title: Tegumentary leishmaniasis in the State of Amazonas: what have we learned and what do we need?
abstract: This study evaluated the occurrence of American tegumentary leishmaniasis (ATL) in the State of Amazonas, Brazil, in the last 30 years with emphasis on the last 10 years (2001 to 2010). The disease was predominantly observed in males (76.2%), in the 21- to 30-year-old age group (26.6%) and in extractive workers (43.7%); 3.3% of the cases were the mucosal form. The endemic channel shows the disease seasonality, with a predominance of cases at the beginning and end of each year. The number of cases by municipality in the period of 2001-2010 shows the maintenance of the endemic in the localities where the highest numbers of cases have always been registered, namely, Manaus, Rio Preto da Eva, Itacoatiara and Presidente Figueiredo. The comparison of data from 2001 to 2005 and from 2006 to 2010 showed the emergence of this disease in municipalities that had been previously unaffected. In the last years, there has been a significant increase in the activities of control, diagnosis and treatment of leishmaniasis in the State of Amazonas. In conclusion, the historical series of ATL analyzed in this study suggests that the transmission foci remain and are even expanding, though without continuous transmission in the intra- or peridomicile settings. Moreover, the disease will persist in the Amazon while the factors associated with infection acquisition relative to forest exploitation continue to have economic appeal. There is a real expectation of wide variations in disease incidence that can be influenced by climate and economic aspects.
authors.affiliation: Gerencia de Leishmaniose, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Jorge Augusto de Oliveira
authors.initials: JA
authors.lastname: Guerra
authors.affiliation: Programa de Pós-Graduação em Doenças Tropicais e Infecciosas, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Marcel Gonçalves
authors.initials: MG
authors.lastname: Maciel
authors.affiliation: Gerencia de Leishmaniose, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Marcus Vinítius de Farias
authors.initials: MV
authors.lastname: Guerra
authors.affiliation: Gerencia de Leishmaniose, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Anette Chursciack
authors.initials: AC
authors.lastname: Talhari
authors.affiliation: Programa de Pós-Graduação em Doenças Tropicais e Infecciosas, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Suzane Ribeiro
authors.initials: SR
authors.lastname: Prestes
authors.affiliation: Programa de Pós-Graduação em Doenças Tropicais e Infecciosas, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Marcos Antonio
authors.initials: MA
authors.lastname: Fernandes
authors.affiliation: Laboratório Interdisciplinar de Pesquisas Médicas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
authors.forename: Alda Maria
authors.initials: AM
authors.lastname: Da-Cruz
authors.affiliation: Gerencia de Leishmaniose, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Martins
authors.affiliation: Departamento de Imunologia, Universidade Federal do Amazonas, Manaus, AM, Brazil.
authors.forename: Leíla Ines de Aguiar Raposo Camara
authors.initials: LI
authors.lastname: Coelho
authors.affiliation: Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, DF, Brazil.
authors.forename: Gustavo Adolfo Sierra
authors.initials: GA
authors.lastname: Romero
authors.affiliation: Gerencia de Leishmaniose, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Maria das Graças Vale
authors.initials: Md
authors.lastname: Barbosa
mesh_terms: D001938:Brazil / Q000453:epidemiology; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D015994:Incidence; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology*; D008297:Male; D012621:Seasons