title: Divergent profile of emerging cutaneous leishmaniasis in subtropical Brazil: new endemic areas in the southern frontier.
abstract: BACKGROUND
  Although known to be highly endemic in the Amazon regions of Brazil, the presence of cutaneous leishmaniasis (CL) in the subtropical southern part of the country has largely been ignored. This study was conducted to demonstrate CL is emerging in the Brazilian state of Santa Catarina, as well as to characterize the epidemiological profile and Leishmania species involved.
  
  
  RESULTS
  For this cross-sectional study, data from all CL cases from Santa Catarina, Brazil, reported to the Brazilian National Notifiable Diseases Information System from 2001 to 2009 were investigated. Amplification of the kDNA minicircle conserved region followed by restriction fragment length polymorphism (PCR-RFLP) was conducted to screen for Leishmania species present in patient biopsy. Overall, 542 CL cases were reported, with majority resulting from autochthonous transmission (n = 401, 73.99%) and occurring in urban zones (n = 422, 77.86%). Age, gender, zone of residence, origin of case, clinical form and case outcome were found to differ significantly by region. Imported cases were over seven times more likely to relapse (95% CI 2.56-21.09). Mapping of cases revealed new endemic areas in northeastern Santa Catarina with two species present. With the exception of three L. (Leishmania) amazonensis cases (1.20%), majority of PCR positive samples were found to be L. (Viannia) braziliensis (n = 248, 98.80%).
  
  
  CONCLUSIONS
  CL is now endemic in the state of Santa Catarina, Brazil, with case profiles varying significantly by region. L. (V.) braziliensis has been identified as the predominant species in the region.
authors: Department of Microbiology, Immunology and Parasitology, Universidade Federal de Santa Catarina, Florianópolis, Brazil.
authors: Mariel Asbury
authors: MA
authors: Marlow
authors: Marise
authors: M
authors: da Silva Mattos
authors: Maria Ernestina
authors: ME
authors: Makowiecky
authors: Iriane
authors: I
authors: Eger
authors: Andre Luiz
authors: AL
authors: Rossetto
authors: Edmundo Carlos
authors: EC
authors: Grisard
authors: Mário
authors: M
authors: Steindel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018105:DNA, Kinetoplast / Q000235:genetics* / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D007891:Leishmania / Q000235:genetics* / Q000302:isolation & purification*; D007892:Leishmania braziliensis / Q000235:genetics / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012150:Polymorphism, Restriction Fragment Length; D055815:Young Adult
chemical_list: D018105:DNA, Kinetoplast