{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:23:34Z","timestamp":1791861814612,"version":"4.3.4"},"reference-count":37,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>This study was carried out to identify the spatial distribution and characterize the clinical\u2013epidemiological profile of Visceral Leishmaniasis (VL) in Maranh\u00e3o state, Brazil, from 2009 to 2020. This descriptive ecological study collected sociodemographic and clinical data of VL cases from the Brazilian Notifiable Diseases Information System database. A spatial autocorrelation analysis (Moran statistics) was performed. From 2009 to 2020, 5699 cases of VL were reported, with incidence of 6.5 cases\/100,000 and prevalence of 7.1 cases\/100,000. The temporal analysis showed a significant growth in incidence from 2009 to 2018, followed by a significant decrease between 2019 and 2020. The Moran map shows hotspots of high values in the central\u2013west and central\u2013east regions, and hotspots of low values in the northern region of Maranh\u00e3o. The profile of patients affected by VL comprises males (OR = 1.8; IC95% = 1.72\u20131.92), aged under 14 years, brown, and with incomplete elementary schooling. The main symptoms reported were fever, fatigue, and edema. The main diagnostic method was laboratory. The mortality rate was 6.8%, and co-infection with HIV was reported by 8.5% of patients. The results of this study indicated the increase in incidence and lethality, as well as the expansion, of leishmaniasis in the state of Maranh\u00e3o.<\/jats:p>","DOI":"10.3390\/tropicalmed9040076","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T08:27:52Z","timestamp":1712305672000},"page":"76","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Spatio-Temporal Analysis and Clinical-Epidemiological Characterization of Visceral Leishmaniasis in Maranh\u00e3o, Brazil, from 2009 to 2020"],"prefix":"10.3390","volume":"9","author":[{"given":"Carolina Azevedo","family":"Amaral","sequence":"first","affiliation":[{"name":"Postgraduate Program in Microbial Biology, Programa de P\u00f3s-Gradua\u00e7\u00e3o em Biologia Microbiana, Universidade CEUMA, S\u00e3o Lu\u00eds 65075-120, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taciana Mirely Maciel","family":"Higino","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o Altino Ventura, Recife 50070-040, PE, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Fernanda Castro","family":"Silva","sequence":"additional","affiliation":[{"name":"Curso de Gradua\u00e7\u00e3o em Biomedicina, Universidade CEUMA, S\u00e3o Lu\u00eds 65075-120, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalia Rodrigues dos","family":"Reis","sequence":"additional","affiliation":[{"name":"Curso de Gradua\u00e7\u00e3o em Biomedicina, Universidade CEUMA, S\u00e3o Lu\u00eds 65075-120, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Gomes","family":"Pereira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Microbial Biology, Programa de P\u00f3s-Gradua\u00e7\u00e3o em Biologia Microbiana, Universidade CEUMA, S\u00e3o Lu\u00eds 65075-120, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2116-1797","authenticated-orcid":false,"given":"Rita de C\u00e1ssia Mendon\u00e7a de","family":"Miranda","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Meio Ambiente, Universidade CEUMA, S\u00e3o Lu\u00eds 65075-120, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1412-9895","authenticated-orcid":false,"given":"Amanda Silva dos Santos","family":"Alian\u00e7a","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Microbial Biology, Programa de P\u00f3s-Gradua\u00e7\u00e3o em Biologia Microbiana, Universidade CEUMA, S\u00e3o Lu\u00eds 65075-120, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"ref_1","unstructured":"Secretaria de Vigil\u00e2ncia em Sa\u00fade, Minist\u00e9rio da Sa\u00fade, Brasil (2016). Coordena\u00e7\u00e3o-Geral de Desenvolvimento da Epidemiologia em Servi\u00e7os, Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Coordena\u00e7\u00e3o Geral de Desenvolvimento da Epidemiologia e Servi\u00e7os."},{"key":"ref_2","unstructured":"WHO\u2014World Health Organization (2023, January 21). Endemicity Status of Visceral Leishmaniasis Worldwide. Available online: https:\/\/www.who.int\/health-topics\/leishmaniasis#tab=tab_3."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105520","DOI":"10.1016\/j.actatropica.2020.105520","article-title":"Spatial analysis and epidemiological profile of visceral leishmaniasis, northeastern Brazil: A cross-sectional study","volume":"208","author":"Machado","year":"2020","journal-title":"Acta Trop."},{"key":"ref_4","unstructured":"Secretaria de Vigil\u00e2ncia em Sa\u00fade, Minist\u00e9rio da Sa\u00fade, Brasil (2014). Departamento de Vigil\u00e2ncia Epidemiol\u00f3gica, Manual de Vigil\u00e2ncia e Controle da Leishmaniose Visceral."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3935","DOI":"10.1590\/1413-812320152012.01672015","article-title":"An\u00e1lise espa\u00e7o-temporal da leishmaniose visceral no estado do Maranh\u00e3o, Brasil","volume":"20","author":"Furtado","year":"2015","journal-title":"Ci\u00eanc Sa\u00fade Coletiva"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1590\/S0037-86822002000300005","article-title":"Expans\u00e3o espacial da leishmaniose visceral americana em S\u00e3o Luis, Maranh\u00e3o, Brasil","volume":"35","author":"Mendes","year":"2002","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_7","first-page":"51","article-title":"Perfil epidemiol\u00f3gico dos casos de leishmaniose visceral em Sobral-CE de 2011 a 2015","volume":"17","author":"Nascimento","year":"2018","journal-title":"SANARE"},{"key":"ref_8","unstructured":"Secretaria de Vigil\u00e2ncia em Sa\u00fade, Minist\u00e9rio da Sa\u00fade, Brasil (2019). Coordena\u00e7\u00e3o-Geral de Desenvolvimento da Epidemiologia em Servi\u00e7os, Guia de Vigil\u00e2ncia em Sa\u00fade: Volume \u00danico."},{"key":"ref_9","unstructured":"IBGE (2023, February 02). Cidades e estados do Brasil: Maranh\u00e3o. Rio de Janeiro, Available online: https:\/\/www.ibge.gov.br\/cidades-e-estados\/ma."},{"key":"ref_10","unstructured":"Secretaria de Vigil\u00e2ncia em Sa\u00fade, Minist\u00e9rio da Sa\u00fade, Brasil (2017). Coordena\u00e7\u00e3o-Geral de Desenvolvimento da Epidemiologia em Servi\u00e7os, Guia de Vigil\u00e2ncia em Sa\u00fade: Volume 3."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2018376","DOI":"10.5123\/S1679-49742020000200020","article-title":"A distribui\u00e7\u00e3o espacial e a tend\u00eancia temporal de recursos humanos para o Sistema \u00danico de Sa\u00fade e para a Sa\u00fade Suplementar, Brasil, 2005 a 2016","volume":"29","author":"Campoy","year":"2020","journal-title":"Epidemiol Serv Sa\u00fade"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2147\/CLEP.S44267","article-title":"Epidemiology of visceral leishmaniasis","volume":"6","author":"Ready","year":"2014","journal-title":"Clin. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Guerra-Silveira, F., and Abad-Franch, F. (2013). Sex bias in infectious disease epidemiology: Patterns and processes. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0062390"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e250","DOI":"10.1111\/ijd.13048","article-title":"A male preponderance in patients with Indian post kala-azar dermal leishmaniasis is associated with increased circulating levels of testosterone","volume":"55","author":"Mukhopadhyay","year":"2016","journal-title":"Int. J. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Nackers, F., Mueller, Y.K., Salih, N., Elhag, M.S., Elbadawi, M.E., Hammam, O., Mumina, A., Atia, A.A., Etard, J.-F., and Ritmeijer, K. (2015). Determinants of Visceral Leishmaniasis: A Case-Control Study in Gedaref State, Sudan. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0004187"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1590\/S1415-790X2009000400005","article-title":"Caracter\u00edsticas cl\u00ednicas e epidemiol\u00f3gicas da leishmaniose visceral em crian\u00e7as internadas em um hospital universit\u00e1rio de refer\u00eancia no norte de Minas Gerais, Brasil","volume":"12","author":"Costa","year":"2009","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"17","DOI":"10.17058\/reci.v3i1.3148","article-title":"Epidemiologia da Leishmaniose Visceral no estado do Rio Grande do Norte, Brasil","volume":"3","author":"Barbosa","year":"2013","journal-title":"Revista de Epidemiologia e Controle de Infec\u00e7\u00e3o"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"44","DOI":"10.18066\/revunivap.v20i35.180","article-title":"Leishmaniose: Perfil epidemiol\u00f3gico dos casos notificados no estado do Piau\u00ed entre 2007 e 2011","volume":"20","author":"Batista","year":"2014","journal-title":"Rev. Univap"},{"key":"ref_19","first-page":"13","article-title":"Perfil epidemiol\u00f3gico dos casos de leishmaniose visceral em Sobral, Cear\u00e1 no per\u00edodo de 2001 a 2010","volume":"12","author":"Silva","year":"2013","journal-title":"SANARE"},{"key":"ref_20","first-page":"135","article-title":"Leishmaniose visceral humana: Reflex\u00f5es \u00e9ticas e jur\u00eddicas acerca do controle do reservat\u00f3rio canino no Brasil","volume":"39","author":"Pereira","year":"2017","journal-title":"Rev. Bio\u00e9tica Derecho"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"97","DOI":"10.5123\/S1679-49742015000100011","article-title":"Epidemiologia da leishmaniose visceral em Bauru, S\u00e3o Paulo, no per\u00edodo de 2004 a 2012: Um estudo descritivo","volume":"24","author":"Ortiz","year":"2015","journal-title":"Epidemiol. Servi\u00e7os Sa\u00fade"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1590\/1809-4503201400040010","article-title":"Epidemiological aspects of visceral leishmaniasis (kala-azar) in Cear\u00e1 in the period 2007 to 2011","volume":"17","author":"Cavalcante","year":"2014","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e0004546","DOI":"10.1371\/journal.pntd.0004546","article-title":"Socioeconomic Inequalities in Neglected Tropical Diseases: A Systematic Review","volume":"10","author":"Houweling","year":"2016","journal-title":"PLoS Negl. Trop. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e167922197","DOI":"10.33448\/rsd-v9i2.2197","article-title":"Evolution of visceral leishmaniasis in S\u00e3o Lu\u00eds, Maranh\u00e3o: An epidemiological and temporal analysis of cases","volume":"9","author":"Oliveira","year":"2020","journal-title":"RSD"},{"key":"ref_25","unstructured":"PNDU (Programa das Na\u00e7\u00f5es Unidas para o Desenvolvimento) (2023, March 15). Desenvolvimento Humano e IDH\u2014O que \u00e9 o IDH. Available online: https:\/\/www.undp.org\/pt\/brazil\/o-que-e-o-idh."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1590\/S0037-86822004000400004","article-title":"Leishmaniose visceral entre \u00edndios no Estado de Roraima, Brasil: Aspectos cl\u00ednicoepidemiol\u00f3gicos de casos observados no per\u00edodo de 1989 a 1993","volume":"37","author":"Guerra","year":"2004","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_27","first-page":"13","article-title":"Ocorr\u00eancia de leishmaniose visceral americana na regi\u00e3o de S\u00e3o Jos\u00e9 do Rio Preto, Estado de S\u00e3o Paulo, Brasil","volume":"8","author":"Scandar","year":"2011","journal-title":"Bepa"},{"key":"ref_28","first-page":"1","article-title":"Leishmaniose visceral no estado do Par\u00e1","volume":"2","author":"Silva","year":"2013","journal-title":"Rev. Para Med."},{"key":"ref_29","unstructured":"DNDI (2023, April 08). Drugs for Neglected Diseases Initiate. DNDi Am\u00e9rica Latina. Available online: https:\/\/dndi.org\/diseases\/cutaneous-leishmaniasis\/."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1590\/s0100-736x2017001000013","article-title":"Epidemiologia da leishmaniose visceral no munic\u00edpio de Fortaleza, Cear\u00e1","volume":"37","author":"Rodrigues","year":"2017","journal-title":"Pesq. Vet. Bras."},{"key":"ref_31","first-page":"108","article-title":"Diagn\u00f3stico de la leishmaniasis: De la observaci\u00f3n microsc\u00f3pica del par\u00e1sito a la detecci\u00f3n Del ADN","volume":"63","author":"Montalvo","year":"2012","journal-title":"Rev. Cuba. Med. Trop."},{"key":"ref_32","first-page":"120","article-title":"Leishmaniose visceral: Aspectos cl\u00ednicos e laboratoriais","volume":"78","author":"Pastorino","year":"2002","journal-title":"J. Pediatr. (Rio J.)"},{"key":"ref_33","unstructured":"Minist\u00e9rio da Sa\u00fade (2023, April 08). Nota Informativa n\u00ba 24\/2019\u2014CGDT\/DEVIT\/SVS\/MS. Bras\u00edlia, Available online: https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/publicacoes\/svsa\/leishmaniose\/5-nota-informativa-n-24-2019-cgdt-devit-svs-ms."},{"key":"ref_34","unstructured":"Minist\u00e9rio da Sa\u00fade (2023, April 30). Nota Informativa n\u00ba 3\/2018\/-CGLAB\/DEVIT\/SVS\/MS. Bras\u00edlia, Available online: https:\/\/www.gov.br\/saude\/pt-br\/assuntos\/saude-de-a-a-z\/l\/leishmaniose-visceral."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Martins-Melo, F.R., Lima Mda, S., Ramos ANJr Alencar, C.H., and Heukelbach, J. (2014). Mortality and case fatality due to visceral leishmaniasis in Brazil: A nationwide analysis of epidemiology, trends and spatial patterns. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0093770"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Cota, G.F., de Sousa, M.R., and Rabello, A. (2011). Predictors of Visceral Leishmaniasis Relapse in HIV-Infected Patients: A Systematic Review. PLoS Negl. Trop. Dis., 5.","DOI":"10.1371\/journal.pntd.0001153"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"436","DOI":"10.4269\/ajtmh.1998.58.436","article-title":"Clinicoepidemiologic characteristics, prognostic factors, and survival analysis of patients coinfected with human immunodeficiency virus and Leishmania in an area of Madrid, Spain","volume":"58","author":"Bellas","year":"1998","journal-title":"Am. J. Trop. Med. Hyg."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/9\/4\/76\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:23:53Z","timestamp":1760106233000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/9\/4\/76"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,5]]},"references-count":37,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["tropicalmed9040076"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed9040076","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,5]]}}}