Human Visceral Leishmaniasis in Brazil in the Past 20 Years: An Epidemiologic Update.

Background: Human visceral leishmaniasis (HVL) is a neglected tropical disease that remains highly lethal if left untreated and continues to affect public health. In Brazil, Leishmania infantum is the main etiological agent, and domestic dogs are considered the primary reservoir. Considering the historic importance of leishmaniasis in Brazil, we aimed to gather information on the epidemiology of HVL in Brazil over 20 years.

Methods: We conducted an integrative review through a bibliographic survey of articles published between 2002 and 2022.

Results: The process resulted in the inclusion of 75 studies. Most of these studies reported data from the northeastern region, which continues to present the highest incidence rates nationwide. Most cases were concentrated in men and children under 10 years of age, particularly in urban and peri-urban areas. Although national case numbers have recently declined in Brazil, the persistence of endemic areas, driven by poverty, inadequate sanitation, deforestation, and unplanned urban growth, underscores the ongoing public health relevance of HVL.

Conclusions: The ongoing spread of HVL and variation in its occurrence across regions underscore the unequal impact of the disease. HVL is not only a parasitic infection but also a manifestation of broader structural inequalities.