Leishmaniasis in Colombia
desjeuxp at who.ch
desjeuxp at who.ch
Wed Jun 13 04:54:31 BRT 2001
I fully support the explanation of Bruce Alexander regarding the increase of
cutaneous leishmaniasis in Colombia which could be extrapolated to several
other countries of South America such as Brazil, Bolivia,
Venezuela...Deforestation, migration and urbanisation are key risk factors.
Widespread deforestation was supposed to reduce ZCL incidence but,has in
fact frequently led to a domestication of transmission increasing peri-and
intra-domiciliary transmission. The plantation of new crops close to the
houses and the presence of rodents attracted by the new source of food, have
created a new and major risk of transmission in and around houses. However
progressive domestication of the transmission cycle has not only brought new
problems (increase of cases, wider age distribution, frequent family cases)
but has also increased the possibilities of vector control in peri- and
intra-domiciliary.
Philippe Desjeux
CSR/EDC
WHO
Geneva, Switzerland
-----Original Message-----
From: Bruce Alexander [mailto:bruce at cpqrr.fiocruz.br]
Sent: Tuesday, 12 June 2001 19:11
To: Multiple recipients of list
Subject: Re: Leishmaniasis in Colombia
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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
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<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><=
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