Abstract
This chapter addresses the leishmaniases in Brazil. The first cases of cutaneous and mucocutaneous leishmaniasis were described in 1909 in São Paulo. Latin American researchers gained international prominence because of their work on this disease they considered autochthonous, which came to be known as American Tegumentary Leishmaniasis. Visceral Leishmaniasis only emerged as a public health problem in Brazil in 1934 thanks to a new diagnostic technique for yellow fever. Zoonoses earned greater attention in the laboratory founded in 1965 at the Evandro Chagas Institute by Ralph Lainson and Jeffrey Shaw. I examine their connections with other research groups and the resulting changes in the perception of the New World Leishmaniases when they showed that parasite, vector, and host populations were much more heterogeneous than previously imagined. Technical innovations provided a better understanding of the distinct epidemiological characteristics of the illnesses caused by different Leishmania amid a backdrop of far-reaching transnational networks.
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Notes
- 1.
Work by Antonio Carini and Ulysses Paranhos (the director and a research assistant at the Pasteur Institute of São Paulo) and Adolpho Carlos Lindemberg (who headed the dermatology department at Santa Casa de Misericórdia and conducted research at the Instituto Bacteriológico de São Paulo) is analyzed in the study by Benchimol and Jogas Jr. (2020, pp. 46–47). The case of visceral leishmaniasis observed in Paraguay and two others subsequently diagnosed in Argentina were seen as isolated events in stark contrast with hundreds of cases of tegumentary leishmaniasis described by Latin American doctors, suggesting that the dermatological disease could also attack the viscera.
- 2.
The Commission included three researchers from the Oswaldo Cruz Institute: Aristides Marques da Cunha, Gustavo de Oliveira Castro, Leoberto de Castro Ferreira, and the Argentine Cecílio Romaña. Evandro Chagas had financial support from the Oswaldo Cruz Institute, the Rockefeller Foundation, and a Brazilian businessman, Guilherme Guinle. Evandro Chagas’s relationship with these sponsors of his activities is analyzed in Barreto (2012).
- 3.
In Belém, Pará, other professionals were soon incorporated into his team: the English nurse Agnes Stewart Waddel (who would become his second wife), Leônidas Gladstone Deane (from Pará), Felipe Nery-Guimarães, and Maria von Paumgartten (who would later marry Leônidas Deane).
- 4.
The original name (Leishmania brasilienses) was altered to L. braziliensis by Vianna himself in a 1914 article, but the name Leishmania brasiliensis (with the s) is still found in many scientific articles up through the 1960s.
- 5.
“Tratamento da leishmaniose pelo tártaro emético” [Treatment by emetic tartar] was a communication presented in a session of the Brazilian Society of Dermatology during the seventh Brazilian Congress on Medicine and Surgery, in Belo Horizonte, the capital of Minas Gerais, in April 1912 (Vianna, 1912). In India, after 1922, emetic tartar was replaced by urea stibamine, a pentavalent antimony developed by Upendranath Brahmachari. Other antimonial compounds such as Fuadin were produced by pharmaceutical companies like Bayer. On this topic, see Brahmachari (1940), Marsden (1985), and Barbeitas (2022).
- 6.
- 7.
A total of 14 cases were diagnosed by viscerotomy in Pará between 1932 and 1940; Evandro Chagas and his team identified eight living cases.
- 8.
The blood of an infected dog was consumed by females of P. longipalpis, and Leishmania identical to those in the protozoan cultures were found in two of these insects (Ferreira et al., 1938). Phlebotomus intermedius was also infected using animals with leishmaniasis. And it was with this fly that Agnes Chagas and Wladimir Lobato Paraense obtained their first positive results for transmission of visceral leishmaniasis to a hamster via Phlebotomus (Paraense & Chagas, 1940; Chagas, 1939). The production and circulation of knowledge about the possible vectors of leishmaniosis is the subject of a chapter by Benchimol and Jogas Jr. (2020, pp. 145–189). An important reference on phlebotomine flies in Brazil is the book edited by Rangel and Shaw (2018).
- 9.
- 10.
- 11.
Aragão published a note on this in 1922 (pp. 129–130) and a more comprehensive work in 1927 (pp. 177–186). Another species described by Lutz and Neiva (1912), Phlebotomus longipalpis (today known as Lutzomyia longipalpis), was later associated with the transmission of visceral leishmaniasis by Evandro Chagas and his team.
- 12.
- 13.
Adler cited Cunha, Chagas, “Estudos sobre o parasito” [Studies on the parasite], part 3 (pp. 329–337) of the report by Chagas et al. (1937) on work done during 1936.
- 14.
In this and other citations of texts from non-English languages, a free translation has been provided.
- 15.
- 16.
Research was important to calibrate the use of DDT against Phlebotomus longipalpis: Deane, Deane, Alencar (1955). At least until 1960, the use of this residual insecticide in Ceará continued to be experimental in nature, since it was applied in one group of 14 municipalities but not in another in order to evaluate the relative efficacity of other prophylactic measures (Alencar, 1961).
- 17.
- 18.
The list of consultants also included P.C. Sen Gupta of the Calcutta School of Tropical Medicine in India, but the book does not contain his opinion. A summary of the opinions produced by the rapporteur Willard H. Wright can be found in NAS (1962b, pp. 59–60) and in NAS (1962a, pp. 376-377). The opinion of Leônidas M. Deane is found in 1962a (p. 505), of Marshall Hertig in 1962a (pp. 505–508), and Philip Edmund Clinton Manson-Bahr (1962a, p. 508).
- 19.
Garnham (21 Jun. 1960, p. 13). The classifications minor and major were proposed in 1915 by a mission organized to study the tropical diseases of men and animals in Turkmenistan, which at that time was a province of tsarist Russia. The expedition found that the lesions called by different local names and seen by doctors in the region as different diseases represented a single illness (Yakimoff & Schockov, 1915). In the 1940s, three Soviet researchers (Latyshev, Kryukova, and Mirzoian) justified the existence of two “races” of Leishmania tropica from clinical and epidemiological differences in illnesses they produced and immunobiological differences. Kryukova showed that the two parasites could be differentiated by inoculation into gerbils and white mice: these animals were resistant to L. tropica minor (the dry type), but the agent of the wet type (L. tropica major) produced infections. References to this research can be found in the invaluable work by Heyneman, Hoostraal, and Djigounian (1980).
- 20.
The International Cooperation Administration (ICA) was the US agency responsible for external assistance and nonmilitary security programs from June 30, 1955, to September 4, 1961. It was the predecessor of the US Agency for International Development (USAID).
- 21.
Garnham considered mechanical transmission by ticks and stable flies possible, as well as contagion via the respiratory or digestive tract and (more rarely) congenital or venereal infection.
- 22.
In Turkmenistan, a country in Central Asia, outbreaks of human infections of L. tropica were found to be associated with infected wild gerbils and ground squirrels. Phlebotomus caucasicus and P. papatasii living in burrows of the rodents maintained the infection among them. Phlebotomus papatasii seemed to be the vector of the parasite from the rodent to man, as observed by Latyshev, Kryukova, and Povalishina (1951), in an article reviewed by the British parasitologist Cecil Arthur Hoare (1954) and by Shekhanov and Suvorova (1960).
- 23.
Inconclusive results were obtained by Pedroso (1913, 1923) and Leônidas and Maria Deane (1955b) in Brazil, by Mazza (1926, 1927) and Romaña and collaborators (1949) in Argentina; and by Felix Pifano (1940) in Venezuela. Negative results were more frequent in the literature. A good analysis of this literature can be found in Forattini (1960) and Pessôa (1961). The role of dogs in visceral leishmaniasis was analyzed in two substantial theses: Joaquim Eduardo Alencar (1959) [in Portuguese: Canine kalazar: a contribution to the study of its epidemiology in Brazil] and Zigman Brener (1957) [in Portuguese: Canine kalazar in Minas Gerais].
- 24.
- 25.
The findings about wild hosts in Panama are analyzed in Lainson and Shaw (1973).
- 26.
Biagi (1953) was the Head of the Department of Microbiology and Parasitology at the UNAM medical school. He was the first Mexican doctor to work in the World Health Organization (WHO). He was the author of Enfermedades parasitarias, a classic work of Mexican parasitology.
- 27.
The epidemiology of this form of leishmaniasis was studied by Biagi and by Garnham and Lewis (1959).
- 28.
- 29.
In an article published in 1963, the insect was classified as Phlebotomus paraensis Costa Lima, but was later reclassified as Lutzomyia pessoana. Subsequent studies carried out in Belize and the Yucatan Peninsula indicated that the vector for L. mexicana was Lutzomyia olmeca.
- 30.
Among many publications, see Lainson (2010, pp. 13–32).
- 31.
The work done by these researchers and their institutions is analyzed by Benchimol and Peixoto (2022).
- 32.
In Pará, for instance, the situation of visceral leishmaniasis has not changed in the decades following the studies done by Evandro Chagas and his team, “however, in the early 1980s the disease resurfaced with greater frequency in rural foci and in the suburban and urban areas of medium-size cities such as Santarém … Over the past two decades the process of expansion increased due to deforestation, socioeconomic factors, and unorganized occupation in the outskirts of cities, where the presence of Lutzomyia longipalpis in peri-domiciliar human area and domesticated dogs highly susceptible to infection have facilitated its spread. Today, AVL [American visceral leishmaniasis] has already arrived in the Metropolitan Region of Belém (Cotijuba island), capital of Pará.” (Silveira et al., 2016, p. 15).
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This research received funding from the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) through the Cientista do Nosso Estado program.
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Benchimol, J.L. (2024). Leishmaniases in Brazil: A Historical Approach. In: Capocci, M., Cozzoli, D. (eds) Empire, Nation-building, and the Age of Tropical Medicine, 1885–1960. Medicine and Biomedical Sciences in Modern History. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-38805-7_5
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