[Leish-l] Leishmaniasis - Argentina: epidemic potential

Marco Tulio Antonio Garcÿffffeda-Zapata mctulian at yahoo.com.br
Thu Mar 26 09:37:10 BRT 2009


To: all
The diseases don't have frontiers 
The climatic changes, the population migration and the increase of the deforestation of the forests, among other factors are constant concerns and of risk in the transmission of diseases transmitted by Phlebotomus.
Here, it is discussed the situation of the Visceral Leishmaniasis in Argentina, probably an expansion of the same from Brazil and that it already arrived in Paraguay. 
Another situation, more preoccupying still is happening after the end of the construction of the inter-oceanic highway (Pacific Ocean à Atlantic Ocean), that crosses the borders of three countries of South America , Peru - Bolivia - Brazil, and that began to generate local and international problems of several type. 
Among them, the exchange of diseases before inexistent in those countries. Some as a result of the passage of transmitter insects, as certain Phlebotomus (Lutzomyia sp), before impeded of arriving to the western Amazonian forest, for the presence of the Andean cordillera. 
Some of those species are responsible for the transmission of the Leishmaniasis. Other, however, can also transmit the Bartonella bacilliformis àCarrion’s Disease or Oroya Fever (ISOPS IV, 2002) responsible for two clinics different forms, an hemolytic anemia, that can be lethal, and another one characterized by a cutaneous eruption that can be disseminated 
Studies in process (MAP’ s initiatives) in the area begin to reveal the presence of some Phlebotomus species involved in the transmission of this disease (XLV  Brazilian Society of Tropical Medicine Meeting, 2009). 
These facts are evidence that the diseases don't have borders. And they are an alert sign so that the sanitary authorities, national and international, implant and implement appropriate measures seeking to avoid the expansion of such diseases. This event is a “bomb of time.” 
 
Marco Tulio A. García-Zapata, MD, PhD 
Tropicologist / Full Professor / Principal Researcher
Research Nucleus about (Re)Emergents Diseases Agents
International and Travellers Medicine Center
Caixa Postal 12911 - Setor Leste Vila Nova - 74643-970 - Goiania-GO, BRAZIL 
Phones: Work (+62) 3269-8219; Fax: (+62) 3269-8219; 3521-1839 
E-mail: mctulian at yahoo.com.br, mctulian1 at hotmail.com; zapata at iptsp.ufg.br 

---------------------------------------

To: all
 
By the way, what is the right English writing: sand fly or sandfly? Is it a matter of England vs. US?
 
Carlos H.
2009/3/21 Chang, Kwang-Poo <KwangPoo.Chang at rosalindfranklin.edu>
To: Prof. Laila Nimri and all
 
The issue appears to be a language translation problem. I was told that all blood sucking flies are referred to as “mosquito” in Spanish.
 
KP
 



From: leish-l-bounces at lineu.icb.usp.br [mailto:leish-l-bounces at lineu.icb.usp.br] On Behalf Of Laila Nimri
Sent: Thursday, February 26, 2009 1:53 AM
To: fred opperdoes; Leish-l at lineu.icb.usp.br
Subject: Re: [Leish-l] Leishmaniasis - Argentina: epidemic potential
 
Just to correct a very important information about the vector of Visceral leishmaniasis, it is definitely not a mosquito, it is a sand fly of the genus Lutzomyia as mentioned correctly below or a Phlebotomus. The environmental or climatic changes that affect mosquitoes might have affected the sand flies and lead to the emergence of the disease.
 
Prof. Laila Nimri



From: leish-l-bounces at lineu.icb.usp.br [leish-l-bounces at lineu.icb.usp.br] On Behalf Of fred opperdoes [fred.opperdoes at uclouvain.be]
Sent: Thursday, February 26, 2009 8:21 AM
To: Leish-l at lineu.icb.usp.br
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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