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CONICET Digital Nro.E8b4f8f5-8B3f Asian Pacific Journal of Tropical Medicine 2019; 12(7): 300-305 300 Original Article Asian Pacific Journal of Tropical Medicine journal homepage: www.apjtm.org doi: 10.4103/1995-7645.262073 Impact factor: 1.77 Leishmaniasis in the Argentine Republic: Temporal and geographical distribution from 2013 to 2017 Germanó María J1, Salomón María C2, Neira Gisela3, Lozano Esteban1,4, Mackern-Oberti Juan P1,4, Cargnelutti Diego E1,2 1Consejo Nacional de Investigaciones Científicas y Técnicas, Centro Científico y Tecnológico de Mendoza, Instituto de Medicina y Biología Experimental de Cuyo, Mendoza, Argentina 2Universidad Nacional de Cuyo, Facultad de Ciencias Médicas, Área de Parasitología, Mendoza, Argentina 3Universidad Juan Agustín Maza, Facultad de Ciencias Veterinarias y Ambientales, Centro de Investigación en Parasitología Regional, Mendoza, Argentina 4Universidad Nacional de Cuyo, Facultad de Ciencias Médicas, Instituto de Fisiología, Mendoza, Argentina ARTICLE INFO ABSTRACT Article history: Objective: To assess the temporal and geographical distribution of confirmed cases of Received 15 January 2019 cutaneous, mucocutaneous and visceral leishmaniasis in the Argentine Republic from 2013 to Received 20 May 2019 Accepted 20 June 2019 2017. Available online 9 July 2019 Methods: A retrospective study was carried out using data collected from the Integrated Surveillance Bulletin database of the National System of Health Surveillance. Confirmed cases Keywords: Leishmaniasis of cutaneous, mucocutaneous and visceral leishmaniasis up to the 52nd epidemiological week Epidemiology of each year was included. Argentine Republic Temporal distribution Results: In the 5 years period, 1 295 confirmed leishmaniasis cases were reported in the Geographical distribution Argentine Republic. One thousand twenty-eight (1 028) cases corresponded to cutaneous leishmaniasis (87.10%), being the most common type of leishmaniasis. Mucocutaneous leishmaniasis was in the second place in the country with 115 cases reported, mostly in the Northwest and Northeast regions. A total of 52 individuals with visceral leishmaniasis were identified and Misiones Province was the most affected. Conclusions: It is important to analyze the temporal and geographical distribution of leishmaniasis in order to provide an adequate management and surveillance. 1. Introduction (to cutaneous and mucocutaneous leishmaniasis) and Lu. longipalpis (to visceral leishmaniasis)[1]. Four species of Leishmania have been Leishmaniasis is a group of diseases caused by different parasites identified in human cases in the Argentine Republic: Leishmania belonging to the Trypanosomatidae family, genus Leishmania, (L.) braziliensis, L. amazonensis, L. guyanensis, which are associated which is transmitted to humans by the bite of the sandfly species with cutaneous leishmaniasis and L. infantum, linked to visceral belonging to Lutzomyia genus in America. The species involved in leishmaniasis[1]. the transmission of leishmaniasis in the Argentine Republic are: ( ) [ ( )] , ( ) , This is an open access journal, and articles are distributed under the terms of the Creative Lutzomyia Lu. Nyssomyia N. whitmani Lu. N. neivai Lu. Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to [Migonemyia (Mg.)] migonei and Lu. [Evandromyia (Ev.)] cortelezzii remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Corresponding author: Diego Esteban Cargnelutti, Laboratory of Immunology and Vaccine For reprints contact: [email protected] Development, IMBECU-CONICET. Av. Ruiz Leal s/n. Parque Gral. San Martín, CP 5500, ©2019 Asian Pacific Journal of Tropical Medicine Produced by Wolters Kluwer- Medknow. Mendoza, Argentina. All rights reserved. Tel.: +54-9261-5699377 Fax: Not applicable How to cite this article: Germanó M, Salomón MC, Neira G, Lozano E, Mackern-Oberti E-mail: [email protected] JP, Cargnelutti DE. Leishmaniasis in Argentine Republic: Temporal and geographical Foundation project: This study was supported by grant from Fundación Alberto Roemmers (2017-2019). distribution from 2013 to 2017. Asian Pac J Trop Med 2019; 12(7): 300-305. Germanó María J et al./Asian Pacific Journal of Tropical Medicine 2019; 12(7): 300-305 301 The infection can be asymptomatic or lead to a spectrum of 2.2. Data collection diseases with different clinical characteristics, such as cutaneous, mucocutaneous and visceral leishmaniasis according to the A retrospective study was conducted using data obtained from the Leishmania species and host background[1]. It is estimated that Integrated Surveillance Bulletin database by the National System of about 12 million people are affected by the disease; furthermore, an Health Surveillance. Confirmed cases of cutaneous, mucocutaneous estimated 50 000 to 90 000 new cases of visceral leishmaniasis, and and visceral leishmaniasis up to the 52nd epidemiological week of 600 000 to 1 000 000 new cases of cutaneous leishmaniasis occur each year in the period of 2013-2017 was collected. In the Argentine annually[2]. Republic, notification to the public health authorities has been Leishmaniasis is a re-emerging infectious disease, and it has been compulsory since 1960 for more than 40 diseases (national law No. categorized by the World Health Organization (WHO) as one of the 15 465), including leishmaniasis. neglected diseases, mainly affecting low income populations with restricted access to health services[2]. 2.3. Data analysis Leishmaniasis is endemic in the Argentine Republic and 17 other American countries[3] and it is of compulsory notification in all The geographical provinces of the Argentine Republic were these countries. The National Disease Surveillance System is used implemented as units of analysis in order to evaluate the differences to collect data on the occurrence of leishmaniasis in some countries, among them. The maps were generated in accordance with the while in others there are specific tools for data collection[4]. total confirmed cases of cutaneous, mucocutaneous and visceral Unfortunately, there is no updated study of overall epidemiological leishmaniasis collected between 2013 and 2017. The Arc-Gis data on human leishmaniasis in the Argentine Republic, except version 10.2.1 GIS software (ESRI; Redlands, USA) was used. The for reported leishmaniasis cases in the Northwest of the Argentine administrative boundaries at country level were obtained from the Republic[5]. SIG-250 of the National Geographic Institute (http://www.ign.gob. Health indicators contain data that provide important information ar/sig250). regarding to the status and the performance of a health system. They Reported cases of each clinical manifestation of leishmaniasis reveal the sanitary conditions of a population and are suitable for were graphed according to year using Graph Pad Prism version surveillance. These indicators provide inputs for analysis, promoting 5.0 software (La Jolla California, USA). In order to confirm if professional analytical capacity and the development of information the northern regions are the areas with the highest prevalence, systems[6]. In consequence, the indicators are used by governments differences of leishmaniasis prevalence between the Northwest and international organizations as tools to guide health policy, to and Northeast towards the rest of the country were analyzed by administer resources and to execute public health strategies. prevalence ratio test. Confirmed leishmaniasis cases per year were The aim of this study is to describe the temporal and geographical analyzed by distribution Chi-square one-way test. distribution of leishmaniasis cases in the Argentine Republic between 2013 and 2017. 2.4. Ethical approval Legal principles and ethical aspects were both considered and 2. Materials and methods respected. This investigation was performed according to public domain data from the Argentine Republic Ministry of Health, 2.1. Study area without the possibility of identifying subjects, thereby dispensing the need for approval by an institutional review board for human This study was conducted in the Argentine Republic, the eighth research. largest country in the world and the second largest in Latin America, with a total area of 3 761 274 km2. The Argentine Republic comprises 23 provinces and a federal district, the Autonomous City of Buenos 3. Results Aires. The Argentine Republic can be grouped into 5 regions: Northwest, Northeast, Center, Cuyo and South (Figure 1). The In the period between 2013 and 2017, a total of 1 295 cases of geographic regions were integrated as follows in accordance with confirmed leishmaniasis was reported in the Argentine Republic Argentina’s National Institute of Statistics and Census[7]: Northwest (Table 1). Among them, 1 128 (87.10%) cases corresponded to (JY: Jujuy, SA: Salta, CA: Catamarca, TUC: Tucumán, SE: Santiago cutaneous leishmaniasis, with an annual average of 225.6 cases del Estero and LR: La Rioja); Northeast (FO: Formosa, CH: Chaco, (ranging from 127 to 343). The highest number of notifications 2 CR: Corrientes, MI: Misiones); Center (CB: Córdoba, SF: Santa Fe, was recorded in 2015 (Pearson Chi-square test: χ =128.93, df =4, ER: Entre Ríos, BA: Buenos Aires and Autonomous City of Buenos P<0.000 1), with 343 cases (30.41%). Six hundred eighty (680) of Aires); Cuyo (SJ: San Juan, MZ: Mendoza and SL: San Luis); and the reported cutaneous leishmaniasis cases (60.28%) were from the
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