[Leish-l] Leishmaniasis - Argentina: epidemic potential

Thu Feb 26 12:30:20 BRT 2009

I wrote to Dr. Salomon as follows:

Dear Dr. Salomon,

Thank you so much for your active participation in WorldLeish4, held early this month in India, by presenting two papers on VL and CL in Argentina as well as chairing the session of Epidemiology in America.  I look forward to your continuing support by active participation in the future WLs.

The message I received below reminded me of you as the leishmaniac I should contact to point out the mistake in the write-up (in red). I also take the liberty of CC this message to Professor Roberto Docampo who is an outstanding researcher originally from Argentina. I have had the good fortune of acquaintance with Roberto as a friend and collaborator for many years. You may have already worked together with Roberto and/or his associates toward the resolution of leishmaniasis in Argentina.

My best regards.

KP

________________________________

From: leish-l-bounces at lineu.icb.usp.br [mailto:leish-l-bounces at lineu.icb.usp.br] On Behalf Of fred opperdoes
Sent: Thursday, February 26, 2009 4:44 AM
To: BobKillick-Kendrick; leish-l at lineu.icb.usp.br
Subject: Re: [Leish-l] Leishmaniasis - Argentina: epidemic potential

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 <mailto:fred.opperdoes at uclouvain.be> 

	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 <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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