RESUMEN

Stroke is the second leading cause of death and disability in Latin America; however, few epidemiological studies have been conducted in South America. An observational study was conducted to analyze trends in stroke mortality in South American (SA) countries. Age-standardized mortality rates and proportional mortality due to stroke in the populations of SA countries between 1990 and 2019 were assessed by extracting data from the Global Burden of Disease 2019 study. Joinpoint regression models were employed to identify trends in the annual percentage change in mortality rates for each segment. Considering the data collected over the 30 years that were studied, the age-standardized stroke mortality trend decreased in Argentina (-1.6%), Uruguay (-0.6%), Brazil (-0.5%), Guyana (-0.5%), and Bolivia (-0.4%), while Venezuela (+1.6%) and Suriname (+1.0%) showed an increasing trend. The proportional stroke mortality trend decreased in Argentina (-1.7%), Paraguay (-0.9%), Uruguay (-0.7%), Guyana (-0.7%), Brazil (-0.5%), and Chile (-0.5%), whereas Bolivia (+1.0%), Suriname (+0.6%), and Peru (+0.4%) exhibited an increasing trend. The trends in stroke mortality between 1990 and 2019 demonstrated considerable variability. While most SA countries experienced significant decreases in stroke mortality trends, Venezuela and Suriname showed increases in age-standardized mortality rates, and Bolivia, Suriname, and Peru exhibited increases in proportional mortality rates. No decreasing stroke mortality trend was observed in the segment after the last joinpoint, highlighting the need for improvement in prevention and treatment.

RESUMEN

The Atlantic Forests outside of the Amazon region in Brazil are low-frequency malaria hotspots. The disease behaves as a zoonosis maintained by nonhuman primates (NHPs), especially howler monkeys. Between 2016 and 2018, Brazil witnessed the largest yellow fever outbreak since 1980, resulting in massive declines in these NHP populations. However, reports of malaria cases continued in transmission areas. This scenario motivated this survey to determine the frequency of infection of the anophelines by Plasmodium species. Mosquitoes were captured using Shannon traps and CDC light traps and identified as to species based on morphological characters. The screening for malaria parasites targeted only Anopheles species belonging to the subgenus Kerteszia, the proven primary malaria vector. A TaqMan qPCR assay using ribosomal primers (18S rRNA gene) was performed in a Step One Plus Real-time PCR to detect Plasmodium species. Seven hundred sixty field-caught anophelines divided into 76 pools were examined. Out of 76 tested pools, seven (9.21%) were positive. Three pools were Plasmodium malariae-positive, and four were Plasmodium vivax-positive. The anopheline infection was expressed as the maximum infection rate (MIR), disclosing a value of 0.92%, indicative of a steady state. Such stability after the yellow fever outbreak suggests that other species of NHPs could support transmission.

Asunto(s)

Alouatta , Anopheles , Malaria , Plasmodium , Fiebre Amarilla , Animales , Malaria/epidemiología , Malaria/veterinaria , Mosquitos Vectores , Plasmodium/genética , Bosques , Plasmodium malariae , Brasil/epidemiología

RESUMEN

In the south and southeast regions of Brazil, cases of malaria occur outside the endemic Amazon region near the Atlantic Forest in some coastal states, where Plasmodium vivax is the recognized parasite. Characteristics of cases and vectors, especially Anopheles (Kerteszia) cruzii, raise the hypothesis of a zoonosis with simians as reservoirs. The present review aims to report on investigations of the disease over a 23-year period. Two main sources have provided epidemiological data: the behavior of Anopheles vectors and the genetic and immunological aspects of Plasmodium spp. obtained from humans, Alouatta simians, and Anopheles spp. mosquitoes. Anopheles (K.) cruzii is the most captured species in the forest canopy and is the recognized vector. The similarity between P. vivax and Plasmodium simium and that between Plasmodium malariae and Plasmodium brasilianum shared between simian and human hosts and the involvement of the same vector in the transmission to both hosts suggest interspecies transfer of the parasites. Finally, recent evidence points to the presence of Plasmodium falciparum in a silent cycle, detected only by molecular methods in asymptomatic individuals and An. (K.) cruzii. In the context of malaria elimination, it is paramount to assemble data about transmission in such non-endemic low-incidence areas.