ABSTRACT This study was conducted to characterize the transmission cycle of the tegumentary leishmaniasis (TL) in an old colonization area at Pernambuco State, Brazil. The aims were to identify autochthonous cases, sandflies fauna, domestic animals as possible reservoir hosts and the Leishmania species involved in this endemic area. A total of 168 suspected human cases of TL and 272 domestic animals (canine, feline, equine, goat, and sheep) were included. The sandflies were captured and identified by species. Patients were predominantly male and the average age was 37+18.1 years old. Of 85 patients who had skin lesions, 25.6% of them had direct positive smears for TL and 34 isolates were identified as Leishmania (Viannia) braziliensis. The confirmation for TL diagnosed by molecular detection (PCR) was almost three times more sensitive than the direct test [p < 0.001; PR = 2.72] associated with clinical examination. The Kappa test on PCR between two different specimens, biopsy, and skin lesion swab was 60.8% (p < 0.001). More than 200 specimens of sandflies (80 males and 159 females) were captured and identified as Lutzomyia whitmani (99.6%) and Lu. evandroi (0.4%). The detection of L. (V.) braziliensis by Real-Time PCR in the blood of a captured fed female was positive in 59.3% of Lu. whitmani. Of the 272 domestic animals included, 61.76% were male (n = 168). Thirty-six animals (13.2%) had lesions compatible with TL (34 dogs, 1 cat and 1 sheep) and 3 of them, all dogs, had lesions on the snout, showing destruction of cartilage and mucosa. The study suggests the participation of domestic animals as possible reservoirs. However, further studies are necessary to better understand the transmission cycle and take recommended measures in order to control the disease.

A leishmaniose cutânea canina causada por Leishmania braziliensis é uma doença negligenciada, mas disseminada entre cães na America do Sul. Este artigo descreve alterações clínicas e hematológicas em 17 cães infectados por L. braziliensis do Brasil. As alterações hematológicas mais comuns foram trombocitopenia (82,4%), anemia (70,6%), baixo valor de hematócrito (52,9%) e eosinofilia (41,2%). Doze (70,6%) cães apresentaram pelo menos uma alteração física; 11 (64,7%) apresentaram lesões cutâneas, quatro (23,5%) perda de peso e dois (11,8%) onicogrifose. Cães infectados por L. braziliensis apresentaram alterações clínicas e hematológicas inespecíficas que são comumente observadas em cães infectados por outros patógenos. Isso indica que veterinários e profissionais de saúde pública não deveriam considerar a presença de tais sinais clínicos como critério de diagnóstico para leishmaniose visceral em cães, em áreas endêmicas, no intuito de evitar um diagnóstico equivocado e a subsequente eliminação de cães infectados por L. braziliensis.

Canine cutaneous leishmaniasis by Leishmania braziliensis is a neglected, but widespread disease of dogs in South America. This paper describes clinical and hematological alterations in 17 L. braziliensis-infected dogs from Brazil. The most common hematological findings were thrombocytopenia (82.4%), anemia (70.6%), low packed cell volume (52.9%) and eosinophilia (41.2%). Twelve (70.6%) dogs displayed at least one evident physical alteration; 11 dogs (64.7%) presented skin lesions, four (23.5%) had weight loss and two (11.8%) onychogryphosis. L. braziliensis-infected dogs present clinical and hematological signs often observed in dogs infected by other pathogens. This indicates that veterinarians and public health workers should not consider the presence of non-specific clinical signs as diagnostic criteria for visceral leishmaniasis in dogs living endemic areas to avoid misdiagnosis and subsequent elimination of dogs infected by L. braziliensis.

Esse estudo teve como objetivo geral caracterizar a fauna de flebotomíneos envolvida em unidade de treinamento militar localizada na Zona da Mata do Estado de Pernambuco, Brasil, onde foram verificados casos humanos autóctones de leishmaniose tegumentar americana (LTA) associados a Leishmania (Viannia) braziliensis. A presença de 16 espécies de flebotomíneos no Centro de Instrução Militar Marechal Newton Cavalcanti indicou uma importante diversidade na área de estudo. Lutzomyia complexa constituiu a espécie mais abundante (51,36%), seguida de L. choti (43,54%). Todas as capturas foram realizadas nas áreas onde foram desenvolvidos treinamentos militares, nas quais foram verificados casos clínicos em indivíduos após realizarem treinamentos. Os dados obtidos sobre a fauna local, associados com achados prévios nessa área da Zona da Mata, apresentam evidências consistentes sobre a manutenção de um ciclo enzoótico, com a ocorrência de surtos periódicos de LTA, posteriores à realização de treinamentos, em áreas correspondentes à Mata Atlântica remanescente e matas secundárias.

The aim of this study was to characterize the sandfly fauna in a military training area situated in the "Zona da Mata" region of Pernambuco State, Brazil, where human cases of American tegumentary leishmaniasis (ATL) had been observed, caused by Leishmania (Viannia) braziliensis. The occurrence of 16 sandfly species in the Marshall Newton Cavalcanti Military Training Camp (CIMNC) indicates an important diversity of sandfly species in this study area. Lutzomyia complexa was the most common species (51.36%) followed by L. choti (43.54%). All the captures were made in areas where training activities were conducted and where clinical cases had been detected in individuals performing training, following this period. The data relating the sandfly behavior to previous data in the same area provides strong evidence for the occurrence of an enzootic cycle of the parasite, and outbreaks followed the period of training activities in the remaining Atlantic Rain Forest and secondary forest areas.

Esse estudo teve como objetivo geral caracterizar a fauna de flebotomíneos envolvida em unidade de treinamento militar localizada na Zona da Mata do Estado de Pernambuco, Brasil, onde foram verificados casos humanos autóctones de leishmaniose tegumentar americana (LTA) associados a Leishmania (Viannia) braziliensis. A presença de 16 espécies de flebotomíneos no Centro de Instrução Militar Marechal Newton Cavalcanti indicou uma importante diversidade na área de estudo. Lutzomyia complexa constituiu a espécie mais abundante (51,36%), seguida de L. choti (43,54%). Todas as capturas foram realizadas nas áreas onde foram desenvolvidos treinamentos militares, nas quais foram verificados casos clínicos em indivíduos após realizarem treinamentos. Os dados obtidos sobre a fauna local, associados com achados prévios nessa área da Zona da Mata, apresentam evidências consistentes sobre a manutenção de um ciclo enzoótico, com a ocorrência de surtos periódicos de LTA, posteriores à realização de treinamentos, em áreas correspondentes à Mata Atlântica remanescente e matas secundárias.

The aim of this study was to characterize the sandfly fauna in a military training area situated in the "Zona da Mata" region of Pernambuco State, Brazil, where human cases of American tegumentary leishmaniasis (ATL) had been observed, caused by Leishmania (Viannia) braziliensis. The occurrence of 16 sandfly species in the Marshall Newton Cavalcanti Military Training Camp (CIMNC) indicates an important diversity of sandfly species in this study area. Lutzomyia complexa was the most common species (51.36%) followed by L. choti (43.54%). All the captures were made in areas where training activities were conducted and where clinical cases had been detected in individuals performing training, following this period. The data relating the sandfly behavior to previous data in the same area provides strong evidence for the occurrence of an enzootic cycle of the parasite, and outbreaks followed the period of training activities in the remaining Atlantic Rain Forest and secondary forest areas.

Este estudo tem como objetivo geral caracterizar a epidemiologia da leishmaniose tegumentar americana em unidade de treinamento militar, localizada no Estado de Pernambuco. Entre 2002 e 2003, vinte e três casos foram diagnosticados através de exame clínico, detecção do parasita e teste de intradermoarreação de Montenegro. Sete amostras de Leishmania (Viannia) braziliensis foram isoladas destes pacientes, identificadas através de reações com anticorpos monoclonais específicos e perfil eletroforético com isoenzimas. Um inquérito epidemiológico de prevalência da infecção por IDRM foi realizado na população que realizou treinamento neste período, no qual foi identificada uma prevalência de 25,3% de infecção. Os dados obtidos, associados com achados prévios nesta área, apresentam evidências da manutenção de um ciclo enzoótico, com a ocorrência de surtos periódicos de leishmaniose tegumentar americana posteriormente à realização de treinamentos nas áreas de floresta Atlântica remanescente.

The aim of work was to study the epidemiology of American tegumentary leishmaniasis in a military training unit situated in Zona da Mata region of Pernambuco State. Between 2002 and 2003 twenty-three cases were notified by clinical exam, detection and/or isolation of parasite and Montenegro skin test. Seven stocks of Leishmania (Viannia) braziliensis were obtained from patients, identified by a panel of specific monoclonal antibodies and isoenzymatic electrophoresis profiles. An epidemiologic survey on prevalence of infection was carried out by Montenegro skin test in the population that underwent training activities during the same period, out of which 25.3% were identified as positive. These results in association with previous data from this area, shows the maintenance of a primary transmission cycle and the occurrence of periodical outbreaks after training activities in local areas of remnant Atlantic rain forest.