%0 Journal Article
%T Challenges in the Therapy of Visceral Leishmaniasis in Brazil: A Public Health Perspective
%A Edson Carvalho de Melo
%A Carlos Magno Castelo Branco Fortaleza
%J Journal of Tropical Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/319234
%X Over 3,000 yearly cases of Visceral Leishmaniasis (VL) are reported in Brazil. Brazilian Public Health System provides universal free access to antileishmania therapeutic options: Meglumine Antimoniate, Amphotericin B deoxycholate, and Liposomal Amphotericin B. Even though Amphotericin formulations have been advised for severe disease, this recommendation is mostly based on the opinion of experts and on analogy with studies conducted in other countries. Presently, there are two ongoing multicenter clinical trials comparing the efficacy and safety of the available therapeutic options. Some other issues require further clarification, such as severity markers and the approach to VL/AIDS coinfection. Brazil is facing the challenge of providing access to diagnosis and adequate treatment, in order to avoid VL-related deaths. 1. Introduction In the second decade of the 21st century, visceral leishmaniasis (VL) continues to challenge public health authorities around the world. The World Health Organization (WHO) estimates yearly incidence of 500,000 cases, with a case-fatality ratio of approximately 10% [1, 2]. This picture is especially worrisome for the six countries that harbor 90% of VL cases: India, Bangladesh, Sudan, South Sudan, Ethiopia, and Brazil [1, 3]. Leishmania infantum chagasi is the agent of VL in Latin America. At least twelve Countries in the continent reported VL cases in the past decade. Brazil is by far the most affected country, with more than 3,000 reported cases per year and case-fatality ratio of 5.8% in the period from 2005 through 2009 [4]. Brazilian picture is worsened by the progressive territorial expansion and urbanization of LV. Up to the early 1980s, the disease was mainly restricted to rural areas in Northeastern Brazil [5]. In the turn of that decade, urban foci of VL were reported in major cities in that region. A southward expansion was also noticed, and the proportion of cases reported outside northeast region increased from 15% in 1998 to 44% in 2005 [6]. The changing epidemiology of visceral leishmaniasis posed new challenges for health protection of the residents of the affected areas. In the first place, there is the difficulty of prevention. Measures directed to the canine reservoirs (dog culling, vaccination) or to the vector (environmental intervention, insect repellents) are often impractical in large urban centers. Besides, they were not proved to be definitely effective [7, 8]. Another challenge concerns the management (including therapy) of VL cases. This is a relevant issue, since case-fatality ratio is
%U http://www.hindawi.com/journals/jtm/2013/319234/