Clinical study and epidemiological of cutaneous leishmaniasis in cocaleiras/coca zone of department La Paz - Bolivia / Estudo clínico e epidemiológico da leishmaniose tegumentar americana em zonas cocaleiras do Departamento de la Paz - Bolívia

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

This study aims to describe clinical and epidemiological data from 2,909 cases of American tegumentary leishmaniasis (ATL) occurred between 2001 and 2006 in areas dedicated to the culture of Erythroxylon coca located in three provinces in the Department of La Paz, Bolivia. Mobile health teams with diagnosis and treatment capacity carried out an active search of cases, in seven municipalities in the Provinces of Sud Yungas, Nor Yungas and Caranavi. Additionally, a cross-sectional survey was carried in two communities (Pastopata, n = 37 families and Chimasi, n = 45 families) in order to obtain demographic and epidemiologic data in Sud Yungas. In this context, we: i) described temporal and spatial distribution of the cases, ii) calculated incidence rates, iii) described clinical data, iv) describe diagnosis and treatment procedures, and v) describe demographic characteristics related to the transmission of ATL in two communities. It was noted that 14.5% of the cases compromised mucous membranes. This frequency was reduced through the study period (19% in 2002, 2% in 2006) and raised with aging. Age distribution showed that 69.3% of the patients were between six and forty years old and 10.7% were under five years old. Majority of individuals (75.4%) exerted their activities in Erythroxylon coca cultures, 38.4% were single, 90.8% were Indian and, from these, 77.6% belonged to the Aymara ethnic group. The municipalities of Palos Blancos and Chulumani presented a higher quantitative of cases (779 and 604 respectively) and higher incidences (129.9 cases / 10.000 habitants / year in 2003 in Palos Blancos and 92.3 cases / 10.000 habitants / year in 2002 in Chulumani). Incidence rates were higher in the beginning of the study period, decreasing progressively. A seasonal pattern of cases distribution was observed, peaking in August and September. Direct parasitological examinations were performed in 85% of the patients, being positive in 61% of the cases without mucous membranes lesions and 22% of the cases were mucous membranes were compromised (p <0.001). Montenegro skin test was positive in 89.4% of the patients. Glucantime was the drug of choice in 2.471 cases and amphotericin B in 105 patients. The community survey demonstrated that 82.9% of the dwellings had animals in peridomicile, 39.5% of the families had emigrated from Altiplano, 29.5% had arrived in the last eight years and 98.3% migrated due to employment reasons. Also, 65.4% cultivated Erythroxylon coca in peridomicile, 32.3% had animals with lesions compatible with ATL, 84.7% used to see ATL vectors in plantations and 54.9% did not know how this disease is transmitted. We concluded that ATL is a common disease in the studied region, affecting mainly adults involved with Erythroxylon coca cultivation. New colonization projects with this purpose, associated with deforestation and immigration may contribute to produce the disease in the studied areas, in an occupational pattern. Nevertheless, existence of under five children and people not involved in Erythroxylon coca cultivation, associated with the vulnerability of houses, suggest the occurrence of intradomiciliary transmission. The active search system could be contributed to the reduction observed in the frequency of ATL between 2002 and 2006.

ASSUNTO(S)

leishmaniasis/epidemiology leishmaniose/epidemiologia leishmaniose/diagnóstico doencas infecciosas e parasitarias coca coca leishmaniasis/diagnosis

ACESSO AO ARTIGO

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