Abstract: INTRODUCTION: The morbidity and mortality profile in a given region reflects its quality of life and provides tools for improving public health policies in that region. METHODS A cross-sectional epidemiological study was performed using secondary mortality data collected from the Monte Negro municipality of the Brazilian Western Amazon from 2000 to 2011. These data were compared with data from similar municipalities in other Brazilian macro-regions. Data were obtained through the Departamento de Informática do Sistema Único de Saúde (DATASUS) information system. RESULTS The number of deaths reported over the study period was 606. The most common cause of death was external causes of morbidity and mortality [International Classification of Diseases (ICD)-10 chapter 20], followed by diseases of the circulatory system (ICD-10 chapter 9). Among the causes of death according to age group, infectious and parasitic diseases were the most common for 2- to 9-year-old children; external causes of disease were the most prevalent for 10- to 59-year-old people; and circulatory diseases prevailed in individuals over 60 years of age. Eleven percent of deaths were due to unknown causes. CONCLUSIONS These results point to a fragility in the public policies for prevention and awareness of this problem. Infectious and parasitic diseases contribute only 4.5% of deaths, but had the third highest Disability-Adjusted Life Year score (1,190 days). Improving support to the Estratégia Saúde da Família (Family Health Strategy) program and implementing a death verification service would significantly aid in reducing the occurrence of non-transmissible chronic diseases and clarifying unknown causes of death.

Abstract: INTRODUCTION Mansonella ozzardi is a widely distributed filaria worm in the Amazon region. This study aimed to determine the prevalence of M. ozzardi infection in riverine communities of Lábrea municipality, Amazonas State, Brazil. METHODS A diagnostic blood filtration method in a polycarbonate membrane was used. RESULTS M. ozzardi was found in 50.3% of the sample, with the highest prevalence in farmers/fishermen (69.4%; χ 2 = -19.14, p<0.001). The prevalence was higher in longer-term residents (≥11 years; 60.2%). CONCLUSIONS M. ozzardi infection rates are high near the Purus River, much greater than those previously reported based on diagnosis using thick blood smears.

INTRODUCTION: Toxoplasma gondii infection is widely prevalent in humans and other animals worldwide. Information on the prevalence of T. gondii infection is scarce in some regions of Brazil, including riverside communities along the Amazon River basin. M METHODS: The prevalence of T. gondii in 231 people, aged 1-85 years, who were living in four riverside communities along the Purus River, Lábrea, State of Amazonas, Brazil, was determined. Antibodies against T. gondii were assayed using a commercial enzyme-linked immunosorbent assay (ELISA) kit. The hearts and brains of 50 chickens, which were raised free-range in the communities, were pooled according to the community of origin and bioassayed in mice. The isolates were genotyped using polymorphisms at 12 nuclear markers (SAG1, 5' and 3'-SAG2, alt.SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, Apico and CS3). RESULTS: The overall seroprevalence of T. gondii was 56.7% (131/231). IgG antibodies were presented by 117 (89.3%) and IgM by 14 (10.7%) of the 131 positive individuals. No association between age group and gender with prevalence was observed (chi-square test, p > 0.05); however, the comparison between localities showed that the seroprevalence of T. gondii was significantly lower among the individuals living in the Boca do Ituxi (p < 0.05) community. Five isolates of T. gondii were obtained in the mouse bioassay, and genotyping revealed two complete genotypes that had not been described previously and three mixed isolates. CONCLUSIONS: These results support previous findings that T. gondii population genetics are highly diverse in Brazil and that T. gondii infection is active in these riverside communities.

O uso de mosquiteiros impregnados com inseticida de longa duração (MILD), quando obedecidas as orientações da Organização Mundial da Saúde, é medida de controle de vetores da malária que pode apresentar excelentes resultados. Em 2012 foram instalados aproximadamente 150.000 MILDs em nove municípios do estado de Rondônia. Concomitantemente não houve estudo de avaliação de impacto na redução da incidência. O presente estudo analisou dados secundários da incidência, na expectativa de avaliar o impacto dos MILDs na incidência parasitária anual (IPA). Os resultados estatísticos mostram que, no período de um ano após a instalação dos MILDs, não houve diferença estatisticamente significativa na variação da IPA em relação a outros municípios que não receberam os MILDs. A adoção de medidas de controle vetorial deve ser acompanhada de estudos epidemiológicos e de avaliação de uso e eficácia para oferecer subsídios mais robustos que justifiquem a adoção desta medida de controle da malária na Região Amazônica.

Mosquito nets treated with long-lasting insecticide (LLINs), when used in compliance with guidelines of the World Health Organization, may be effective for malaria vector control. In 2012, approximately 150,000 LLINs were installed in nine municipalities in the state of Rondônia. However, no studies have assessed their impact on the reduction of malaria incidence. This study analyzed secondary data of malaria incidence, in order to assess the impact of LLINs on the annual parasite incidence (API). The results showed no statistically significant differences in API one year after LLIN installation when compared to municipalities without LLINs. The adoption of measures for malaria vector control should be associated with epidemiological studies and evaluations of their use and efficiency, with the aim of offering convincing advantages that justify their implementation and limit malaria infection in the Amazon Region.

Introduction: This work was carried out on the purpose of identifying the species of phlebotomine sandflies in the municipality of Monte Negro, state of Rondonia, Brazil, that may have been transmitting the American cutaneous leishmaniasis (ACL), and concisely describe epidemiological aspects of disease. METHODS: The epidemiologic and socioeconomical indicators were obtained from government institutions and the local Municipal Secretary of Health. Phlebotomine sandflies were captured using CDC light traps between July 2006 to July 2008. The total of 1,240 of female sandflies were examined by PCR method directed to k-DNA. RESULTS: There has been a significant decrease in the incidence of ACL of about 50% over the last ten years in the municipality. A total of 1,935 specimens of 53 sandfly species were captured, three of the genus Brumptomyia genus and 50 of the genus Lutzomyia. The predominant species was Lutzomyia acanthopharynx, Lutzomyia whitmani, Lutzomyia geniculata and Lutzomyia davisi. None were positive for Leishmania sp. CONCLUSIONS: Four sandflies species were found in the State of Rondonia for the first time: Brumptomyia brumpti, Lutzomyia tarapacaensis, Lutzomyia melloi and Lutzomyia lenti. The presence of Lutzomyia longipalpis, was also captured. Socioeconomical improvement of Brazilian economy and the increase of environmental surveillance in the last 15 years collaborated in the decrease of people exposed to vectors, reducing the incidence of ACL.

INTRODUÇÃO: Mansonella ozzardi é uma filária humana que tem como vetor dípteros simulídeos e é amplamente distribuída na Amazônia. Não há informações sobre a ocorrência de casos de mansonelose no Estado de Rondônia, e neste trabalho procurou-se investigar a situação epidemiológica desta parasitose em áreas urbanas e ribeirinhas na Amazônia Ocidental. MÉTODOS: Foram examinados 4.452 moradores às margens dos rios Madeira, Mamoré, Guaporé, Machado e Preto em Rondônia, através da técnica da gota espessa de sangue. Capturou-se às margens do rio Machado e Guaporé 2.112 simulídeos adultos das espécies Cerqueirellum pydanieli e Chirostilbia pertinax. RESULTADOS: Não foram encontradas pessoas infectadas com M. ozzardi e foram encontradas diferentes espécies de simulídeos com potencial de transmissão da mansonelose. CONCLUSÕES: Não foram encontrados indivíduos infectados com M. ozzardi neste estudo. Este fato pode ser explicado pela existência de pacientes com baixas microfilaremias, associado à técnica diagnóstica de baixa sensibilidade utilizada no estudo. Pode-se ainda aventar a possibilidade de ter ocorrido migração insuficiente de pacientes infectados de áreas endêmicas, impossibilitando a implantação da endemia. Estudos posteriores com técnicas diagnósticas mais sensíveis podem ajudar a esclarecer esta questão.

INTRODUCTION: Mansonella ozzardi, a human filarial nematode transmitted by Diptera Simuliidae flies (black flies), is widely spread in the Amazon, while the occurrence of mansonelliasis in the State of Rondônia (Western Amazonia) has not been reported thus far. The existence of this parasitic disease in this state is investigated in this study. METHODS: A total of 4,452 people who lived alongside the Madeira, Mamore, Guapore, Machado and Preto Rivers, in the State of Rondônia, were examined using the thick blood smear method. Alongside the Machado and Guapore rivers, 2,112 adult simuliid specimens were captured. RESULTS: Infected people were not reported, although simuliids with vector potential such as Cerqueirellum pydanielli, C. argentiscutum and C. amazonicum were found. CONCLUSIONS: This study registered no infected people. This finding may be explained by the individuals' low level of microfilaremia that is below the limit of detection of the diagnostic method used in the study or insufficient migration of people infected with M. ozzardi from endemic areas, making it impossible to introduce the disease into Rondônia. Further studies using more sensitive diagnostic techniques could shed light on this question.

INTRODUÇÃO: A mansonelose é uma filariose causada pela Mansonella ozzardi, ocorrendo na Amazônia com prevalências de até 60%. A técnica de diagnóstico habitual (hemoscopia através da gota espessa) tem baixa eficácia o para o diagnóstico de pacientes com baixa parasitemia. MÉTODOS: Neste contexto foi aperfeiçoada a técnica da PCR para seu diagnóstico. RESULTADOS E CONCLUSÕES: Quando comparada à gota espessa, a PCR apresenta sensibilidade de 100%, e valor preditivo negativo (VPN) de 100% mostrando eficácia bastante superior à técnica da filtração em membrana que apresenta sensibilidade de 88,9% e VPN de 84,6%, quando também comparada à gota espessa de sangue.

INTRODUCTION: Mansonelliasis is caused by Mansonella ozzardi. It is widespread in the Amazon region, with a high prevalence. The common exam of thick blood smears stained with Giemsa shows low efficacy levels and has been an obstacle to diagnosing individuals with low blood parasitemia. METHODS: In order to increase diagnosis efficacy, the PCR technique was improved. RESULTS AND CONCLUSIONS: PCR demonstrated the best performance, with sensitivity and negative predictive values (NPV) of 100%, followed by blood filtration through membrane filters, which showed a sensitivity of 88.9% and a NPV of 84.6%, when compared to thick blood smears.

A Leishmaniose Tegumentar Americana (LTA) é uma doença causada por protozoários do gênero Leishmania, transmitida ao homem pela picada de mosquitos flebotomíneos (Ordem Diptera; Família Psychodidae; Sub-Família Phlebotominae). No Brasil existem atualmente 6 espécies de Leishmania responsáveis pela doença humana, e mais de 200 espécies de flebotomíneos implicados em sua transmissão. Trata-se de uma doença que acompanha o homem desde tempos remotos e que tem apresentado, nos últimos 20 anos, um aumento do número de casos e ampliação de sua ocorrência geográfica, sendo encontrada atualmente em todos os Estados brasileiros, sob diferentes perfis epidemiológicos. Estima-se que, entre 1985 e 2003, ocorreram 523.975 casos autóctones, a sua maior parte nas regiões Nordeste e Norte do Brasil. Neste estudo, são discutidos aspectos relacionados ao tratamento e ao controle dessa doença, assim como também as dificuldades para a implementação dessas medidas. São apontadas alternativas que passam pela estruturação dos serviços de saúde, com respeito ao diagnóstico, no desenvolvimento de drogas de aplicação tópica ou por via oral, no desenvolvimento de vacinas, no controle diferenciado de vetores e no aprofundamento de estudos relacionados à biologia celular do parasita.

American Cutaneous Leishmaniasis (ACL) is an infectious disease transmitted by the bite of phlebotomines mosquitos (Order Diptera: Family Psychodidae: Sub-Family Phlebotominae) and caused by protozoa from the genus Leishmania (ROSS 1903). In Brazil, there are six different species of Leishmania and more than 200 different species of phlebotomines. It's a disease that has been afflicting human beings for many centuries, and in Brazil, in the past two decades, there has been an important increase in the number of cases and also in its geographical distribution. Presently, ACL cases are registered in all Brazilian states under three different epidemiological profiles (sylvatic, sylvatic-modified and periurban). Between 1985 and 2003, 523,975 cases were registered, mainly in the northeast and north of the country, although the north has the highest incidence rate. In this study, aspects related to difficulties in treatment and transmission control, and new strategies to approach the disease are discussed. Alternatives such as the development of new drugs (topical and oral routes), the implementation of diagnostic methods in public health services, differentiated transmission control based on the 3 different epidemiological profiles and basic research on the molecular biology of the parasite are pointed out.

A Leishmaniose Tegumentar Americana (LTA) é uma doença causada por protozoários do gênero Leishmania, transmitida ao homem pela picada de mosquitos flebotomíneos (Ordem Diptera; Família Psychodidae; Sub-Família Phlebotominae). No Brasil existem atualmente 6 espécies de Leishmania responsáveis pela doença humana, e mais de 200 espécies de flebotomíneos implicados em sua transmissão. Trata-se de uma doença que acompanha o homem desde tempos remotos e que tem apresentado, nos últimos 20 anos, um aumento do número de casos e ampliação de sua ocorrência geográfica, sendo encontrada atualmente em todos os Estados brasileiros, sob diferentes perfis epidemiológicos. Estima-se que, entre 1985 e 2003, ocorreram 523.975 casos autóctones, a sua maior parte nas regiões Nordeste e Norte do Brasil. Neste estudo, são discutidos aspectos relacionados ao tratamento e ao controle dessa doença, assim como também as dificuldades para a implementação dessas medidas. São apontadas alternativas que passam pela estruturação dos serviços de saúde, com respeito ao diagnóstico, no desenvolvimento de drogas de aplicação tópica ou por via oral, no desenvolvimento de vacinas, no controle diferenciado de vetores e no aprofundamento de estudos relacionados à biologia celular do parasita.

American Cutaneous Leishmaniasis (ACL) is an infectious disease transmitted by the bite of phlebotomines mosquitos (Order Diptera: Family Psychodidae: Sub-Family Phlebotominae) and caused by protozoa from the genus Leishmania (ROSS 1903). In Brazil, there are six different species of Leishmania and more than 200 different species of phlebotomines. It's a disease that has been afflicting human beings for many centuries, and in Brazil, in the past two decades, there has been an important increase in the number of cases and also in its geographical distribution. Presently, ACL cases are registered in all Brazilian states under three different epidemiological profiles (sylvatic, sylvatic-modified and periurban). Between 1985 and 2003, 523,975 cases were registered, mainly in the northeast and north of the country, although the north has the highest incidence rate. In this study, aspects related to difficulties in treatment and transmission control, and new strategies to approach the disease are discussed. Alternatives such as the development of new drugs (topical and oral routes), the implementation of diagnostic methods in public health services, differentiated transmission control based on the 3 different epidemiological profiles and basic research on the molecular biology of the parasite are pointed out.