Residência e deslocamentos por imigrações, atividades laborais ou lazer na leishmaniose cutânea em Centro de Referência da Fundação Oswaldo Cruz no Rio de Janeiro, 2000-2015

Cutaneous leishmaniasis (CL) from the point of view of occupational medicine or traveller's health has drawn increasing attention, being one of the risk conditions for people who work or move to endemic areas. Information related to displacement due to immigration, work and leisure activities in CL in Brazil is scarce. The objective was to study the cases of CL according to the residence or displacements due to immigration, work or leisure. Retrospective study with a cohort of 711 patients with CL attended between 2000 and 2015 at Laboratorio de Pesquisa Clinica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro. The 696 patients domiciled in the state of Rio de Janeiro (RJ) were studied for transmission due to residence or displacement due to immigration, work or leisure. The 171 patients with a history of displacement were included in a spatial analysis using geoprocessing tools. Leishmania species could be identified in 66.8% of 465 patients with parasitic visualization or isolation. There was a marked predominance of males in residents of RJ (63%). The mean age was 35.9 years (SD 19.2). The most likely infection site was the residence in endemic area (82.6%), with diversity of professions. Regarding transmission by displacements related to work activities (7.5%), military personnel represented the most important group. Lower percentages were due to immigration (3.6%) or leisure (6.3%) displacements. The predominant species was Leishmania (Viannia) braziliensis, being responsible for almost all of the characterized isolates when the reason for transmission was residence in endemic areas The greatest variety of species and variants was found when transmission occurred due to displacement for labor activities. The endemic in the autochthonous cases of the state of RJ predominated in urban areas; there was a higher occurrence in the cities around the forested area of the mountain region. In the municipality of Rio de Janeiro, autochthonous cases occurred mainly in the neighborhoods surrounding the Pedra Branca and GericinoMendanha massifs, forested areas in the interior of the urban region. Regarding the isolates of 171 patients with a history of displacement, these were identified as L. (V.) braziliensis in 104 cases (80.8%) in addition to L. (V.) naiffi (7.7%), L. (V. ) guyanensis (6.7%), L. (Leishmania) amazonensis (1%), and genetic variants of L. (V.) braziliensis (3.8%). The flow maps showed that the probable site of infection included four countries, 19 Brazilian states and 18 cities in the state of RJ. The probable sites of infection in Brazilian states other than RJ were in Amazonas (32), Bahia (18) and Ceara (15 patients). The knowledge of the migratory flow and the geographic location of these Leishmania species brought from other areas can contribute to the surveillance of CL in the state of RJ, since there is a possibility that these species can be introduced in areas with susceptible sand flies and establish themselves in the territory, with repercussions on clinical presentations, treatment and disease control. Our results demonstrate the geographical and epidemiological complexity of cutaneous leishmaniasis in RJ.