T, Rodrigues Marcos A G, Wilson Mary E, Pearson Richard D, Queiroz José W, Jerônimo Selma M B
Health Graduate Program, Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
Center for Zoonotic Control, Health Secretariat of Natal, Rio Grande do Norte, Brazil.
Trans R Soc Trop Med Hyg. 2017 Oct 1;111(10):440-447. doi: 10.1093/trstmh/trx080.
Visceral leishmaniasis (VL) continues to be a deadly parasitic disease in Brazil but the epidemiology has changed. The objective of this study was to assess the evolution of urban VL in the city of Natal, Brazil, over the past 25 y.
A retrospective study of human VL was performed, considering reported cases over the past 25 y in Natal. Analyses considered the spatial distribution of VL cases, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) co-infection, Leishmania infantum infection in dogs, density of the insect vector (Lutzomyia longipalpis) and socio-economic factors.
Paralleling migration of the population, VL cases changed from mostly rural to predominantly urban regions. The incidence of human VL was highest during the initial years (1990-1994) of our study. Human VL was positively associated with a high density of L. longipalpis, a high prevalence of canine L. infantum infection and HIV/AIDS co-infection. The average age at diagnosis increased over prior years and males were more frequently affected. The overall fatality rate was 6%. Socio-economic variables indicative of poverty were associated with a greater incidence of VL and clusters of VL.
VL has become endemic in Natal. The disease is associated with poverty and male gender. Surprisingly, there has been an increase in the age at diagnosis.
内脏利什曼病（VL）在巴西仍然是一种致命的寄生虫病，但流行病学已发生变化。本研究的目的是评估巴西纳塔尔市过去25年中城市VL的演变情况。
对人类VL进行回顾性研究，考虑纳塔尔市过去25年报告的病例。分析考虑了VL病例的空间分布、人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）合并感染、犬类婴儿利什曼原虫感染、昆虫媒介（长须罗蛉）密度和社会经济因素。
随着人口迁移，VL病例从主要在农村地区转变为主要集中在城市地区。在我们研究的最初几年（1990 - 1994年），人类VL的发病率最高。人类VL与长须罗蛉的高密度、犬类婴儿利什曼原虫感染的高流行率以及HIV/AIDS合并感染呈正相关。诊断时的平均年龄比前几年有所增加，男性受影响更频繁。总体死亡率为6%。表明贫困的社会经济变量与VL的更高发病率和VL聚集有关。
VL在纳塔尔已成为地方病。该疾病与贫困和男性性别有关。令人惊讶的是，诊断年龄有所增加。
