Epidemiological, Clinical, and Socioenvironmental Characteristics of Cutaneous Leishmaniasis Cases in the Xakriabá Indigenous Population, Brazil

Acta Parasitologica (2026) 71:122 https://doi.org/10.1007/s11686-026-01312-2 ORIGINAL ARTICLE Epidemiological, Clinical, and Socioenvironmental Characteristics of Cutaneous Leishmaniasis Cases in the Xakriabá Indigenous Population, Brazil Dilceu Silveira Tolentino Júnior1 · Arlete Lisboa Gonçalves2 · Artur Costa Cruz3 · Hilana Danielle Honorato Veloso3 · Fabrício Xavier de Oliveira3 · Maelso Bispo de Sousa3 · Roberto Carlos de Oliveira4 · Eliseu Miranda de Assis5 Received: 10 April 2026 / Accepted: 13 May 2026 © The Author(s) 2026 Abstract Background Cutaneous leishmaniasis (CL) remains a neglected tropical disease that disproportionately affects indigenous populations, where transmission is shaped by complex socioenvironmental conditions. Our objective is to describe and analyze the sociodemographic, environmental, clinical, and therapeutic characteristics of CL cases in the Xakriabá indigenous population, and to explore associations between these characteristics and clinical outcomes. Methods An observational analytical study based on a case series was conducted using secondary data from the Brazilian Notifiable Diseases Information System (SINAN), covering the period from 2013 to 2024. Analyses were restricted to internal associations among reported cases, without inference of population-level risk. Sociodemographic, environmental, clinical, and therapeutic variables were analyzed using descriptive statistics and logistic regression models. Results A total of 259 CL cases were identified. Most cases occurred in males (63%) and individuals aged 20–39 years (38%), with nearly all cases residing in rural areas (99%). Associations were observed between clinical outcomes and variables such as occupational exposure (OR = 2.45; 95% CI 1.38–4.33) and proximity to vegetation (OR = 2.71; 95% CI 1.49–4.92). These findings represent associations within the case population and should not be interpreted as causal effects or population risk estimates. A high proportion of missing laboratory data was identified. Spatial distribution was described without inferential analysis. Conclusion CL in the Xakriabá population is characterized by heterogeneous distribution and associations with socioenvironmental factors within reported cases. Given the study design, results should be interpreted cautiously, without causal inference. Strengthening diagnostic capacity, improving data quality, and implementing territorially adapted public health strategies are essential to improve disease management in indigenous contexts. Keywords Cutaneous leishmaniasis · Indigenous health · Epidemiology · Case series · Brazil · Social determinants of health Dilceu Silveira Tolentino Júnior 1 Postgraduate Program in Collective Health, René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil 2 Regional Health Superintendency of Montes Claros, State Health Secretariat of Minas Gerais, Montes Claros, Minas Gerais, Brazil 3 São João das Missões Type 2 Base Pole, Secretariat for Indigenous Health, São João das Missões, Minas Gerais, Brazil 4 Department of Health Sciences, University of Brasília, Distrito Federal, Brasília, Brazil 5 Academic Department, Federal Institute of Bahia, Eunápolis, Bahia, Brazil 122 Page 2 of 8 Introduction Cutaneous leishmaniasis (CL) remains one of the most globally relevant neglected tropical diseases, with estimates ranging from 600,000 to 1 million new cases annually, disproportionately affecting populations in situations of socioeconomic vulnerability [1]. In Brazil, the disease has a wide geographic distribution and complex transmission dynamics, strongly influenced by environmental transformations, territorial occupation patterns, and persistent social inequalities [2, 3]. In recent decades, the epidemiological profile of CL has changed, with the transition from a predominantly sylvatic cycle to peridomestic and domestic patterns. This process has been associated with changes in land use, deforestation, and the expansion of human settlements in previously forested areas, intensifying the interface between humans, vectors, and reservoirs [4]. As a consequence, exposure to the vector has increased, especially in socially vulnerable populations . Indigenous populations constitute a group particularly exposed to CL, not only due to their proximity to natural environments, but also due to structural conditions that influence access to health services. In these contexts, the dynamics of the disease involve complex interactions between environmental factors, sociocultural practices, and territorial organization, and are not adequately explained by linear biomedical models [5, 6]. Furthermore, structural limitations, such as restricted diagnostic capacity, geographical barriers, and weaknesses in health care, can influence the time to diagnosis, clinical management, and continuity of care [7, 8]. Despite this recognized vulnerability, the literature on cutaneous leishmaniasis in indigenous populations still presents important limitations. Most available studies adopt predominantly descriptive approaches, with limited incorporation of analytical strategies that allow exploring associations between sociodemographic, environmental, and clinical characteristics. In addition, there is often a lack of clear definition of outcomes and standardization in the operationalization of variables, which restricts the comparability between studies and the robustness of interpretations [9, 10]. In the Xakriabá Indigenous Territory, located in northern Minas Gerais, cutaneous leishmaniasis constitutes a significant public health problem, in a scenario marked by intense human–environment interaction, the presence of phlebotomine vectors, and socio-environmental conditions that favor the maintenance of transmission [9]. Previous studies in the region point to the influence of ecological and cultural factors on the dynamics of the disease; however, analyses that 13 Acta Parasitologica (2026) 71:122 systematically integrate epidemiological, clinical, and contextual dimensions in this territory are still scarce . Given this context, it becomes necessary to deepen the understanding of cutaneous leishmaniasis in indigenous populations from approaches that consider the complexity of the interactions between socio-environmental determinants, clinical characteristics, and structural health conditions. This perspective can contribute to the development of surveillance and control strategies that are more sensitive to the territorial and sociocultural context. Thus, this study aimed to describe and analyze the sociodemographic, environmental, clinical, and therapeutic characteristics of cutaneous leishmaniasis cases in the Xakriabá indigenous population, as well as to explore associations between these characteristics and the observed clinical outcomes. By adopting this approach, the goal is to broaden the understanding of the epidemiological profile of the disease in (...truncated)