title: Active surveillance of American tegumentary leishmaniasis in endemic areas in rural Bolivia.
abstract: BACKGROUND
  American tegumentary leishmaniasis (ATL), including mucocutaneous leishmaniasis (MCL) and localized cutaneous leishmaniasis (LCL), is endemic in Bolivia. We describe the results of active surveillance of ATL from 2001 to 2006 and assess demographic data related to ATL epidemiology in the Yungas valleys.
  
  
  METHODS
  Community-based active ATL surveillance was performed by the institutions SERVIR, CÁRITAS, and the Health Services Department of La Paz, whose files were reviewed retrospectively. A cross-sectional survey was carried out to assess demographic data in two communities.
  
  
  RESULTS
  Two thousand nine hundred nine cases of ATL were detected from 2001 to 2006: 2,488 (85.5%) corresponded to LCL and 421 (14.5%) to MCL. A reduction in the proportion of mucosal cases was observed between 2001 and 2006. The proportion of MCL cases increased with age and was higher among males (15.5% versus 12.1%, p=0.018). The rate of positivity via direct observation of the parasite in dermal scrapings and in parasite cultivation was significantly higher for LCL than for MCL (p<0.001 and p=0.009, respectively). The rate of reactivity in the leishmanin skin test was higher in the group with mucosal lesions (p=0.012). The cross-sectional survey showed that 40% of the families had emigrated from the Altiplano.
  
  
  CONCLUSIONS
  It is necessary to undertake continuous case detection of ATL in the area, where the disease presents a high rate of mucosal cases. Increasing incidence seems to be associated with immigration and continuous deforestation to expand the crop-growing areas.
authors.affiliation: Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ.
authors.forename: Vladimir Luna
authors.initials: VL
authors.lastname: Tedesqui
authors.forename: Guido Noel Chuquimia
authors.initials: GN
authors.lastname: Calleja
authors.forename: Rolando
authors.initials: R
authors.lastname: Parra
authors.forename: Javier Palacios
authors.initials: JP
authors.lastname: Pabón
authors.forename: Márcio Neves
authors.initials: MN
authors.lastname: Bóia
authors.forename: Filipe Anibal
authors.initials: FA
authors.lastname: Carvalho-Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001838:Bolivia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007223:Infant; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors