title: Leishmania panamensis transmission in the domestic environment: the results of a prospective epidemiological survey in Santander, Colombia.
abstract: BACKGROUND
  Domestic transmission now appears to be the principal route of Leishmania panamensis infection in deforested regions characterized by the replacement of primary forest by permanent plantations, i,e coffee or cacao crops. This paper presents the results of the disease patterns in a representative population of the Opón focus, in Santander, Colombia.
  
  
  OBJECTIVE
  The principal aims were: 1) to measure the incidence rate in a representative population of the Opón focus; 2) to identify demographic risk factors for infection; 3) to estimate the proportion of infections which cause disease; 4) to estimate the protection against disease from acquired immunity; 5) to estimate the frequency of reactivations, and 6) to estimate the risk of mucosal leishmaniasis.
  
  
  METHODS
  A 19 month prospective survey of leishmaniasis caused by Leishmania panamensis was carried out amongst 1380 people in a cacao growing region of Santander Department, Colombia. The population was diagnosed clinically and by the Montenegro skin test (at two time points).
  
  
  RESULTS
  The incidence rate was 0.19 infections/person-year, with 31% of infections apparently subclinical. The risk of acquiring cutaneous leishmaniasis decreased with age even in the absence of apparent previous infections. Protective immunity followed both clinical and subclinical infections, persisting for at least 10 years after a primary lesion. Mucocutaneous leishmaniasis was detected in 12% of the population with cutaneous lesions, of which 77% had mild symptoms, and 23% perforated nasal septa. The risk of mucosal leishmaniasis was greatest for males, and for people whose primary cutaneous lesion was on the head.
  
  
  CONCLUSIONS
  The average age of infection in Opón, 7.7 years (1/lambda), and the absence of gender as a risk factor is highly indicative of intradomiciliary or peridomiciliary transmission.
authors.affiliation: Departamento de Ciencias Básicas, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia. germun@uis.edu.co
authors.forename: Gerardo
authors.initials: G
authors.lastname: Muñoz
authors.forename: Clive R
authors.initials: CR
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003105:Colombia; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D018334:Leishmania guyanensis; D007897:Leishmaniasis, Mucocutaneous / Q000453:epidemiology* / Q000635:transmission*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors