Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru
Abstract Background American cutaneous leishmaniasis (CL) is a neglected tropical disease typically associated with men working in remote, sylvatic environments. We sought to identify CL risk factors in a highly deforested region where anecdotal reports suggested an atypical proportion of women and...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | Tropical Medicine and Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41182-021-00332-0 |
| _version_ | 1818597425660559360 |
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| author | Justin T. Lana Andrés Mallipudi Ernesto J. Ortiz Jairo H. Arevalo Alejandro Llanos-Cuentas William K. Pan |
| author_facet | Justin T. Lana Andrés Mallipudi Ernesto J. Ortiz Jairo H. Arevalo Alejandro Llanos-Cuentas William K. Pan |
| author_sort | Justin T. Lana |
| collection | DOAJ |
| description | Abstract Background American cutaneous leishmaniasis (CL) is a neglected tropical disease typically associated with men working in remote, sylvatic environments. We sought to identify CL risk factors in a highly deforested region where anecdotal reports suggested an atypical proportion of women and children were infected with CL raising concern among authorities that transmission was shifting towards domestic spaces and population centers. Methods We describe the characteristics of CL patients from four participating clinics after digitizing up to 10 years of patient data from each clinic’s CL registries. We assessed risk factors of CL associated with intradomestic, peridomestic, or non-domestic transmission through a matched case-control study with 63 patients who had visited these same clinics for CL (cases) or other medical reasons (controls) between January 2014 and August 2016. The study consisted of an in-home interview of participants by a trained field worker using a standard questionnaire. Risk factors were identified using bivariable and multivariable conditional logistic regression. Results Between 2007 and 2016, a total of 529 confirmed CL positives were recorded in the available CL registries. Children and working aged women made up 58.6% of the cases. Our final model suggests that the odds of sleeping in or very near an agricultural field were five times greater in cases than controls (p = 0.025). Survey data indicate that women, children, and men have similar propensities to both visit and sleep in or near agricultural fields. Conclusions Women and children may be underappreciated as CL risk groups in agriculturally dependent regions. Despite the age-sex breakdown of clinical CL patients and high rates of deforestation occurring in the study area, transmission is mostly occurring outside of the largest population centers. Curbing transmission in non-domestic spaces may be limited to decreasing exposure to sandflies during the evening, nighttime, and early morning hours. Our paper serves as a cautionary tale for those relying solely on the demographic information obtained from clinic-based data to understand basic epidemiological trends of vector-borne infections. |
| first_indexed | 2024-12-16T11:47:36Z |
| format | Article |
| id | doaj.art-0cdffd5d3627436094599c31fe5fd441 |
| institution | Directory Open Access Journal |
| issn | 1349-4147 |
| language | English |
| last_indexed | 2024-12-16T11:47:36Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Tropical Medicine and Health |
| spelling | doaj.art-0cdffd5d3627436094599c31fe5fd4412022-12-21T22:32:47ZengBMCTropical Medicine and Health1349-41472021-05-0149111010.1186/s41182-021-00332-0Risk factors for cutaneous leishmaniasis in a high-altitude forest region of PeruJustin T. Lana0Andrés Mallipudi1Ernesto J. Ortiz2Jairo H. Arevalo3Alejandro Llanos-Cuentas4William K. Pan5Nicholas School of the Environment, Duke UniversityThe Johns Hopkins University School of MedicineDuke Global Health Institute, Duke UniversityFacultad de Medicina San Fernando, Universidad Nacional de San Martin TarapotoInstituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano HerediaNicholas School of the Environment, Duke UniversityAbstract Background American cutaneous leishmaniasis (CL) is a neglected tropical disease typically associated with men working in remote, sylvatic environments. We sought to identify CL risk factors in a highly deforested region where anecdotal reports suggested an atypical proportion of women and children were infected with CL raising concern among authorities that transmission was shifting towards domestic spaces and population centers. Methods We describe the characteristics of CL patients from four participating clinics after digitizing up to 10 years of patient data from each clinic’s CL registries. We assessed risk factors of CL associated with intradomestic, peridomestic, or non-domestic transmission through a matched case-control study with 63 patients who had visited these same clinics for CL (cases) or other medical reasons (controls) between January 2014 and August 2016. The study consisted of an in-home interview of participants by a trained field worker using a standard questionnaire. Risk factors were identified using bivariable and multivariable conditional logistic regression. Results Between 2007 and 2016, a total of 529 confirmed CL positives were recorded in the available CL registries. Children and working aged women made up 58.6% of the cases. Our final model suggests that the odds of sleeping in or very near an agricultural field were five times greater in cases than controls (p = 0.025). Survey data indicate that women, children, and men have similar propensities to both visit and sleep in or near agricultural fields. Conclusions Women and children may be underappreciated as CL risk groups in agriculturally dependent regions. Despite the age-sex breakdown of clinical CL patients and high rates of deforestation occurring in the study area, transmission is mostly occurring outside of the largest population centers. Curbing transmission in non-domestic spaces may be limited to decreasing exposure to sandflies during the evening, nighttime, and early morning hours. Our paper serves as a cautionary tale for those relying solely on the demographic information obtained from clinic-based data to understand basic epidemiological trends of vector-borne infections.https://doi.org/10.1186/s41182-021-00332-0American tegumentary leishmaniasisAgricultureCoffeeCase controlDeforestationUrbanization |
| spellingShingle | Justin T. Lana Andrés Mallipudi Ernesto J. Ortiz Jairo H. Arevalo Alejandro Llanos-Cuentas William K. Pan Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru Tropical Medicine and Health American tegumentary leishmaniasis Agriculture Coffee Case control Deforestation Urbanization |
| title | Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru |
| title_full | Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru |
| title_fullStr | Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru |
| title_full_unstemmed | Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru |
| title_short | Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru |
| title_sort | risk factors for cutaneous leishmaniasis in a high altitude forest region of peru |
| topic | American tegumentary leishmaniasis Agriculture Coffee Case control Deforestation Urbanization |
| url | https://doi.org/10.1186/s41182-021-00332-0 |
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