Aracatuba

[Heitor Franco de Andrade Junior]

Dear friends,
In fact, the prevalence of canine leishmaniasis was high in Araçatuba, but
the IIF gtest used for diagnosis cannot elliminate the incidence of
cutaneous leishmaniasis in the same area. One interesting finding of this
epidemy was the introduction of an infected dog, from an endemic area, in
the city of Araçatuba, that was traced to occur in the mid of 1998. As
Brazilian patients presented a lower index of disease/infection(1 to 18
infected patients) with a chronic disease of more than 6 months of
incubation period, it was not surprising that the human infection will occur
only after a few months of the canine disease, as the dog is much more
suscetible to infection. Now is the time of the diagnosis and detection of
human cases. Unfortunately, a few weeks ago, a girl died of visceral
leishmaniasis, misdiagnosed as lymphoproliferative disease, in Araçatuba.
As the sandfly breeds on faeces and other organic matter, the mosquito
campaign against dengue had few effect on its population, as directed to
water-breeding mosquitos. Due to this fact, reservoir elimination is the
main approach now to reduce human disease in this area, with good educative
campaigns to the sand-fly control.
I am sorry for the dogs, but there are no effective treatment for canine
visceral leishmaniasis, only leishmania-static drugs at high cost.
Vaccination would be the next step and must be carefully controlled, because
it could induce resistance to disease but not to infection, as seen in
several experimental models.
Heitor Franco de Andrade Jr., M.D., Ph.D.
Laboratório de Protozoologia
Instituto de Medicina Tropical de São Paulo
Av.Dr.E.C.Aguiar, 470
05403-000 - São Paulo - SP
BRAZIL
-----Mensagem original-----
De: Clarisa B. Palatnik <immgcpa at microbio.ufrj.br>
Para: Multiple recipients of list <leish-l at bdt.org.br>
Data: Tuesday, July 06, 1999 2:10 PM
Assunto: Aracatuba


>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
>