RESUMO
This article focuses on the conceptions, attitudes and practices of the inhabitants from four villages (veredas) in Tierralta and Valencia (Cordoba, Colombia), who have suffered from or are aware of the existence of cutaneous leishmaniasis. A mixed methodology was implemented based in a qualitative design using interviews and focus groups (n=45) and an epidemiological design which included applying the Montenegro test (n=251), uncovering suspected cases of cutaneous leishmaniasis in humans, (n=5) and applying epidemiological surveys (n=409). Among the results, a lack of knowledge regarding the vector was found; although respondents could identify the Lutzomyia (known as "alú"), they did not correlate it with cutaneous leishmaniasis. In addition, traditional home treatments were more frequently used, increasing the underrecording of cases. With respect to healthcare personnel, flaws in diagnosis and treatment were found, which reinforces adherence to home treatments. This scenario calls for a reflection upon the challenges of the health care system in relation to the interventions of health personnel in communities situated in endemic areas.
Assuntos
Características Culturais , Conhecimentos, Atitudes e Prática em Saúde , Leishmaniose Cutânea/epidemiologia , Adolescente , Adulto , Criança , Colômbia/epidemiologia , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/psicologia , Leishmaniose Cutânea/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Pesquisa Qualitativa , Adulto JovemRESUMO
RESUMEN Este artículo se centra en las concepciones, actitudes y prácticas de los pobladores de cuatro veredas en Tierralta y Valencia (Córdoba, Colombia), que han padecido o conocen la leishmaniasis cutánea. Se implementó una metodología mixta que combinó un diseño cualitativo con entrevistas y grupos focales (n=45), y un diseño epidemiológico en el que se aplicó la prueba de Montenegro (n=251), se relevaron casos sospechosos de leishmaniasis cutánea en humanos (n=5) y se realizaron encuestas epidemiológicas (n=409). Entre los resultados se encontró que hay un desconocimiento del vector y, aunque identificaron la Lutzomyia (Alú), no la correlacionaron con la leishmaniasis cutánea. Por otra parte, los tratamientos tradicionales caseros son los más usados, lo que provoca el aumento del subregistro de casos. Respecto al personal de salud, se encontraron fallas en el diagnóstico y el tratamiento, lo que refuerza la adherencia a tratamientos caseros. Este escenario nos insta a reflexionar acerca de los retos del sistema de salud respecto a las intervenciones del personal de salud en las comunidades asentadas en zonas endémicas.
ABSTRACT This article focuses on the conceptions, attitudes and practices of the inhabitants from four villages (veredas) in Tierralta and Valencia (Cordoba, Colombia), who have suffered from or are aware of the existence of cutaneous leishmaniasis. A mixed methodology was implemented based in a qualitative design using interviews and focus groups (n=45) and an epidemiological design which included applying the Montenegro test (n=251), uncovering suspected cases of cutaneous leishmaniasis in humans, (n=5) and applying epidemiological surveys (n=409). Among the results, a lack of knowledge regarding the vector was found; although respondents could identify the Lutzomyia (known as “alú”), they did not correlate it with cutaneous leishmaniasis. In addition, traditional home treatments were more frequently used, increasing the underrecording of cases. With respect to healthcare personnel, flaws in diagnosis and treatment were found, which reinforces adherence to home treatments. This scenario calls for a reflection upon the challenges of the health care system in relation to the interventions of health personnel in communities situated in endemic areas.
Assuntos
Humanos , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Conhecimentos, Atitudes e Prática em Saúde , Leishmaniose Cutânea/epidemiologia , Características Culturais , Prevalência , Entrevistas como Assunto , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/psicologia , Grupos Focais , Colômbia/epidemiologia , Pesquisa QualitativaRESUMO
Leishmania panamensis and Leishmania guyanensis are two species of the subgenus Viannia that are genetically very similar. Both parasites are usually associated with cutaneous leishmaniasis, but also have the potential to cause the mucocutaneous form of the disease. In addition, the study of foci and consequently the identification of vectors and probable reservoirs involved in transmission require a correct differentiation between both species, which is important at epidemiological level. We explored the possibility of identifying these species by using restriction fragment length polymorphisms (RFLP) in the gene coding for heat-shock protein 70 (hsp70). Previously, an hsp70 PCR-RFLP assay proved to be very effective in differentiating other Leishmania species when HaeIII is used as restriction enzyme. Based on hsp70 sequences analysis, BccI was found to generate species-specific fragments that can easily be recognized by agarose gel electrophoresis. Using the analysis of biopsies, scrapings, and parasite isolates previously grouped in a cluster comprising both L. panamensis and L. guyanensis, we showed that our approach allowed differentiation of both entities. This offers the possibility not only for identification of parasites in biological samples, but also to apply molecular epidemiology in certain countries of the New World, where several Leishmania species could coexist.
Assuntos
Proteínas de Choque Térmico HSP70/genética , Leishmania guyanensis/genética , Reação em Cadeia da Polimerase/métodos , Humanos , Leishmania guyanensis/classificação , Leishmaniose Cutânea/genética , Leishmaniose Cutânea/parasitologia , Polimorfismo de Fragmento de Restrição , Análise de Sequência de DNA , Especificidade da EspécieRESUMO
First generation candidate vaccines against leishmaniasis, prepared using inactivated whole parasites as their main ingredient, were considered as promising because of their relative ease of production and low cost. These vaccines have been the subject of many investigations over several decades and are the only leishmaniasis vaccine candidates which have undergone phase 3 clinical trial evaluation. Although the studies demonstrated the safety of the vaccines and several studies showed reasonable immunogenicity and some indication of protection, an efficacious prophylactic vaccine is yet to be identified. Despite this overall failure, these trials contributed significantly to increasing knowledge on human leishmaniasis immunology. To provide a collective view, this review discusses the methods and findings of field efficacy trials of first generation leishmaniasis vaccine clinical trials conducted in the Old and New Worlds.
Assuntos
Vacinas contra Leishmaniose/uso terapêutico , Leishmaniose/imunologia , Leishmaniose/prevenção & controle , África/epidemiologia , Animais , Ásia/epidemiologia , Ensaios Clínicos como Assunto , Humanos , Leishmania/imunologia , Ensaios Clínicos Controlados Aleatórios como Assunto , América do Sul/epidemiologiaRESUMO
la leishmaniosis comprende un grupo de enfermedades antropozoonóticas causadas por varias especies de parásitos del género Leishmania, que llegan al hombre a través de la picadura de un insecto díptero perteneciente en América al género Lutzomyia y en el Viejo Mundo al género Phlebotomus. Tiene como reservorios animales domésticos y silvestres y en ocasiones al hombre. En el hombre afecta piel, mucosas y órganos del sistema mononu-clear fagocítico, produciendo los cuadros clínicos de leishmaniosis cutánea, mucosa y visceral