[leish-l] treatment of CanL

Luigi Gradoni gradoni at iss.it
Fri May 30 08:21:38 BRT 2003


Dear Jeffrey,
I agree with your comments to the organizers of the site
"www.leishmaniasis.info". Information on treatment results in CanL should
be given more clearly, as appears in the FAQ section.
However, to your question "Why try to treat a dog" the obvious answer is
that in many communities of endemic zones (e.g. southern Europe, but Brazil
too) dogs are part of the family, and from the veterinary point of you they
are just seen as patients. If an individual has got AIDS, one tries to cure
him/her despite the poor virological response and the risk of transmission
to other individuals. On this respect, my long experience in planning
control measures against ZVL in Italian endemic foci has convinced me about
the existence of two irreconciliable adversaries: the dog lovers and the
public health scientists, to which I belong. My conclusion is that one
should find a compromise between the two parties, for instance by
investigating on new tools aimed to avoid that a treated dog continues to
spread parasites around, maybe with increased resistance to the drug used.
In the example above, AIDS patients are strongly recommended to use condom
or to avoid syringe exchange... Our work with insecticide-impregnated
collars has been in this direction.

As regards a wide use of amphotericine B in dogs as suggested by Torsten,
this would be of great impact in countries of southern Europe, where the
first-line drugs for human VL are now lipid-associated AmB drugs. Although
resistance to AmB has not yet documented in human Leishmania isolates,
there is great risk that a massive use of AmB in dogs can give rise to
resistant strains, as it has already happened with antimony in the
Mediterranean. Our work on AmBisome in CanL showed that despite the rapid
clinical recovery of dogs, the parasitological response is poor and
relapses are frequent.

best regards,

Luigi            




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