title: An urban outbreak of visceral leishmaniasis in Natal, Brazil.
abstract: The epidemiological pattern of visceral leishmaniasis in north-eastern Brazil is changing. The disease was typically seen in rural, endemic areas, but is now occurring as an epidemic in the city of Natal where 316 cases have been reported since 1989; 49% were in children less than 5 years of age. The principle clinical and laboratory findings were weight loss, fever, hepato-splenomegaly, anaemia, leucopenia and hypergammaglobulinaemia. Elevated transaminases and hyperbilirubinaemia were also observed. The diagnosis was confirmed in 87% of cases by identifying amastigotes in aspirates from bone marrow or spleen. Five isolates were identified as Leishmania (L.) chagasi by isoenzyme analysis. The mortality rate was 9%; all deaths occurred during the first week in hospital. One person had concurrent human immunodeficiency virus infection. Among 210 household contacts and neighbours of patients from the endemic area examined for evidence of L. (L.) chagasi infection, 6 additional cases of visceral leishmaniasis were diagnosed. Thirty-eight percent of house-mates and neighbours gave a positive Montenegro skin test reaction, indicating prior subclinical infection.
authors.affiliation: Department of Biochemistry, Universidade Federal do Rio Grande do Norte, Brazil.
authors.forename: S M
authors.initials: SM
authors.lastname: Jeronimo
authors.forename: R M
authors.initials: RM
authors.lastname: Oliveira
authors.forename: S
authors.initials: S
authors.lastname: Mackay
authors.forename: R M
authors.initials: RM
authors.lastname: Costa
authors.forename: J
authors.initials: J
authors.lastname: Sweet
authors.forename: E T
authors.initials: ET
authors.lastname: Nascimento
authors.forename: K G
authors.initials: KG
authors.lastname: Luz
authors.forename: M Z
authors.initials: MZ
authors.lastname: Fernandes
authors.forename: J
authors.initials: J
authors.lastname: Jernigan
authors.forename: R D
authors.initials: RD
authors.lastname: Pearson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001853:Bone Marrow / Q000469:parasitology; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D013154:Spleen / Q000469:parasitology; D014505:Urban Population