| Abstract: | Brazil, a country of continental proportions, presents three profiles of malariatransmission. The first and most important numerically, occurs inside the Amazon. TheAmazon accounts for approximately 60% of the nation’s territory and approximately 13%of the Brazilian population. This region hosts 99.5% of the nation’s malaria cases,which are predominantly caused by Plasmodium vivax (i.e., 82% ofcases in 2013). The second involves imported malaria, which corresponds to malariacases acquired outside the region where the individuals live or the diagnosis wasmade. These cases are imported from endemic regions of Brazil (i.e., the Amazon) orfrom other countries in South and Central America, Africa and Asia. Imported malariacomprised 89% of the cases found outside the area of active transmission in Brazil in2013. These cases highlight an important question with respect to both therapeuticand epidemiological issues because patients, especially those with falciparummalaria, arriving in a region where the health professionals may not have experiencewith the clinical manifestations of malaria and its diagnosis could suffer dramaticconsequences associated with a potential delay in treatment. Additionally, becausethe Anopheles vectors exist in most of the country, even a singlecase of malaria, if not diagnosed and treated immediately, may result in introducedcases, causing outbreaks and even introducing or reintroducing the disease to anon-endemic, receptive region. Cases introduced outside the Amazon usually occur inareas in which malaria was formerly endemic and are transmitted by competent vectorsbelonging to the subgenus Nyssorhynchus (i.e., Anophelesdarlingi, Anopheles aquasalis and species of the Albitarsis complex). Thethird type of transmission accounts for only 0.05% of all cases and is caused byautochthonous malaria in the Atlantic Forest, located primarily along thesoutheastern Atlantic Coast. They are caused by parasites that seem to be (or to bevery close to) P. vivax and, in a less extent, by Plasmodiummalariae and it is transmitted by the bromeliad mosquitoAnopheles (Kerteszia) cruzii. This paper deals mainly with the twoprofiles of malaria found outside the Amazon: the imported and ensuing introducedcases and the autochthonous cases. We also provide an update regarding the situationin Brazil and the Brazilian endemic Amazon. |
