Aracatuba

[Clarisa B. Palatnik]

Dear colleagues,
This is a copy of a message sent on 22.6.99. The message was 
originally sent in Portuguese as I wanted it to have an impact at the 
national and local level.



Dear colleagues
I am also very worried about the canine kala-azar burst in 
Araçatuba, that seems to be an emergent zoonotic disease in a 
region previously thought as non- endemic. However, some events 
related to this burst seem to me very intriguing.
A professor of the Veterinary Medical School, UNESP, Aracatuba, 
got in touch with us, last year, when we reported our results about 
vaccination against canine kala-azar in Sao Goncalo do Amaranto, 
Rio Grande do Norte, in the International Congress on Vaccination. 
(Salvador, Bahia, 1998). She wanted to initiate a project in 
collaboration with us in order to perform the serodiagnosis of 
canine 
kala-azar. She was very enthusisistic and we prepared a project for 
diagnosisi and vaccination that was recently sumitted to the 
analysis of several finnacial agencies.
The investment that has been made in canine control in Aracatuba 
recently is much more impressive than the one we see in 
Norhteast of the country (RN). I have never seen the scrifice of 
such a high number of dogs (739/10000). This number represents 
7.4% of seropsitivity in Immunofluorescency (IF). This is a very 
hygh value considering that in Natal for instance serprevalence 
reach 2%, and it is indeed the Northeast of the country  that shows 
90% of the total cases of human kala-azar of the country (3700 in 
1995). We know from literature that the canine endemy precede 
the human endemy. In the case of Aracatuba is difficult to 
understand how with a 7.4% prevalence of canine seropositivity no 
human cases were reported until know, eventhough when it is 
known that IF subestimates the real number of kala-azar cases 
due to its low sensitivity. Several groups are working on the 
development of more predicitive and sensitive tests, since it is 
known that even subclinical assymptomatic dogs constitute 
Leishmania reservoires in endemic areas. Therefore it is obvious 
that one cannot solve an epidemic problem of canine kala-azar only 
with IF assay that will mainly recognize only the symptomatic 
dogs. Furthermore, a weel organized campaign is needed in order 
to educate the population to cooperate with the canine control and 
to allow the remotion of infected dogs for sacrifice.A specific and 
didactic material was already prepared by National Foundation of 
Health (FNS).
Suddenly, the first kala-azar human case happens, in an 
adolescent, and it is lethal!
What kind of Leishmania promoted this? There is no human 
epidemy and the first case is lethal?!?
I believe that Public Health situation in Sao Paulo state is better 
than that in Northeast of the country. I would ask why so much 
money was invested in scientific research of these problems and 
all the available knowledge is not used. For instance: it would be 
useful to receive advise of the infectologist from RN in order make 
easer the diagnosis and treatment of kala-azar in Aracatuba. 
Looking to a patient with fever, hepatosplenomegaly and pan 
cytopeny they would always suspect first of kala-azar, make an 
investigation and only after getting negative results by several 
daignostic methods they would look for leukemia.
I think that much more human cases of kala-azar will appear soon 
in Aracatuba. 
I think that the decision know is more politic than scientific but I 
hope we are not going to see, once more a case of disassociation 
between the results of scientific investigation and their application 
in Public Health of the country.

Clarisa B. Palatnik de Sousa
Inst. Microbiologia UFRJ