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ABSTRACT This study aimed to assess the factors associated with mucosal leishmaniasis (ML) within the scope of tegumentary leishmaniasis (TL) cases reported in Brazil. Surveillance data were assessed, and comparisons were made between ML and cutaneous leishmaniasis (CL) cases. Additionally, ML incidence rates for municipalities were depicted through a geographic information system. From 2007 to 2017, 235,489 TL cases were reported, of which 235,232 were classified as follows: 14,204 (6%) were ML cases and 221,028 (94%) were CL cases. Multivariate analysis showed that the proportion of ML cases reached 16.8% among individuals >75 years (adjusted OR = 2.77; 95% CI = 2.41-3.19; p < 0.001), and ML was also more frequent among males (aOR = 1.28; 95% CI = 1.20-1.38; p < 0.001), HIV-positive patients (aOR = 2.15; 95% CI = 1.80-2.56; p < 0.001), patients residing in urban areas (aOR = 1.52; 95% CI = 1.43-1.62; p < 0.001), and imported cases (with respect to county) when compared to autochthonous cases (aOR = 1.84; 95% CI = 1.71-1.98; p < 0.001). A lower proportion of positive results in direct parasitological examinations was observed in ML cases (32.6% vs. 60.8%; p < 0.001). The leishmanin skin test results were more often positive in ML cases (41.7% vs. 25.9%; p < 0.001). In ML, compatible changes in histopathology were more frequent (14.6% vs. 3.9%; p < 0.001). A greater proportion of ML cases were treated with amphotericin B (6.9% vs. 0.9%; p < 0.001). The case-fatality rate was higher in ML (0.6% vs. 0.1%; p < 0.001). A higher incidence of ML was observed in a geographical band extending across the Amazon region from the southern Para State to the Acre State. ML exhibited varying frequencies within specific populations. The definition of predictable factors predisposing Leishmania-infected subjects to develop ML is important for defining strategies to mitigate the mucosal damage caused by leishmaniasis. (ML (TL Brazil assessed (CL Additionally system 200 2017 235489 235 489 235,48 235232 232 235,23 follows 14204 14 204 14,20 6% 6 (6% 221028 221 028 221,02 94% 94 (94% 168 16 8 16.8 75 >7 adjusted 2.77 277 2 77 95 2.413.19 241319 2.41 3.19 41 3 19 2.41-3.19 0.001, 0001 0.001 , 0 001 0.001) aOR 1.28 128 1 28 1.201.38 120138 1.20 1.38 20 38 1.20-1.38 HIVpositive HIV 2.15 215 15 1.802.56 180256 1.80 2.56 80 56 1.80-2.56 1.52 152 52 1.431.62 143162 1.43 1.62 43 62 1.43-1.62 county 1.84 184 84 1.711.98 171198 1.71 1.98 71 98 1.71-1.98 0.001. . 32.6% 326 32 (32.6 vs 60.8% 608 60 41.7% 417 7 (41.7 25.9% 259 25 9 14.6% 146 (14.6 3.9% 39 6.9% 69 (6.9 0.9% 09 casefatality case fatality 0.6% 06 (0.6 0.1% 01 populations Leishmaniainfected Leishmania infected 201 23548 23 48 235,4 23523 235,2 1420 14,2 (6 22102 22 02 221,0 (94 16. > 2.7 27 413 2.413.1 24131 241 2.4 319 3.1 4 2.41-3.1 000 0.00 00 1.2 12 1.201.3 12013 120 138 1.3 1.20-1.3 2.1 21 802 1.802.5 18025 180 1.8 256 2.5 5 1.80-2.5 1.5 431 1.431.6 14316 143 1.4 162 1.6 1.43-1.6 18 711 1.711.9 17119 171 1.7 198 1.9 1.71-1.9 32.6 (32. 60.8 41.7 (41. 25.9 14.6 (14. 3.9 6.9 (6. 0.9 0.6 (0. 0.1 2354 235, 2352 142 14, ( 2210 221, (9 2. 2.413. 2413 24 31 3. 2.41-3. 0.0 1. 1.201. 1201 13 1.20-1. 1.802. 1802 1.80-2. 1.431. 1431 1.43-1. 1.711. 1711 17 1.71-1. 32. (32 60. 41. (41 25. 14. (14 6. 0. (0 2.413 2.41-3 1.201 1.20-1 1.802 1.80-2 1.431 1.43-1 1.711 1.71-1 (3 (4 (1 2.41- 1.20- 1.80- 1.43- 1.71-