Visceral and Cutaneous Leishmanisis in the Argentine border with Brazil and Paraguay

SALOMÓN OD; SANTINI MS; FERNÁNDEZ MS; QUINTANA MG; MASTRANGELO AV

Congreso; 5º World Congress on Leishmaniasis, Worldleish 5; 2013

The province of Misiones, Argentina, located in the NE border with Brazil and Paraguay, reported from 1954 to 2007 7.2 cases of cutaneous leishmaniasis (CL)/year scattered in time-space, and none case of visceral leishmaniasis (VL) until 2006. Our CL foci studies in the tripartite frontier area (up to 60 km from the Iguazu waterfalls) started in 1998 with an outbreak of 201 CL cases (Puerto Esperanza). The transmission was peridomestic, in old modified environments close to primary forest patches with recent deforestations, and Nyssomyia neivai as the prevalent phlebotomine (79.7%). During 2004-2005 two CL outbreaks (mean 40 cases) took place at 20 km (Libertad) and 60 km (Puerto Iguazu) from Puerto Esperanza, In these last foci most of the cases involved males over 15 years old (75%) infected during work related to primary forest or to new deforestations to establish individual farms. The phlebotomine associated with cases were Ny whitmani (87.4%) followed by Mygonemyia migonei (7.6%), it highest abundance was found in pig and chicken dwellings, but correlated with the vector abundance in the respective houses. The higher vector densities were also associated with rodent captures, and temperature up to 31?47 days after the sampling day. Leishmania braziliensis DNA was identified from human cases, and Lu. whitmani. The meanings of risk, environment, and needs from the actor´s perspective were studied, and so the conditioning of social actor?s behavior related with Health-Illness-Care process was characterized. On the other hand, Lutzomyia longipalpis was reported for the first time in Puerto Iguazu during 2010 associated with canine VL, in urban-periurban peridomiciles, and remains since then in urban patches. In conclusion, the distribution of vectors of CL and VL is discriminated in space (habitat characteristics) and time (climate conditions), while the actual risk is also modulated by individual perception and group practices (urban inhabitants, rural new settlers, deforestation workers, rangers, tourists, etc.). Therefore, in order to design appropriate sustainable surveillance, prevention and control strategies for emergent urban-periurban VL and epidemic rural-periruban CL, an interdisciplinary ecohealth approach is needed, coordinated between the three countries, taking into account the ecological continuities, the cultural particularities, and the intense traffic and transit of goods, pets and persons across the borders.