[Leish-l] Leishmaniasis - Argentina: epidemic potential

Thu Feb 26 07:43:49 BRT 2009

Dear Bob,
Thank you for the comment which I think is very useful. Please note  
that I am not the author of this article. It was forwarded from the  
ProMed mailing list because I thought it might be of interest to  
everybody working in this field.
With best wishes,
Fred
On Feb 26, 2009, at 11:16 AM, BobKillick-Kendrick wrote:

> Dear Fred,
>     Thank you for this account. I didn't know leishmaniasis was  
> transmitted by a mosquito! I thought it was a sand fly!
>     The killing of infected dogs does is not a feasible means of  
> reducing the risk of infection. Far better is to use an insecticide- 
> impregnated dog collar to reduce contact between sand flies and dogs.
>     Best wishes,
>     Bob
> ----- Original Message -----
> From: fred opperdoes
> To: Leish-l at lineu.icb.usp.br
> Sent: Thursday, February 26, 2009 7:21 AM
> Subject: [Leish-l] Leishmaniasis - Argentina: epidemic potential
>
>> 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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