[Leish-l] Leishmaniasis - Argentina: epidemic potential

fred opperdoes fred.opperdoes at uclouvain.be
Thu Feb 26 03:21:41 BRT 2009


> Date: Wed, 25 Feb 2009 21:23:15 -0500 (EST)
> From: ProMED-mail <promed at promed.isid.harvard.edu>
> Subject: PRO/AH/EDR> Leishmaniasis - Argentina: epidemic potential
>
> LEISHMANIASIS - ARGENTINA: EPIDEMIC POTENTIAL
> ***********************************************
> A ProMED-mail post
> <http://www.promedmail.org>
> ProMED-mail is a program of the
> International Society for Infectious Diseases
> <http://www.isid.org>
>
> Date: Tue 24 Feb 2009
> Source: Datachaco.com [trans. Mod JGM, edited]
> <http://datachaco.com/noticia.php?numero=17399>
>
>
> The occurrence of cases of yellow fever made people pay attention to
> mosquito-borne diseases, and dengue fever, which is currently
> attacking with unusual strength in Paraguay, set another alarm in
> Chaco, Corrientes, and Misiones provinces, which share borders with
> Paraguay and Bolivia.
>
> However, a new emerging disease has become the main epidemic threat
> in Argentina: Visceral leishmaniasis. This little known disease is
> being analyzed now as a cause for a sanitary red alert in Argentina.
>
> Visceral leishmaniasis is also caused by a mosquito-borne parasite.
> There is no vaccine for this disease, and therapy is instituted only
> once a case is clearly defined. Its mortality rate is around 8 per
> cent, and it has a particular feature: Dogs may act as reservoirs for
> the parasite.
>
> A summary of the life cycle of the parasite indicates that
> _Lutzomyia_ insects infect dogs. These animals develop the disease
> and transmit the parasite to another insect vector, which now is
> capable of transmitting visceral leishmaniasis to humans. There is no
> human-to-human transmission.
>
> Since the very 1st case was reported in 2006, 36 persons have been
> affected, and there are 4 deceased patients. The possibility of a
> rapid increase in the number of cases is a reason for concern.
>
> Last week 2 cases of visceral leishmaniasis were reported in Posadas.
> One is an 18-year-old woman, and the other is a 21-year-old man, who
> separately developed the symptoms of the disease. Some personnel from
> the army are currently collaborating with municipal authorities in
> Posadas for cleaning wastelands, which are considered breeding places
> for insect vectors.
>
> This health problem has become quite dangerous and important in the
> main cities in Misiones province, and specialists warn that the
> disease may reach other provinces in the short term.
>
> "We are observing that the vector is spreading fast, and 2 corridors
> have been established, one directing towards Resistencia and the
> other one towards Corrientes. Also, the northern area of Entre Rios,
> as well as Santa Fe, and Cordoba are vulnerable places. The mosquito
> vector for visceral leishmaniasis has become an urban-living insect,
> so there is a substantial risk for its presence in big urban
> centers," explained Dr. Daniel Salomon, from the National Center for
> Epidemics in Argentina's Ministry of Health.
>
> "It is quite difficult to implement preventive measures, because
> people are so in love with their pets," commented Dr. Salomon. There
> are very few options for controlling the spread of the disease apart
> from sacrificing sick animals.
>
> In 2004, the 1st dog infected with the causative agent of visceral
> leishmaniasis was detected. When 40 cases were reported in Misiones
> province, the Ministry of Health issued a red alert. Nonetheless, the
> current situation is much worse. In Posadas, it was determined that
> 7000 dogs actually have the parasite. Additionally, there are 300
> infected dogs in Corrientes, and it is worth mentioning that in its
> capital city, there are thousands of homeless dogs considered to be
> infected with the parasite.
>
> The analysis of the experience from Brazil and Paraguay indicates
> that there is a probability of having one person infected for every
> 60 infected dogs. There is a high risk for an epidemic.
>
> Sanitary authorities recommend that pets must not be carried to the
> areas considered to be at risk. It is also advisable not to transport
> dogs from the affected regions to other areas in the country. The
> idea is to cut the transmission cycle of the parasite. Those persons
> who may visit the northern part of Argentina must be immunized
> against yellow fever as an ordinary preventive measure, and they must
> leave their pets at home as an additional preventive measure.
>
> "Visceral leishmaniasis was present in the northern part of South
> America until migrating workers started moving it towards the south.
> In early 2000, there were some important outbreaks in Campo Grande do
> Sul and in Asuncion, where the average number of persons infected is
> around 70 per year. In Brazil there are around 4000 cases and 200
> deaths per year," pointed out Dr. Salomon, who had been doing some
> field work during the past few weeks in the Litoral provinces.
>
> He also added: "There is a trend for an increase in visceral
> leishmaniasis, so the disease may spread, and it is expected to have
> more cases."
>
> Climate changes and deforesting seem to be the main explanations for
> the migration of mosquito-borne diseases. However, trying to justify
> the occurrence of emergent diseases only because of reasons inherent
> to nature itself may exonerate provincial and municipal authorities
> for not complying with their obligations with respect to the
> implementation of disease control programs and cleaning empty lots.
>
> Consequently, now there are many public accusations between Misiones,
> Corrientes, and Chaco health officers. These persons, now that there
> are cases of visceral leishmaniasis, immediately try to explain that
> transmission may have taken place outside their respective
> jurisdictions. The clear point is that the mosquito vector appears
> because of lack of public hygiene.
>
> - --
> Communicated by:
> ProMED-mail <promed at promedmail.org>
>
> [Leishmaniasis has been slowly spreading in northern Argentina over
> the past decades (Salomon O et al. First visceral leishmaniasis focus
> in Argentina. Mem Inst Oswaldo Cruz. 2008;103:109-11
> <http://www.ncbi.nlm.nih.gov/pubmed/18368242?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum 
> >).
>
> The ecology of the vector has been changing, and increasing
> urbanization has been suggested as one of the explanations (Salomon
> OD et al. Phlebotominae (Diptera: Psycodidae) fauna in the Chaco
> region and Cutaneous Leishmaniasis transmission patterns in
> Argentina. Mem Inst Oswaldo Cruz. 2008;103:578-84
> <http://www.ncbi.nlm.nih.gov/pubmed/18949328?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum 
> >).
>  - Mod.EP]
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