The Giant Anteater in the Room: Brazil’s Neglected Tropical Diseases Problem

The phrase “the 800-pound gorilla in the room” refers to an obvious problem that everyone knows exists but pretends or chooses to ignore. In my December 2007 PLoS Neglected Tropical Diseases editorial I wrote about an unseemly underbelly of poverty that exists in my country, the United States of America, and the unacceptable disease burden among our poor that results from such neglected diseases as toxocariasis, cysticercosis, and toxoplasmosis. According to the Pan American Health Organization (PAHO) (the regional office of the World Health Organization in the Americas) the Latin American and Caribbean region suffers from much larger pockets of poverty, and with it endemic neglected tropical diseases (NTDs). While researching a review of the NTDs in Latin America, I was particularly struck by the disproportionate concentration of these conditions among the poor living in Brazil. Although there are no gorillas in the rooms of Brazil I have concluded that the NTDs represent an ominous giant anteater (Myrmecophaga tridactyla, the largest species of anteater found in Brazil and elsewhere in the American tropics) that requires notice, attention, and urgent action.

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