No subject
Sat Feb 18 11:22:33 BRST 2006
located within classical endemic areas including territories of Emilia
Romagna, Tuscany, Umbria, Marche, and Abruzzi regions. But the most
relevant aspect, from an epidemiological point of view, has been the
appearance of stable CanL foci in northern Italy, namely in Veneto and
Piedmont regions. In these two foci, entomological surveys showed the
presence of P. perniciosus and of a second phlebotomine vector, P.
neglectus, which may have played a role in the CanL diffusion in some
parts of northern Italy. Furthermore, in these areas, autochthonous
human VL cases have occurred. There is therefore a realistic risk that
CanL infection could rapidly spread through northern latitudes and a
surveillance activity is strongly needed. For this reason, in October
2002, thanks to the collaboration and support of Intervet Italia, the
network "LeishMap" was created, with the main purpose of monitoring the
spread of CanL and vectors in northern Italy. LeishMap consists of
scientific and sanitary institutions with proven experience both in
field surveys and diagnostic methodologies on CanL and phlebotomine
vector. It is organised in 4 Operational Units (OU), represented by
researchers of the Veterinary Faculties of the University of Bologna,
Padua, Milan and Turin, under the scientific coordination of the MIPI
Department, ISS of Rome and with the collaboration of private and public
veterinarians operating in the regions under study. During the first
year of activity, each OU was involved in the serological and
entomological surveillance of several territories in the respective
regions, where recent autochthonous CanL cases were registered. The
studies have involved five regions, namely Valle D'Aosta, Piedmont,
Lombardia, Veneto, Trentino-Alto Adige and Emilia Romagna. In the
Symposium 6 of this Congress we report detailed results of a
retrospective analysis of data concerning CanL and vectors in northern
Italy till 2002 and the preliminary results of 2003 on the
seroprevalence rates observed in foci studied and on the entomological
surveys carried out. In summary, the results outlined that already known
foci of CanL are expanding from the original sites. Several new foci
have been identified and many others are at high risk of evolving toward
a stable endemicity. P. perniciosus has been found in all but one the
suspected new foci. In Emilia Romagna region P. perfiliewi was
identified in 2 areas and in one was the only species present. The
occurrence of P. neglectus was confirmed in three regions, Veneto,
Lombardia and Piedmont. In conclusion, from the 2002-2003 LeishMap
activities it appears that further monitoring activities are necessary
to identify new endemic foci of CanL, this representing the prerequisite
for the implementation of programs for leishmaniasis control in
northern Italy.
PMID: 15305716
TITLE: [Change in human visceral leishmaniasis treatment in Italy]
AUTHORS: L Gradoni, M Gramiccia, A Scalone
AFFILIATION: Reparto di Malattie Trasmesse da Vettori e Sanità Internazionale,
Dipartimento MIPI, Istituto Superiore di Sanità , Roma, Italy.
REFERENCE: Parassitologia 2004 Jun 46(1-2):199-201
Since the 1940s meglumine antimoniate (MA) has been the only first-line
drug for visceral leishmaniasis (VL) treatment in Italy. From 1991
through 1994, several patients of all ages, representing 1/3 of all
immunocompetent VL patients reported during that period, were enrolled
in clinical trials of liposomal amphotericin B (L-AmB), which led to a
novel, safe, short course of VL treatment as an alternative to MA. In
the same period, other lipid-associated AmB drugs were registered in
Italy for the treatment of fungal infections, i.e., AmB colloidal
dispersion (ABCD) and AmB lipid complex (ABLC). A retrospective analysis
was performed on data collected at the Unit of Protozoology of Istituto
Superiore di Sanità , Rome, to assess whether changes have occurred in
first-line drug regimens adopted in Italy for routine VL treatment,
during the 1995-2002 period. The sample consisted of immunocompetent
individuals clinically suspected for VL, in whom the disease was
confirmed by the examination of serum and bone marrow specimens sent to
the Unit by hospitals from throughout the country. Relevant information
on patients was then recorded, which included drug regimens used and
post-therapy results. We recorded treatment information for 630 patients
, representing a large proportion (55.5%) of 1,135 immunocompetent
individuals with VL reported in Italy from 1995 through 2002. About half
were children (306). Every year, patients were referred by 19 to 42
hospitals, with a range of 1 to 30 patients per hospital. MA was the
first-line drug used in 159 patients (25.2%). However, the proportion of
MA-treated patients has steadily decreased from 55.9% in 1995 to 1.0%
in 2002. We recorded the failure of MA therapy in 16 patients (10.1%),
who were successfully retreated with a L-AmB regimen. The rate of MA
failures significantly increased in recent years, from 5.3% in 1995 to
36.4% in 2000 (p = 0.01). AmB drugs have been the only alternative drugs
used in the remaining 471 patients (74.8%). L-AmB accounted for most
regimens (441, 93.6%). The proportion of patients treated with any AmB-
based drugs increased from 44.1% in 1995 to 99.0% in 2002. Drug
treatment was unsuccessful in 15 patients (3.2%), who were successfully
retreated with a high-dose L-AmB regimen. This rate was significantly
lower than the MA failure rate (p = 0.001). Results have shown a
countrywide change in therapy over the period considered. A
traditionally effective, but moderately toxic drug (MA) has been almost
fully replaced by a new compound (L-AmB) with negligible toxicity, in an
epidemiologic context of disease reemergence. Furthermore, short
courses of 6 to 7 days, as required for lipid-associated AmB, are highly
cost-effective if compared with 21- to 28-day courses needed for
standard MA treatment.
PMID: 15305717
TITLE: [Feline leishmaniasis: what's the epidemiological role of the cat?]
AUTHORS: F Mancianti
AFFILIATION: Dipartimento di Patologia Animale, Profilassi ed Igiene degli
Alimenti, Università di Pisa.
REFERENCE: Parassitologia 2004 Jun 46(1-2):203-6
Feline leishmaniasis (FL) is a quite uncommon feature. Clinical disease
has been described in cats since nineties begin. More than 40 reports in
world literature have been referred, but the clinical cases have been
only recently well defined. Most of the reports focus on infected cats
living in endemic areas, even if, more recently FL due to Leishmania
infantum was found in Sao Paulo State, in Brazil where autochthonous
human or canine leishmaniasis cases have never reported. In Europe
clinical cases of FL have been described from Portugal, France, Spain
and Italy from 1996 to 2002. When a typing of the etiological agent was
performed L. infantum was identified in all reported cases. In some
endemic areas serological surveys have also been carried out in cats,
using IHAT in Egypt, Western blot in France or IFAT in Italy. Sixty
Egyptian cats had low serological antibody titers, from 1/32 to 1/128,
in the endemic focus of canine leishmaniasis of Alpes Maritimes 12 out
of 97 (12.5%) cats showed antibodies versus antigens 14 and/or 18 kDa of
L. infantum. A previous survey by means of IFAT in Liguria and Toscana
on 110 and 158 feline sera respectively reports a seroprevalence of 0.9
% with low titer, while sera from Sicily seem to be positive at higher
dilutions. Animals living in an endemic area can develop specific
antibodies against leishmania and, in our experience, they can be
evidentiated by means of IFAT. The antibody titers appear to be lower in
affected cats than in dogs, even if the number of clinical cases is
very scanty. PCR tests on feline blood samples are in progress, but
preliminary results confirm the presence of leishmania DNA in such
specimens. Cutaneous leishmaniasis is the more frequent form in cats and
it was reported from several countries. Typical signs include nodular
to ulcer or crusty lesions on the nose, lips, ears, eyelids, alopecia:
clinical signs of cutaneous FL are unspecific and in endemic area this
infection must be taken into account. Visceral leishmaniasis is not
common in cats: this form shows visceral involvement: liver and spleen
are interested, with lymph nodes and kidney. The cat probably has to
considerate to play an active role in the disease, in contrast to goats
, calves and horses who could act as accidental reservoirs of leishmania
, while sheep appears to be not susceptible to experimental infection.
In endemic foci for kala-azar in Sudan cows, goats and donkeys had a
high prevalence of specific antibodies. Recently in Europe sporadic
cases of equine leishmaniasis have been reported: L. infantum was the
causative agent. Equine leishmaniasis appears as a self-healing skin-
dwelling disease, with a massive accumulation of parasites. The animals
do not often show detectable specific antibodies and recover without any
chemotherapy. Untreated affected cats can frequently die and we also
observed lymph nodes and blood involvement indicating a spread of
leishmania in feline hosts. The epidemiological role of the cat has
never been clarified due also to lack of xenodiagnosis trials. This
species is believed to have a high degree of natural resistance, as
observed following experimental infection. Some of the affected cats
were FIV and/or FeLV positive and these viroses such as stress may
induce an impaired cellular immune response, even if leishmania infected
cat was not submitted to CD4+, CD8+ lymphocyte counts nor other
immunological test. However the resistance of the cat to leishmania
infection probably depends on genetic factors, not strictly related to
cell mediated immunity, taking into account the high seroprevalence of
FIV infections (30%) in our country versus the number of clinical cases.
PMID: 15305718
TITLE: [Parasite identification in the surveillance of leishmaniasis imported
cases in Italy]
AUTHORS: M Gramiccia, T Di Muccio, M Marinucci
AFFILIATION: Reparto di Malattie Trasmesse da Vettori e Sanità Internazionale,
Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Istituto
Superiore di Sanità , Roma.
REFERENCE: Parassitologia 2004 Jun 46(1-2):207-10
An accurate Leishmania classification was defined since 1980s by the use
of isoenzyme analysis. To date, this procedure still represents the
reference identification technique, despite the increasing use of
molecular approaches. Studies and surveillance methods on leishmaniases
are strongly conditioned by the knowledge and mapping of all the
parameters characterizing each nosogeographical entity. On this respect
, the identification of parasites from all the actors of the natural
life cycle plays a key role. With the increasing population movements
and climate changes, novel risk factors could be identified associated
to Leishmania geographical distribution and spreading: a) the
introduction into Italy of new populations of L. infantum from other
countries; b) the introduction of new Leishmania species that may find a
suitable milieau to support their life cycle in our country. The
objective of this report is to present the surveillance activity on
imported leishmaniases by the Leishmania Identification Reference Centre
, ISS. Two different methodologies were routinely applied: a) isoenzyme
electrophoretic analysis, which requires parasite culture, and b) a
number of molecular techniques, used for both diagnosis and parasite
identification, differently applied according to the geographical origin
of the suspected leishmaniasis case. When possible, both types of
methodologies were applied. From 1986 to June 2002, 38 imported cases of
leishmaniases were identified: 9 visceral (VL) and 29 cutaneous (CL)
cases, of which 22 from the Old and 7 from the New World. Pathology,
Leishmania species/zymodeme and geographical origin features are
reported in the paper. Seven out of 9 VL patients were HIV positive, of
whom 5 detected in the period 1993-1995. This high importation rate can
be associated to the general increase in Mediterranean Leishmania/HIV
coinfections in that period. Following HAART treatment, VL imported
cases became occasional; no introduction of new L. infantum populations
has been detected. On the other hand, our findings show an increase of
CL imported cases from different areas of the Old and New Worlds. This
phenomenon, however, is so far limited to new Leishmania species that
could hardly be introduced in our country, because of their strict
biological requirements (i.e. vectors and/or natural reservoir hosts).
Since June 2002, 10 further suspected imported cases were recorded. For
these patients--whose Leishmania identification is still in course--the
origin/visited geographical areas were only slight different from the
previous. However, the characteristics of the patients are changing:
there are more immigrants that occasionally visited their place of
origin, and Italian military staff.
PMID: 15305719
TITLE: [Prevention and control of leishmaniasis vectors: current approaches]
AUTHORS: M Maroli, C Khoury
AFFILIATION: Reparto di Malattie Trasmesse da Vettori e Sanità Internazionale,
Dipartimento di Malattie Infettive, Parassitarie ed Immunomediate, Istituto
Superiore di Sanità , Roma. maroli at iss.it
REFERENCE: Parassitologia 2004 Jun 46(1-2):211-5
Phlebotomine sandflies (Diptera: Psychodidae) are the suspected or
proven vectors of Leishmania spp. in at least 88 countries, including
over 40 Phlebotomus species in the Old World and a further 30 belonging
to the genus Lutzomyia in the New World. In recent years, both cutaneous
(CL) and zoonotic visceral leishmaniasis (ZVL) have become increasingly
prevalent in urban areas, including large Latin American cities. A
similar trend has been recorded in all Mediterranean areas during the
last decade. Based on mathematical models, insecticidal control of
sandflies appears to represent a more effective way of reducing
Leishmania infantum transmission than the present strategy of culling
infected dogs in Latin America as well as being more acceptable to the
human population. Since man is a dead-end host of most Leishmania
species, treatment of existing human cases generally does not affect
transmission. Interruption of the cycle by vector control may offer a
cheaper, more practical solution to treatment and improved knowledge of
the alternatives available could lead to preventative measures being
undertaken in more leishmaniasis foci. In this note a review of current
knowledge on sandfly control is presented. Different measures to control
phlebotomine sandflies, including residual spraying of dwellings and
animal shelters, insecticide treated nets, application of repellents/
insecticides to skin or to fabrics and impregnated dog collars are
discussed. Although effective in urban areas with high concentrations of
sandflies, residual spraying of insecticides is no often longer tenable
in most situations. In rural areas where dwellings are more dispersed
and surrounded by large, untargeted "reservoir" populations of sandflies
, residual spraying of houses may be both impractical for logistic
reasons and ineffective. Actually, this control measure depends on the
availability of a suitable public health infrastructure, including
adequate supplies of insecticide, spraying equipment and trained
personnel. Ideally such personnel should be trained in insecticide
application, monitoring techniques and interpretation of sampling data,
as well as safety techniques. To date reports of resistance refer to one
insecticide (DDT) in only three species (Phlebotomus papatasi, P.
argentipes and Sergentomyia shorti) in one country (India), although
there are reports of increased tolerance to this compound in several
countries. Fortunately the insects remain susceptible to all the major
insecticidal groups. Impregnated bednets may offer the best solution in
rural areas where transmission is largely intradomiciliary. This measure
has the advantage that it can be employed at the individual household
level and affords collateral benefits such as privacy and control of
other biting insects such as mosquitoes, fleas and bedbugs. Sandfly
larvae are generally difficult to find in nature so control measures
that act specifically against immatures are not feasible, although the
effectiveness of a few biological and chemical agents has been
demonstrated in laboratory evaluations. In ZVL foci, where dogs are the
unique domestic reservoir, a reduction in Leishmania transmission would
be expected if we could combine an effective mass treatment of infected
dogs with a protection of both healthy and infected dogs from the
sandfly bites. Laboratory and field evaluations have shown that
impregnated dog collars and topical application of insecticides could
protect dogs from most sandfly bites by means of both anti-feeding and
killing effect of the pirethorids used.
PMID: 15305720
TITLE: [Canine leishmaniasis in Campania: new and old foci]
AUTHORS: L Baldi, V Mizzoni, A Guarino
AFFILIATION: Istituto Zooprofilattico Sperimentale del Mezzogiorno.
REFERENCE: Parassitologia 2004 Jun 46(1-2):217-20
Canine Leishmaniasis (CanL) is endemic in Campania Region (Italy) and is
strictly related to Human Visceral Leishmaniasis. Past and present
reports of the prevalence in the Region show that exist places were CanL
has been known for a century (Vesuvius and Ischia Foci) and other
localities where the disease appears to be recent (Caserta and Salerno
provinces); moreover, the zoonosis is seen not only in endemic foci (
autochthonous), but also in non-endemic areas (imported cases), for
example in the Benevento and Avellino provinces. Two zymodemes have been
identified in human and canine population and also in sandflies: MON 1
and MON 72. Endemic or stable CanL foci correspond with Vesuvius Area,
Ischia island, Maddaloni and neighbouring Commons, other foci in the
Salerno province. These foci are associated with optimal ecological
condition, abundance of reservoirs and hosts, abundance of phlebotomine
vectors, prevalence in canine population around 10-40%, incidence in
canine population 5%, risk for human population 0.002%. Instable foci
occur at the border of the stable foci: they may be the result of
changes in climate with the occasional introduction of infected dogs in
the areas; in the foci are registered low presence of phlebotomine
vectors, prevalence around 0.5-3%, sporadic human cases. Today, in
Campania region CanL undoubtedly has an increased incidence and a wider
geographic distribution than before: new cases are now reported in areas
that were previously non-endemic. Ecological, demographic and
environmental changes, large population movements, urbanization have led
to an increased incidence and to importation into suburbs with high
densities of people and sand-flies. These changes include "global
warming", increased number of stray dogs, dogs and population movements
, changes in human population (increased number of immune-depressed and
old people). Nowadays, the most important focus of CanL and Human
Visceral Leishmaniasis of the Mediterranean area is located in Campania
Region: during the year 2000, 143 cases of Human Visceral Leishmaniasis
have been recorded in Italy, an half of them (83 cases) in Campania
region.
PMID: 15305721
TITLE: [Infantile visceral leishmaniasis in the Campania region, Italy:
experience from a Paediatric Reference Centre]
AUTHORS: L di Martino, M Gramiccia, P Occorsio, T Di Muccio, A Scalone, L
Gradoni
AFFILIATION: Centro Regionale di Riferimento per la Leishmaniosi Viscerale
Pediatrica, Dipartimento di Pediatria, Ospedale Santobono, Napoli, Italy.
REFERENCE: Parassitologia 2004 Jun 46(1-2):221-3
In the first half of the 20th century, visceral leishmaniasis (VL) was a
common infantile syndrome in coastal territories of the Campania region
of Italy. After World War II, the incidence dropped to a few cases/year
for three decades; in late 1980s the disease reemerged among both
children and adults. To face the VL recrudescence, a Paediatric
Reference Centre was established at the Santobono-Pausilipon hospital in
Naples, for the clinical diagnosis, care and drug treatment of all
infantile VL cases occurred in the Campania region. Rapid laboratory
diagnosis was secured by a Diagnostic Reference Centre established at
the Istituto Superiore di Sanità . Here, we report on the
epidemiological and parasitological features of all cases referred to
the Centre in the past 15 years. From 1990 to March 2004, a total of 255
cases were diagnosed and treated at the Centre. The Figure shows the
yearly trend of patients (min. 3 cases in 1990 and 1991, max. 30 cases
in 2000). There were 135 males (52.9%); the age ranged 4 months-14 years
, but 189 patients (74.1%) were < or = 3 years old. The majority of
the patients (189, 74.1%) were from the Naples province, with a cluster
of 102 cases (40% of total patients) from the towns and districts
surrounding Vesuvius. Twenty-seven cases (10.6%) were from the town of
Maddaloni, Caserta province, whereas 15 cases (5.9%) were from coastal
villages of the Salerno province. Only 1 and 2 cases were from Benevento
and Avellino provinces, respectively. All patients but seven, who have
been treated with antimonial drugs in the 1990-1993 period, were
successfully treated with a liposomal amphotericin B regimen. From bone-
marrow aspirate samples, 138 Leishmania cultures were obtained in EMTM
and Sloppy Evans' media, of which 134 have been typed by the
electrophoretic analysis of 13 isoenzymes. Two zymodemes (Z) of L.
infantum were routinely identified over the study period, ZMON-1 (the
commonest zymodeme in the Mediterranean area) and ZMON-72, variant from
MON-1 in PGM mobility and detected only in our region. The latter,
identified in 61 patients (45.5%), was found exclusively distributed in
towns of the Vesuvius area and in Maddaloni until 1996, but in recent
years it appears to have spread to other areas of the Naples (including
the island of Ischia) and Caserta provinces, but not to Salerno province
. In conclusion, the VL macrofocus of the Naples-Caserta area is
probably responsible for the highest number of infantile cases among any
VL macrofoci described in southern Europe. Considering the limited
efforts paid to control the canine reservoir, rapid diagnosis and
appropriate treatment of patients still remain the first-line control
measures aimed at reducing the health impact of the disease.
PMID: 15305722
TITLE: [Changes of clinical signs of visceral leishmaniasis in adults]
AUTHORS: G B Gaeta
AFFILIATION: Centro di Riferimento Regionale per la Leishmaniosi Viscerale,
Dipartimento di Malattie Infettive, Seconda Università di Napoli.
REFERENCE: Parassitologia 2004 Jun 46(1-2):225-6
Although the typical clinical signs and symptoms of visceral
leishmaniasis (VL) are always the same, in the recent years the disease
has emerged in new settings, for example in HIV infected individuals, in
organ transplant recipients, in patients with chronic liver disease, in
pregnancy. At the same time, VL has emerged as a model for exploring
the host-parasite interplay for intracellular infections. The common
feature of VL is that it is fatal without treatment. Liposomal
Amphotericin B is the first line treatment in developed countries.
Unfortunately, the high cost makes this treatment unaffordable for
developing countries.
PMID: 15305723
TITLE: [Diagnostic test to detect cryptic leishmaniasis in dog]
AUTHORS: A E Gravino
AFFILIATION: Dipartimento di Scienze Cliniche Veterinarie, Università degli
Studi di Napoli Federico II.
REFERENCE: Parassitologia 2004 Jun 46(1-2):227-9
Leishmaniasis is a zoonosis caused by an intracellular parasite
belonging to the genus Leishmania. In Europe, Africa, South America and
China, visceral leishmaniasis is caused by L. infantum. The vectors of
leishmaniasis are phlebotomine sandflies belonging to the genera
Phlebotomus. According to the World Health Organization there are 2
million new cases each year and 1/10 of the world's population is at
risk of infection. Leishmaniasis is considered a zoonosis and human are
generally accidental hosts. The animal reservoir includes rodents, dog
and other mammals. Several studies have indicate that half of the dogs
with antileishmanial antibodies have no signs of disease although,
animal with subclinical infections are potentially infectious to sand
flies. The factors determining susceptibility or resistence to visceral
leishmaniasis remain unclear, but the genetics of the host may play a
major role. Clinical signs are: intermittent fever, hepatosplenomegaly,
skin lesions and ulcers, alopecia, onychogryphosis, anemia,
thrombocytopenia and hypergammaglobulinemia. In mice, the outcome of
infection depends on the polarized activation of one of two subsets of
CD4+ T cells, Th1 or Th2, the subdivision into Th1 and Th2 cells is
based on the pattern of cytokines that they produce. Th1 cells produce
gamma interferon (IFN-gamma) and interleukin -2 (IL-2), whereas Th2
cells produce IL-4, IL-5, and IL-10. An important difference between
susceptible and resistant mice is that the resistant mice are able to
switch to a Th1 profile and control the disease. An important factor in
the "decision" to form a Th1 or Th2 phenotype is the early cytokine
environment, and IL-12 is one of the cytokines that contributes
significantly to the establishment of the Th1 phenotype. Canine
leishmaniosis is endemic in the Mediterranean basin and, in most cases
is caused by the parasite Leishmania infantum. The main clinical
findings are skin lesions, local or generalized lymphoadenopathy, loss
of body weight, glomerulopathy, ocular lesions, epistaxis and lameness.
Non pruritic skin lesions are the usual manifestation and several forms
have been described, such as exfoliative dermatitis and alopecia, and
ulcerative, nodular and pustular dermatitis. Seroepidemiological studies
of canine leishmaniasis have revealed a large number of asymptomatic
seropositive animals. Moreover in areas where leishmaniasis is highly
endemic, high proportion of apparently healthy animals show low levels
of anti-Leishmania antibodies. Others have regressive forms of the
desease, and their antibody levels will decrease in the following months
or years; still others maintain low levels of antibodies without
developing the desease for many years. However, the total number of
infected animals is unknown. Canine leishmaniasis is a major zoonosic
parasitic disease, enzootic in the Mediterranean area, caused by the
intracellular protozoan Leishmania infantum. The dog is the main
reservoir host of the parasite. However, most infected dogs do not
present any clinical signs, and there is evidence that Leishmania
infection prevalence rates in areas of endemicity are higher than those
ascertained by serological studies. Visceral leishmaniasis is becoming a
real problem of public health because it is an opportunistic infection
in immunocompromised patients and in human immunodeficiency virus-
positive subjects. The detection of the extent of the infection,
particularly among asymptomatic dogs, is of great importance for the
control of leishmaniasis. PCR has been applied successfully in recent
years to detect Leishmania spp. even in the cases with any of the
clinical manifestation of leishmaniasis. Very recently, real-time PCR
for Leishmania has been applied to evaluate the parasitic load of dog
tissues both at the time of the diagnosis and during follow-up of the
therapy and to measure cytokine mRNA levels in different clinical
samples of infected and uninfected dogs.
PMID: 15305724
TITLE: [Canine leishmaniasis: evolution of the chemotherapeutic protocols]
AUTHORS: G Oliva, V Foglia Manzillo, A Pagano
AFFILIATION: Dipartimento di Scienze Cliniche Veterinarie (Sezione di Clinica
Medica), Facoltà di Medicina Veterinaria dell'Università degli Studi di
Napoli Federico II, via F. Delpino, 1 80137 Napoli.
REFERENCE: Parassitologia 2004 Jun 46(1-2):231-4
Dogs are the domestic reservoir for Leishmania infantum (syn.: L.
chagasi), the parasite causing zoonotic visceral leishmaniasis (ZVL) in
both the Old and New Worlds. In foci of canine leishmaniasis (CanL),
symptomatic disease occurs in less than 50% of infected dogs, and is
characterized by chronic evolution of viscero-cutaneous signs. Among
strategies recommended to control ZVL, detection and drug treatment of
infected dogs are usually employed in the endemic countries of southern
Europe. However, the conventional antileishmanial drugs successfully
used in human therapy, such as pentavalent antimonials, amphotericin B,
pentamidine or miltefosine, have low efficacy in the treatment of CanL.
In dogs, these drugs induce only temporary remission of clinical signs,
do not prevent occurrence of relapses, and often cause severe side
effects. Leishmaniotic dogs may be classified into 4 groups: 1)
Asymptomatic resistant dogs ("contacted dogs"), 2) Asymptomatic dogs (
preclinical), 3) Dogs with minimal signs of leishmaniasis (
oligosymptomatic dogs? Chronic form of leishmaniasis?), 4) Dogs
suffering from different forms of clinical leishmaniasis (symptomatic
dogs). The dog's immunological status and the associated clinical signs
may influence the efficacy of antileishmanial drugs. Subjects belonging
to groups 2, 3 and 4 should be always treated, in order to reduce their
parasite load. Parameters that must be considered before starting the
antileishmanial treatment are hemogram, renal and hepatic functions,
electrophoretic protein pattern, antileishmania antibody titres, and
bone marrow and lymph node parasite load. The most common
antileishmanial drugs currently used in Italy to treat CanL are
pentavalent antimonials (meglumine antimoniate) and allopurinol, alone
or in combination. Other used drugs are aminosidine (syn.: paromomycin
), pentamidine, metronidazole and spyramicin. Each drug regimen has
different duration, from a few weeks (aminosidine), to a few months (
meglumine antimoniate) or several months (allopurinol). One of the most
recent drug used in human VL is liposomal amphotericin B (AmBisome--L-
AMB), a powerful antileishmanial drug in both experimental murine models
and in VL patients. In Italy, L-AMB is now considered the drug of
choice for the treatment of human cases. However, in HIV co-infected
patients high doses of L-AMB are ineffective in obtaining a radical cure
. In dogs, L-AMB treatment rapidly leads to clinical recovery but is
uneffective to eliminate the parasites. Drugs containing amphotericin B
should not be used in veterinary practice in order to avoid selection of
parasites resistant to the drug, as it already occurred for the
pentavalent antimonials. Currently, there is not a standard protocol for
CanL treatment in Italy, as there is an extreme variability of proposed
dosages. Clinical studies on immunotherapeutics and new antileishmanial
drugs, such as miltefosine and its derivates, are in progress.
PMID: 15107544
TITLE: Modulation of the immune system by Listeria monocytogenes-mediated gene
transfer into mammalian cells.
AUTHORS: Hua Shen, Makoto Kanoh, Fengzhi Liu, Saho Maruyama, Yoshihiro Asano
AFFILIATION: Department of Immunology and Host Defenses, Ehime University School
of Medicine, Japan.
REFERENCE: Microbiol Immunol 2004 48(4):329-37
In this study, we established a method for Listeria monocytogenes(Lm)-
mediated gene transfer into mammalian cells to manipulate the immune
response of the host during infection by pathogens. We used the Lm-
mediated gene transfer method in an in vivo study to manipulate host
immune responses against Leishmania major(L. major )-infection. The
injection of Lm modulated the susceptible host into a resistant state
against L. major-infection. A more efficient protective effect was
obtained with the injection of IL-12-cDNA containing Lm, and the
protective effect was stronger than that of the resistant strain. The
protective mechanism of Lm-injection against L. major-infection observed
here appeared to be a result of the activation of the local immune
system by the Lm-mediated gene transfer method. The present study is the
first demonstration that a gene introduced into a host by Lm works to
modulate the murine host immune response against infections in vivo.
Since this system strongly induces Th1 responses and suppresses Th2
responses in infected hosts, the system can be used for controlling
infectious diseases and for protection against allergic responses in the
future.
PMID: 15307565
TITLE: An emerging peri-urban pattern of infection with Leishmania chagasi, the
protozoan causing visceral leishmaniasis in northeast Brazil.
AUTHORS: Selma M B Jeronimo, Priya Duggal, Regina F S Braz, Chun Cheng, Gloria R
G Monteiro, Eliana T Nascimento, Daniella R A Martins, Theresa M Karplus, Maria
F F M Ximenes, Carlos C G Oliveira, Vanessa G Pinheiro, Wogelsanger Pereira,
Jose M Peralta, Jacira Sousa, Iara M Medeiros, Richard D Pearsoni, Trudy L
Burns, Elizabeth W Pugh, Mary E Wilson
AFFILIATION: Department of Biochemistry, Universidade Federal do Rio Grande do
Norte, Natal, RN, Brazil. smbj at cb.ufrn.br
REFERENCE: Scand J Infect Dis 2004 36(6-7):443-9
Peri-urban visceral leishmaniasis (VL) caused by Leishmania chagasi is
emerging in a new epidemiologic pattern in Brazilian cities. We studied
peri-urban VL in endemic neighborhoods surrounding Natal, Brazil,
identified through hospitalized individuals with VL. Clinical and
environmental information obtained for 1106 members of 216 families
living in endemic neighborhoods enabled us to identify 4 groups: VL:
individuals with current or prior symptomatic visceral leishmaniasis (n
= 135); DTH+: individuals with positive delayed-type hypersensitivity
response with no history of VL (n = 390); Ab +: individuals with
negative DTH response and seropositive (n = 21); DTH -: individuals with
negative DTH and seronegative (n = 560). The mean +/-SD age of VL was 9
.3+/-12.3 y. The gender distribution was nearly equal below age 5, but
skewed toward males at higher ages. Acutely infected VL subjects had
significantly lower hematocrits, neutrophils, and eosinophils than other
categories. AB+ subjects also had lower eosinophil counts than others,
a possible immune marker of early infection. VL was not associated with
ownership of dogs or other animals, raising the question whether the
reservoir differs in peri-urban settings. This new pattern of L. chagasi
infection enables us to identify epidemiological and host factors
underlying this emerging infectious disease.
PMID: 15307590
TITLE: Disseminated intravascular coagulation as an unusual presentation of
Kala-azar: report of two cases.
AUTHORS: Pravas Mishra, Ashish Dixit, Tathagat Chatterjee, Maitreyee
Bhattacharya, Jina Bhattacharya, Pankhi Dutta, Manoranjan Mahapatra, Hara
Prasad Pati, Ved Prakash Choudhry, Renu Saxena
AFFILIATION: Department of Haematology, All India Institute of Medical Sciences,
New Delhi, India.
REFERENCE: Scand J Infect Dis 2004 36(6-7):519-21
Kala-azar (visceral leishmaniasis) is a common problem in various well-
defined areas of India. It is characterized by fever of long duration,
enlarged liver and spleen, anaemia and leucopoenia. Bleeding is an
uncommon manifestation of kala-azar. We report 2 cases, in which
disseminated intravascular coagulation was an unusual complication.
PMID: 15307436
TITLE: Sodium stibogluconate cardiotoxicity and safety of generics.
AUTHORS: S Rijal, F Chappuis, R Singh, M Boelaert, L Loutan, S Koirala
AFFILIATION: B P Koirala Institute of Health Sciences, Dharan, Nepal.
REFERENCE: Trans R Soc Trop Med Hyg 2003 Sep-Oct 97(5):597-8
Between April 9 and May 5 2000, an outbreak of fatal cardiotoxicity
occurred in Nepal amongst visceral leishmaniasis patients treated with a
recently introduced batch of generic sodium stibogluconate (SSG) from
GL Pharmaceuticals, Calcutta, India. Eight (36%) of 23 patients treated
with this batch died, and in 5 (23%) death was attributed to the
cardiotoxicity of the drug. This contrasts with the low total death rate
(3.2%) and death rate due to cardiotoxicity (0.8%) observed among 252
patients treated between August 1999 and December 2001 with generic SSG
from Albert David Ltd, Calcutta, India. These data show that every batch
of generic SSG should be subject to rigorous quality control prior to
use.
PMID: 15307414
TITLE: Emergence or re-emergence of visceral leishmaniasis in areas of Somalia,
north-eastern Kenya, and south-eastern Ethiopia in 2000-01.
AUTHORS: M V L Marlet, D K Sang, K Ritmeijer, R O Muga, J Onsongo, R N Davidson
AFFILIATION: Medecins Sans Frontieres-Holland, Max Euweplein, EA Amsterdam, The
Netherlands. mvlmarlet at hetnet.nl
REFERENCE: Trans R Soc Trop Med Hyg 2003 Sep-Oct 97(5):515-8
Visceral leishmaniasis (VL) was known to be endemic in Somalia along the
basins of the (Middle) Shebelle and (Lower) Juba rivers, and in Kenya
in parts of the Rift Valley, on the border with Uganda and the Eastern
Provinces. From May 2000 to August 2001, we diagnosed 904 patients with
VL. The patients came from an area which spanned the Wajir and Mandera
districts of north-eastern Kenya, southern Somalia, and south-eastern
Ethiopia. Small numbers of patients were also seen in northern Somalia.
These areas were either previously non-endemic for VL, or had only
sporadic cases prior to the epidemic. We describe the features of the
outbreak and review the history of VL in the region. Unusual rainfall
patterns, malnutrition, and migration of a Leishmania-infected
population seeking food and security may have contributed to this
outbreak.
PMID: 15307426
TITLE: Case report: effect of antileishmanial treatment on hepatitis C viraemia
in a visceral leishmaniasis patient with chronic hepatitis C.
AUTHORS: Davide F Precone, Gianfranca Stornaiuolo, Domenico Galante, Anna Amato,
Luigi Gradoni, Giovanni B Gaeta
AFFILIATION: Department of Medicine and Public Health, Unit of Infectious
Diseases, Second University of Naples, Naples, Italy.
REFERENCE: Trans R Soc Trop Med Hyg 2003 Sep-Oct 97(5):559-60
We describe a case of Mediterranean visceral leishmaniasis (VL) in a
patient with pre-existing chronic hepatitis C, which caused high
hepatitis C virus (HCV) plasma concentration and was followed by a
rapidly growing hepatocellular carcinoma (HCC). The high HCV load was
drastically and persistently reduced soon after treatment with liposomal
amphotericin B suggesting a cause-effect interaction. Some data suggest
that liposomal amphotericin B may have an immunomodulatory effect. VL
may directly affect the liver function, but HCC has never been reported
as a consequence of the disease. This case suggests that VL causes an
increase in HCV replication, but, although the growth of the HCC can be
defined as exceptional, a relationship with VL is not proven.
********************************************************************************************************************
The following references are revised files and are brought to you in accordance
to license agreement with the NLM.
********************************************************************************************************************
PMID: 12360815
TITLE: [Skin manifestations of parasites in occupational diseases]
AUTHORS: A Ioli, L Lo Giudice, C Fenga
AFFILIATION: Dipartimento di Medicina Sociale del Territorio, Università degli
Studi di Messina.
REFERENCE: G Ital Med Lav Ergon 2002 Jul-Sep 24(3):202-4
PMID: 9480022
TITLE: [The biological activity of the transfer factor induced by bacterial
antigens]
AUTHORS: T A Liubchenko, O H Holeva, L S Kholodna, V V Smirnov, A Iu Vershyhora
REFERENCE: Mikrobiol Z 1997 Sep-Oct 59(5):83-100
Today's statement of transfer factor, an immunostimulator derived from
leukocytes which enhances antiinfectious immunity, is observed in the
review. Basic biological, physical and chemical characteristics of the
transfer factor, its possible action mechanisms, and laboratory and
clinical methods of use to cure infectious fungal (Candida, Coccidium),
invasive (schistosomiasis, leishmaniasis, cryptosporidiosis), viral (
varicella zoster, ophthalmic herpes, Herpes simplex types 1 and 2, H.
zoster, H. simplex ceratitis, genital herpes, human herpes virus type 6
, postherpetic neuritis, hepatitis B, AIDS), and bacterial infections (
Mycobacterium leprae, M. tuberculosis, M. fortuitum, Salmonella cholerae
suis, S. dublin, S. Virchov, Brucella abortus, Actinobacillus
pleuropneumoniae, bacterial sepsis, Staphylococcus) are described.
PMID: 8668822
TITLE: [Dermatology in the tropics]
AUTHORS: A Tapia Collantes
AFFILIATION: La Escuela de Medicina de la Universidad de Panamá.
REFERENCE: Rev Med Panama 1995 Sep 20(3):65-71
The Author reviews the cases diagnosed in the Republic of Panama of
Mycetoma, Paracoccidioidosis, Lobo's disease, Chromomycosis,
Histoplasmosis, Rhinosporidiosis, Sporotrichosis, Lepra, Rhinoscleroma,
and cutaneous and mucocutaneous Leishmaniasis, and mentions the observed
clinical manifestations in order to familiarize young physicians with
the tropical dermatopathology which occurs in the rural areas of the
country.
PMID: 1439001
TITLE: [Cloning of kDNA minicircles in different species of Leishmania and its
use as probes for diagnosis]
AUTHORS: J M Pascale, O E Sousa, U López
AFFILIATION: Centro de Investigación y Diagnóstico de Enfermedades
Parasitarias (CIDEP), Facultad de Medicina, Universidad de Panamá.
REFERENCE: Rev Med Panama 1992 Sep 17(3):163-72
The present study describes the cloning procedure for fragments of
kinetoplast DNA minicircles from different Leishmania species and its
use for detecting the presence of these parasites. Our methodology was
as follow: the DNA of the kinetoplast from Leishmania mexicana
amazonensis and Leishmania braziliensis panamensis was extracted,
purified and digested with the enzyme Dra I. These fragments were cloned
in the site for Hinc II in the plasmid pKS. E. coli was the bacterial
strain used for transforming and amplifying the cloned fragments; the
selection was carried out in LB medium supplemented with ampicillin.
With the clones suspected to be positives we run a Southern blot and
total kDNA, from each Leishmania species, was used as hybridization
probe. Finally, the cloned purified fragments were tested as diagnostic
probes against kDNA from eleven different species of Leishmania and one
of Trypanosoma cruzi parasites. After cloning, transforming, amplifying
and selecting, we obtained two probes of fragments of kDNA minicircles:
one from L. m. amazonensis and the other from L. b. panamensis. Both
probes showed high sensitivity for diagnosing cutaneous Leishmania
complexes (Mexicana or Braziliensis); however, we observed a low grade
crossreaction between some species belonging to the same complex. It is
necessary to continue studies in order to obtain subfragments of these
probes with a higher grade of specificity at the level of species and
subspecies.
PMID: 2392575
TITLE: [Evaluation of the development of immunologic response in patients with
cutaneous leishmaniasis]
AUTHORS: P F de Carreira, M O Suárez, J M Pascale, O E Sousa
AFFILIATION: Centro de Investigación y Diagnóstico de Enfermedades
Parasitarias, Facultad de Medicina, Universidad de Panamá.
REFERENCE: Rev Med Panama 1990 May 15(2):119-26
In this study we present epidemiological and immunological data about
cutaneous Leishmaniasis in Panama, in an area where recurrence occurs in
65% of the cases evaluated. The development of the cellular immune
response, during clinical evolution of primary and recurrent cases,
indicates that initial stimulation index (SI) less than 3 are observed
in recurrent cases, while this level is higher than 3 in primary cases.
The humoral immune response is related only with the time of clinical
evolution. We point out the importance of looking at the population of T
lymphocytes quantitatively, as well as looking at the levels of
lymphokines, in order to explain the differences that we observed in the
cellular immune response.
PMID: 2727332
TITLE: [Mucocutaneous leishmaniasis in Panama. Etiologic agent, epidemiologic
and clinical aspects]
AUTHORS: R E Sáenz, H M Paz, G C de Rodriguez, A M de Vásquez, R E Mata, C M
Johnson
REFERENCE: Rev Med Panama 1989 Jan 14(1):6-15
More information about the Leish-l
mailing list