ABSTRACT Background: This cross-sectional study compared the general impact of cutaneous leishmaniasis (CL) and patient satisfaction with treatment and health services as perceived by those undergoing different therapeutic regimens in an endemic region in South-Eastern Brazil. We also investigated the factors associated with both outcomes (general impact and satisfaction). Methods: We included 84 patients with CL treated between 2018 and 2019 with intravenous meglumine antimoniate, liposomal amphotericin B, or intralesional meglumine antimoniate therapy. Data were collected through interviews that assessed sociodemographic characteristics, comorbidity status, access and use of health services for CL diagnosis and treatment, and the items of the Cutaneous Leishmaniasis Impact Questionnaire (CLIQ). The CLIQ is a psychometric questionnaire previously validated to assess the general impact of CL on patient satisfaction with treatment and health services. Multivariate logistic regression analysis was used to identify the factors associated with high CL impact and low patient satisfaction. Results: The general impact of CL and patient satisfaction with treatment and health services were not significantly associated with the therapeutic regimen. High CL impact was associated with low family income (odds ratio [OR]:3.3; 95% confidence interval [CI]:1.0-10.3), occurrence of complications/adverse effects during treatment (OR:7.7; 95%CI:2.4-25.6), and additional costs during diagnosis and/or treatment (OR:12.1; 95% CI:2.8-52.4). Low satisfaction was associated with high disease impact (OR: 9.5; 95% CI:2.7-33.9), occurrence of complications/adverse effects (OR:4.2; 95% CI:1.3-13.0), and high family income (OR:7.1; 95%CI:1.7-28.2). Conclusions: Our data support public health policies aimed at reducing the impact of CL and its treatment as well as the use of therapy with fewer adverse effects. Background crosssectional cross sectional (CL SouthEastern South Eastern Brazil . satisfaction) Methods 8 201 B characteristics status CLIQ. (CLIQ) Results regimen odds OR3.3 OR33 OR 3.3 3 [OR]:3.3 95 CI1.010.3, CI10103 CI 1.0 10.3 , 1 0 10 [CI]:1.0-10.3) complicationsadverse complications OR7.7 OR77 7.7 7 (OR:7.7 95%CI2.425.6, 95CI24256 95%CI 2.4 25.6 2 4 25 6 95%CI:2.4-25.6) andor OR12.1 OR121 12.1 12 (OR:12.1 CI2.852.4. CI28524 2.8 52.4 52 CI:2.8-52.4) (OR 9.5 9 5 CI2.733.9, CI27339 2.7 33.9 33 CI:2.7-33.9) OR4.2 OR42 4.2 (OR:4.2 CI1.313.0, CI13130 1.3 13.0 13 CI:1.3-13.0) OR7.1 OR71 7.1 (OR:7.1 95%CI1.728.2. 95CI17282 1.7 28.2 28 95%CI:1.7-28.2) Conclusions 20 (CLIQ OR3 OR3. 3. [OR]:3. CI1 010 CI1.010.3 CI1010 1. 103 10. [CI]:1.0-10.3 OR7 OR7. 77 7. (OR:7. CI2 425 95%CI2.425.6 95CI2425 95CI 24 2. 256 25. 95%CI:2.4-25.6 OR12 OR12. 121 12. (OR:12. 852 CI2.852.4 CI2852 524 52. CI:2.8-52.4 9. 733 CI2.733.9 CI2733 27 339 33. CI:2.7-33.9 OR4 OR4. 42 4. (OR:4. 313 CI1.313.0 CI1313 130 13. CI:1.3-13.0 71 728 95%CI1.728.2 95CI1728 17 282 28. 95%CI:1.7-28.2 [OR]:3 01 CI1.010. CI101 [CI]:1.0-10. (OR:7 95%CI2.425. 95CI242 95%CI:2.4-25. OR1 (OR:12 85 CI2.852. CI285 CI:2.8-52. 73 CI2.733. CI273 CI:2.7-33. (OR:4 31 CI1.313. CI131 CI:1.3-13. 72 95%CI1.728. 95CI172 95%CI:1.7-28. [OR]: CI1.010 CI10 [CI]:1.0-10 95%CI2.425 95CI24 95%CI:2.4-25 (OR:1 CI2.852 CI28 CI:2.8-52 CI2.733 CI27 CI:2.7-33 CI1.313 CI13 CI:1.3-13 95%CI1.728 95CI17 95%CI:1.7-28 [OR] CI1.01 [CI]:1.0-1 95%CI2.42 95CI2 95%CI:2.4-2 CI2.85 CI:2.8-5 CI2.73 CI:2.7-3 CI1.31 CI:1.3-1 95%CI1.72 95CI1 95%CI:1.7-2 [OR CI1.0 [CI]:1.0- 95%CI2.4 95%CI:2.4- CI2.8 CI:2.8- CI2.7 CI:2.7- CI1.3 CI:1.3- 95%CI1.7 95%CI:1.7- CI1. [CI]:1.0 95%CI2. 95%CI:2.4 CI2. CI:2.8 CI:2.7 CI:1.3 95%CI1. 95%CI:1.7 [CI]:1. 95%CI2 95%CI:2. CI:2. CI:1. 95%CI1 95%CI:1. [CI]:1 95%CI:2 CI:2 CI:1 95%CI:1 [CI]: 95%CI: CI: [CI] [CI

Abstract INTRODUCTION: Panstrongylus megistus is the main triatomine involved in the human transmission of Trypanosoma cruzi in Minas Gerais, Brazil. We analyzed the occurrence of triatomines in the Itaúna micro-regions for healthcare. METHODS: Data were collected as part of routine entomological surveillance activities, including the species identity, capture site, developmental stage, and trypanosome infection. RESULTS: In total, 503 specimens from five species were captured (495 P. megistus). Adults were mainly captured by residents inside their homes, whereas nymphs were mostly captured by public health professionals outside. CONCLUSIONS: The epidemiologically important triatomine, P. megistus, continues to persist in our study region.

BACKGROUND Timely diagnosis is recommended by the Brazilian Visceral Leishmaniasis (VL) Surveillance and Control Program to reduce case fatality. Attempts at assessing this topic in Brazil are scarce. OBJECTIVE This study aimed to describe where, when, and how the diagnosis of VL has been performed in a Brazilian endemic setting. METHODS Data of all autochthonous cases confirmed between 2011 and 2016 (N = 81) were recorded. The care-seeking itinerary until the confirmation of VL diagnosis was assessed among 57 patients. FINDINGS The majority of VL cases (79.1%) were reported by referral hospitals. The patients mainly sought primary health care centres at the onset of symptoms. However, they had to visit seven health services on average to achieve a confirmed diagnosis. The time from the onset of symptoms to the diagnosis of VL (TD) ranged from 1-212 (median, 25) days. The TD was longer among adult patients. There was a direct correlation between the patient’s age and TD (r = 0.22; p = 0.047) and a higher occurrence of deaths due to the disease among older patients (p = 0.002). Almost all the patients (98.9%) underwent laboratory investigation, and the VL diagnosis was mainly confirmed based on clinical-laboratory criteria (92.6%). Positive results for the indirect fluorescence antibody test (22.7%) and parasitological examination plus rk39-based immunochromatographic tests (21.3%) were commonly employed. MAIN CONCLUSIONS VL diagnosis was predominantly conducted in hospitals with a long TD and wide application of serology. These findings may support measures focused on early diagnosis, including a greater involvement of the primary health care system.

ABSTRACT The Brazilian municipality of Rondonópolis, Mato Grosso State, represents an important visceral leishmaniasis (VL) endemic area. This study described epidemiological and clinical aspects of the occurrence, VL/HIV coinfection and lethality related to VL in Rondonópolis. Data from autochthonous cases reported between 2011 and 2016 were obtained from official information systems. During this period, 81 autochthonous cases were reported, with decreasing incidence through 2016. Contrastingly, the lethality rate was 8.6% overall, but varied widely, reaching a peak (20%) in 2016. Almost 10% of patients had VL/HIVcoinfection. The occurrence of VL prevailed among men (56.8%), brown-skinned (49.4%), urban residents (92.6%), aged 0-4 years (33.3%). Housewives or retired (29.6%) were the most affected occupational groups. Lower age was the main difference among the total VL cases and those who were coinfected or died. Clinically, fever, weakness and splenomegaly were more frequent among all VL cases and VL/HIV coinfected individuals. Bacterial infections (p=0.001) and bleeding (p<0.001) were associated with death due to VL. Pentavalent antimonial and liposomal amphotericin B were the first choices for treatment among all VL cases (71.6%) and those who died (71.4%), respectively. VL/HIV patients were equally treated with both drugs. These findings may support control measures and demonstrate the need for further investigations.

RESUMO Objetivo: O presente estudo teve como objetivo avaliar a presença de helmintos e protozoários intestinais em hortaliças comercializados em Diamantina, um município localizado no Vale do Jequitinhonha, uma das regiões mais pobres do mundo. Métodos: Cento e oito exemplares, incluindo alface, cebolinha e rúcula, foram mensalmente coletados em uma feira livre, uma quitanda e um supermercado do município. As amostras foram processadas por um método de concentração e avaliadas por microscopia óptica para pesquisa de estruturas parasitárias. Resultados: O percentual global de contaminação foi de 50,9% (55/108), com predominância de larvas de nematódeos (36,5%), cistos de Entamoeba coli e ovos de ancilostomídeos/Strongyloides spp. (12,9%). A alface demonstrou a maior taxa de contaminação (61,1%) e as amostras da feira livre foram as mais contaminadas (77,8%). Informações coletadas em cada ponto de venda apontaram o cultivo em campo como a etapa crítica para a contaminação. Conclusão: Hortaliças comercializadas em Diamantina apresentam uma ampla variedade de parasitas intestinais, o que representa um risco potencial à saúde dos consumidores da área.

ABSTRACT Objective: The present study aimed to evaluate the presence of helminthes and intestinal protozoa in vegetables commercialized in Diamantina, a municipality located at Jequitinhonha Valley, one of the poorest regions of the world. Methods: A total of 108 specimens, including lettuce, green onion and rocket, were monthly collected from the most popular open street market, green grocery and supermarket of the municipality. The samples were processed by a concentration method and evaluated by light microscopy for parasitological identification. Results: The percentage of contamination was 50.9% (55/108), with predominance of nematode larvae (36.5%), cysts of Entamoeba coli (26.0%) and eggs of hookworms/Strongyloides spp. (12.9%). Lettuce showed greater contamination rate (61.1%) and samples from the open street market were more contaminated (77.8%). Information collected at each point of sale pointed the field cultivation as the critical step for such contaminations. Conclusion: Vegetables marketed in Diamantina presents a wide variety of intestinal parasites, which may represent a potential risk to the health of consumers of fresh vegetables.

This study aimed to analyse the spatial distribution of human (2007-2013) and canine (2013) visceral leishmaniasis (VL) in the city of Araçuaí, Minas Gerais, Brazil, and identify the socio-environmental factors related to their occurrence. The spatial distribution of human and canine cases was analysed by kernel density estimation (KDE) and the K function. The KDE values were analysed for correlation between human and canine LV and for normalised difference vegetation index (NDVI). Socio-environmental aspects of household structures and surroundings were evaluated. The spatial distribution of human and canine VL cases exhibited a significant aggregated pattern in distances greater than 350 and 75 m, respectively. The higher occurrence of human and canine infection occurred in the central area of the city. A positive correlation between the densities of human and canine cases was observed, as well as a negative correlation between NDVI and densities of human and canine cases. Socio-environmental analysis revealed that the large amount of animals, organic material from trees and deficiencies in environmental sanitation are possibly contributing to the continuation of the transmission cycle of Leishmania infantum in Araçuaí. These results can contribute to the planning by competent agencies to reduce the incidence of infection in the city.

Abstract: INTRODUCTION: Triatomines are targeted for the control of Chagas disease in endemic areas of Brazil. METHODS: Data regarding triatomines captured during 2001-2008 in 34 municipalities in the Northeast of Minas Gerais were analyzed. RESULTS: In total, 11,187 triatomines from eight species were captured, mostly in henhouses and bedrooms. Trypanosomes were found in 203 samples. Main species were Triatoma sordida, Panstrongylus megistus, and Triatoma vitticeps. The number of P. megistus adults was positively correlated with temperature and precipitation, whereas the number of nymphs followed the inverse pattern. CONCLUSIONS: Occurrence of triatomines in domiciles indicates the need for sustained entomological surveillance.

Resumo A participação comunitária é a principal estratégia para a manutenção da vigilância entomológica da doença de Chagas. O objetivo deste estudo foi avaliar conhecimentos sobre triatomíneos e a doença de Chagas entre moradores de oito localidades de Diamantina, Minas Gerais, atentando a uma eventual relação entre os conhecimentos e a infestação vetorial. Para avaliação dos conhecimentos foi aplicado questionário com questões fechadas e abertas a 583 moradores com idade igual ou superior a dez anos e, para avaliar a capacidade de reconhecimento de triatomíneos, foi apresentado mostruário com insetos. As respostas às questões fechadas foram analisadas quanto à frequência e associação com a infestação triatomínica. As respostas às questões abertas foram organizadas em eixos temáticos e analisadas descritivamente. Embora a capacidade de reconhecer os triatomíneos não tenha sido associada à infestação das localidades, os residentes em áreas com maior infestação demonstraram conhecer melhor os serviços de referência e a necessidade de encaminhar os insetos a estes. Não foi observada associação entre a infestação triatomínica e os conhecimentos sobre a doença de Chagas. Os resultados ora apresentados podem orientar ações de educação em saúde voltadas para a participação da comunidade na notificação de triatomíneos.

Abstract Community participation is the main strategy to sustainability of Chagas disease entomological surveillance. The purpose of this study was to evaluate the level of knowledge on triatomine insects and Chagas disease among the residents from eight localities of Diamantina, in Minas Gerais, with a view to observing any associations between their knowledge and infestations by triatomines. In order to evaluate this knowledge, questionnaires were used containing both closed and open questions. They were applied to 583 residents who were ten years old or over. To establish if they could recognize the triatomine insect, they were given samples to look at. The responses to the closed questions were analyzed with reference to any frequencies of and associations with infestations involving this insect. The responses to the questions were organized into different thematic areas and were descriptively analyzed. Although the resident’s ability to recognize the triatomine insect was not associated with the infestation of the localities, the residents in the areas that had higher infestations showed that they had a good knowledge of the available support services and the need to send the insects to them. We did not observe any associations between triatomine infestations and knowledge of Chagas disease. The results of this study can provide guidance on education that can be given by the health services to the community in order to encourage them to provide notifications of the triatomine insects.

Resumo A participação comunitária é a principal estratégia para a manutenção da vigilância entomológica da doença de Chagas. O objetivo deste estudo foi avaliar conhecimentos sobre triatomíneos e a doença de Chagas entre moradores de oito localidades de Diamantina, Minas Gerais, atentando a uma eventual relação entre os conhecimentos e a infestação vetorial. Para avaliação dos conhecimentos foi aplicado questionário com questões fechadas e abertas a 583 moradores com idade igual ou superior a dez anos e, para avaliar a capacidade de reconhecimento de triatomíneos, foi apresentado mostruário com insetos. As respostas às questões fechadas foram analisadas quanto à frequência e associação com a infestação triatomínica. As respostas às questões abertas foram organizadas em eixos temáticos e analisadas descritivamente. Embora a capacidade de reconhecer os triatomíneos não tenha sido associada à infestação das localidades, os residentes em áreas com maior infestação demonstraram conhecer melhor os serviços de referência e a necessidade de encaminhar os insetos a estes. Não foi observada associação entre a infestação triatomínica e os conhecimentos sobre a doença de Chagas. Os resultados ora apresentados podem orientar ações de educação em saúde voltadas para a participação da comunidade na notificação de triatomíneos.

Abstract Community participation is the main strategy to sustainability of Chagas disease entomological surveillance. The purpose of this study was to evaluate the level of knowledge on triatomine insects and Chagas disease among the residents from eight localities of Diamantina, in Minas Gerais, with a view to observing any associations between their knowledge and infestations by triatomines. In order to evaluate this knowledge, questionnaires were used containing both closed and open questions. They were applied to 583 residents who were ten years old or over. To establish if they could recognize the triatomine insect, they were given samples to look at. The responses to the closed questions were analyzed with reference to any frequencies of and associations with infestations involving this insect. The responses to the questions were organized into different thematic areas and were descriptively analyzed. Although the resident’s ability to recognize the triatomine insect was not associated with the infestation of the localities, the residents in the areas that had higher infestations showed that they had a good knowledge of the available support services and the need to send the insects to them. We did not observe any associations between triatomine infestations and knowledge of Chagas disease. The results of this study can provide guidance on education that can be given by the health services to the community in order to encourage them to provide notifications of the triatomine insects.

Reports of triatomine infestation in urban areas have increased. We analysed the spatial distribution of infestation by triatomines in the urban area of Diamantina, in the state of Minas Gerais, Brazil. Triatomines were obtained by community-based entomological surveillance. Spatial patterns of infestation were analysed by Ripley’s K function and Kernel density estimator. Normalised difference vegetation index (NDVI) and land cover derived from satellite imagery were compared between infested and uninfested areas. A total of 140 adults of four species were captured (100 Triatoma vitticeps, 25Panstrongylus geniculatus, 8 Panstrongylus megistus, and 7 Triatoma arthurneivai specimens). In total, 87.9% were captured within domiciles. Infection by trypanosomes was observed in 19.6% of 107 examined insects. The spatial distributions ofT. vitticeps, P. geniculatus, T. arthurneivai, and trypanosome-positive triatomines were clustered, occurring mainly in peripheral areas. NDVI values were statistically higher in areas infested by T. vitticeps and P. geniculatus. Buildings infested by these species were located closer to open fields, whereas infestations of P. megistus andT. arthurneivai were closer to bare soil. Human occupation and modification of natural areas may be involved in triatomine invasion, exposing the population to these vectors.

INTRODUÇÃO: As capturas de triatomíneos em meio silvestre são laboriosas e demoradas. Algumas armadilhas podem auxiliar nessa tarefa. Relata-se novo modelo de armadilha e captura de exemplar de espécie de triatomíneo raramente encontrada. MÉTODOS: Duas armadilhas luminosas foram instaladas em Diamantina, Estado de Minas Gerais e acompanhadas, semanalmente, durante um ano. RESULTADOS: Uma fêmea de Triatoma arthurneivai foi capturada além de outros triatomíneos. CONCLUSÕES: Um novo modelo de armadilha poderá ser empregado na captura de triatomíneos principalmente em áreas de baixa densidade. Presume-se que o centro de endemismo de Triatoma arthurneivai seja a Cordilheira do Espinhaço.

INTRODUCTION: Triatomine bug captures in the wild are laborious and time-consuming. Some traps may assist in this task. We report a new trap design and the capture of a specimen of a triatomine rarely found. METHODS: Two luminous traps were installed in the city of Diamantina, State of Minas Gerais, and surveyed weekly for a year. RESULTS: A Triatoma arthurneivai female and other triatomine bugs were caught. CONCLUSIONS: A new trap design may be used in triatomine bugs field captures, mainly in low density areas. We assume the center of endemism of Triatoma arthurneivai is the Espinhaço Mountain range.