Leishmaniasis in Colombia
Bruce Alexander
bruce at cpqrr.fiocruz.br
Mon Jun 11 09:58:16 BRT 2001
This is a multi-part message in MIME format.
------=_NextPart_000_0001_01C0F25D.095DDAC0
Content-Type: text/plain;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Leishmania spp. in Colombia are transmitted by Lutzomyia spp. not =
Phlebotomus. The idea that the increase in cases is explained by large =
numbers of combatants of "both" sides (two main guerrilla groups plus =
right-wing paramilitaries and the Colombian armed forces) spending more =
time in the forest at night seems to me flawed. First, the conflict has =
now been going on for over 40 years and second, guerrillas and =
paramilitaries wouldn't generally seek treatment in the usual places and =
thus appear on the official records. Although about 5-6,000 cases of =
leishmaniasis are reported each year in Colombia this is probably a =
considerable underestimate of the true incidence. Increasing numbers of =
cases in urban areas (which I believe was the theme of the original =
message) might be due to displaced people from rural areas seeking =
treatment for existing infections in cities. Increasing numbers of =
people are being forced to flee the violence of the countryside to the =
larger cities of Colombia. Alternatively, urbanisation of several vector =
species and transmission of Leishmania already occur here in Brazil and =
could take place elsewhere.=20
I would also dispute the continuing tenet that tegumentary leishmaniases =
are always diseases resulting from occupational, extradomiciliary risk. =
This idea has hampered control measures, since the prevailing view is =
that nothing much can be done if all transmission takes place within =
forests. Phlebotomine sand flies readily enter houses, particularly =
those surrounded by coffee plantations and the risk of peri- and =
intradomiciliary transmission (which could be the focus of control or =
preventative measures) must be significant.
Bruce Alexander=20
Centro de Pesquisas Rene Rachou
Avenida Augusto de Lima 1715
Belo Horizonte MG 30190-002 Brazil
[2]=20
Date: 29 May 2001=20
From: Ellicott McConnell, PhD <eck at intercom.net> [edited]
Leishmaniasis is, of course, transmitted by sand flies (Phlebotomus), =
not=20
mosquitoes; there was probably a problem in translation.=20
It was remarked [in the previous posting] that the continued armed =
conflict=20
is probably responsible for the "alarming" prevalence of the disease in=20
rural areas. Yes, and no. There probably are few, if any, areas where=20
active control of sand flies is undertaken at any time. I suspect [that] =
the observed high incidence of the disease results from the presence of=20
fighters from both sides of the conflict in rural areas, particularly at =
night, where under normal circumstances they would never spend any time. =
Thus, it is doubtful that the reservoir of infection has changed; there =
are=20
just more people being exposed due to circumstances.
- --=20
ProMED-mail=20
<promed at promed.org>
[Thank you very much to Steve Berger for providing background =
information=20
on leishmaniasis in Colombia, and to Ellicott McConnell [and others!] =
for=20
pointing out that sand flies are flies, not mosquitoes. - Mod.EP]=20
............ep/pg/sh
------------------------------
------=_NextPart_000_0001_01C0F25D.095DDAC0
Content-Type: text/html;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META content=3D"text/html; charset=3Diso-8859-1" =
http-equiv=3DContent-Type>
<META content=3D"MSHTML 5.00.2614.3500" name=3DGENERATOR>
<STYLE></STYLE>
</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><FONT face=3DArial size=3D2><EM>Leishmania </EM>spp. in Colombia =
are=20
transmitted by <EM>Lutzomyia </EM>spp. not <EM>Phlebotomus</EM>. =
The idea=20
that the increase in cases is explained by large numbers =
of combatants=20
of "both" sides (two main guerrilla groups plus right-wing =
paramilitaries=20
and the Colombian armed forces) spending more time in the forest at =
night seems=20
to me flawed. First, the conflict has now been going on for over 40 =
years and=20
second, guerrillas and paramilitaries wouldn't generally seek treatment =
in the=20
usual places and thus appear on the official records. Although about =
5-6,000=20
cases of leishmaniasis are reported each year in Colombia this is =
probably a=20
considerable underestimate of the true incidence. Increasing numbers of =
cases=20
in urban areas (which I believe was the theme of the original message) =
might be=20
due to displaced people from rural areas seeking treatment for existing=20
infections in cities. Increasing numbers of people are being forced =
to flee=20
the violence of the countryside to the larger cities of Colombia.=20
Alternatively, urbanisation of several vector species and transmission =
of=20
<EM>Leishmania </EM>already occur here in Brazil and could take place =
elsewhere.=20
</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT> </DIV>
<DIV><FONT face=3DArial size=3D2>I would also dispute the continuing =
tenet=20
that tegumentary leishmaniases are always diseases resulting from=20
occupational, extradomiciliary</FONT><FONT face=3DArial size=3D2> risk. =
This idea=20
has hampered control measures, since the prevailing view is that nothing =
much=20
can be done if all transmission takes place within forests. Phlebotomine =
sand=20
flies readily enter houses, particularly those =
surrounded by=20
coffee plantations and the risk of peri- and intradomiciliary =
transmission=20
(which could be the focus of control or preventative measures) must =
be=20
significant.</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2>Bruce Alexander </FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Centro de Pesquisas Rene =
Rachou</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Avenida Augusto de Lima =
1715</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Belo Horizonte MG 30190-002 =
Brazil</FONT></DIV>
<DIV> </DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2></FONT> </DIV>
<DIV><FONT face=3DArial size=3D2> </FONT>[2] <BR>Date: 29 May 2001 =
<BR>From:=20
Ellicott McConnell, PhD <eck at intercom.net> =
[edited]<BR>Leishmaniasis is,=20
of course, transmitted by sand flies (Phlebotomus), not <BR>mosquitoes; =
there=20
was probably a problem in translation. <BR>It was remarked [in the =
previous=20
posting] that the continued armed conflict <BR>is probably responsible =
for the=20
"alarming" prevalence of the disease in <BR>rural areas. Yes, and no. =
There=20
probably are few, if any, areas where <BR>active control of sand flies =
is=20
undertaken at any time. I suspect [that] <BR>the observed high incidence =
of the=20
disease results from the presence of <BR>fighters from both sides of the =
conflict in rural areas, particularly at <BR>night, where under normal=20
circumstances they would never spend any time. <BR>Thus, it is doubtful =
that the=20
reservoir of infection has changed; there are <BR>just more people being =
exposed=20
due to circumstances.<BR>- -- <BR>ProMED-mail=20
<BR><promed at promed.org><BR>[Thank you very much to Steve Berger =
for=20
providing background information <BR>on leishmaniasis in Colombia, and =
to=20
Ellicott McConnell [and others!] for <BR>pointing out that sand flies =
are flies,=20
not mosquitoes. - Mod.EP]=20
<BR>............ep/pg/sh<BR>------------------------------<BR><BR></DIV><=
/BODY></HTML>
------=_NextPart_000_0001_01C0F25D.095DDAC0--
More information about the Leish-l
mailing list