Leishmania infantum chagasi in Northeastern Brazil: Asymptomatic Infection at the Urban Perimeter

Iraci D. Lima Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Jose W. Queiroz Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Henio G. Lacerda Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Paula V. S. Queiroz Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Nubia N. Pontes Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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James D. A. Barbosa Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Daniella R. Martins Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Jason L. Weirather Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Richard D. Pearson Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Mary E. Wilson Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Selma M. B. Jeronimo Health Post-Graduate Program, Department of Infectious Diseases, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Biochemistry and Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte Natal, RN, Brazil; Fundação Nacional de Saúde, Natal, RN, Brazil; Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia; Interdisciplinary Graduate Program in Genetics, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa, Iowa City, Iowa; Veteran's Affairs Medical Center, Iowa City, Iowa; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT/CNPQ/MCT), Brazil

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Visceral leishmaniasis (VL) is endemic in large cities in Brazil, including Natal. We determined the prevalence of asymptomatic human infection with Leishmania infantum chagasi and associated environmental risks around Natal. Infection was detected by Leishmania skin test (LST) and anti-leishmanial antibodies in humans and anti-leishmanial antibodies in dogs. Amongst 345 humans, 24.6% were seropositive, and 38.6% were LST-positive. Prevalence of positive serology was similar in both sexes and across all ages. However, positive LST responses increased with age, suggesting that LST is long-lasting and cumulative. Multinomial logistic analysis showed that LST response varied with location (P = 0.007) and that males were more frequently LST-positive (P = 0.027). Indicators of lower socioeconomic status associated significantly with human infection. Furthermore, there was geographic coincidence of seropositive humans and dogs (r = 0.7926, P = 0.011). These data suggest that dog and human L. i. chagasi infection are intimately interrelated in environmental conditions associated with low income.

Author Notes

*Address correspondence to Selma M. B. Jeronimo, Department of Biochemistry and Health Post-Graduate Program, Federal do Rio Grande do Norte, Av. Sen. Salgado Filho, SN Natal, RN, 59078-970, Brazil, CP 1624. E-mail: smbj@cb.ufrn.br

Financial support: This work was supported in part by funds from National Institutes of Health Grant NIHP50 AI-030639 and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Studies were also supported by grants from the Department of Veterans' Affairs (to J.L.W. and M.E.W.) and National Institutes of Health Grants R01 AI045540 (to M.E.W.), R01 AI067874 (to M.E.W.), and R01 AI076233 (to M.E.W.).

Authors' addresses: Iraci D. Lima, Health Post-Graduate Program, Universidade Federal do Rio Grande do Norte and Fundação Nacional de Saúde, Natal, RN, Brazil, E-mail: iraci.duarte@ig.com.br. Jose W. Queiroz, Paula V. S. Queiroz, Nubia N. Pontes, and James D. A. Barbosa, Health Post-Graduate Program, Federal do Rio Grande do Norte, Natal, RN, Brazil, E-mails: jwq@supercabo.com.br, paulavivianne@hotmail.com, nnatalir@yahoo.com.br, and jamesdary@oi.com.br. Henio G. Lacerda, Health Post-Graduate Program and Department of Infectious Diseases, Federal do Rio Grande do Norte, Natal, RN, Brazil, E-mail: heniolacerda@ufrnet.br. Daniella R. Martins, Department of Biology and Genetics, Biosciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil, E-mail: daniellamartins@cb.ufrn.br. Jason L. Weirather, Interdisciplinary Graduate Program in Genetics, University of Iowa, Iowa City, IA, E-mail: jason-weirather@uiowa.edu. Richard D. Pearson, Division of Infectious Diseases and International Health, Departments of Medicine and Pathology, Center for Global Health, University of Virginia School of Medicine, Charlottesville, VA, E-mail: rdp9g@virginia.edu. Mary E. Wilson, Departments of Internal Medicine, Microbiology, and Epidemiology, University of Iowa and the Veteran's Affairs Medical Center, Iowa City, IA, E-mail: mary-wilson@uiowa.edu. Selma M. B. Jeronimo, Department of Biochemistry and Health Post-Graduate Program, Federal do Rio Grande do Norte, Natal, RN, Brazil, E-mail: smbj@cb.ufrn.br.

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