[Leish-l] RES: name

[Sinval Pinto Brandão Filho]

Recently a group of WHO experts worked in Genève in the revision and up-to-dating of the Control of Leishmaniasis WHO Manual (Technical report series, last edition of 1990). Perhaps would be interesting hear the opinion of whom participated in this work about the names of VL that will be include in the next edition. I also suggest an little session to discuss this matter in next Worldleish5 program will be held in Brazil.
Regards,
Sinval


-----Mensagem original-----
De: Patrick BOURDEAU [mailto:patrick.bourdeau at oniris-nantes.fr] 
Enviada em: quarta-feira, 21 de abril de 2010 08:43
Para: Dr.Basu Pandey
Cc: leish-l at lineu.icb.usp.br; Sinval Pinto Brandão Filho
Assunto: Re: [Leish-l] name

Dear colleagues

The discussion about signification of "kala azar" was very interesting 
and informative  although a consensus should be made on an international 
use.


1) Every terminology of a disease should tend to be as precise as 
possible (we do not speak about syndrome) = As narrow as possible  = A 
specific agent


2) A lot of disease have  (one or several ) historical name(s)  that is 
(are)  generally not anymore used  or even can be confusing (are we sure 
a unique agent was responsible ? or are we sure that different diseases 
are not due to the same agent?).
- A good example for instance in South America is Oroya fever and 
Verruga which is call now internationally bartonellosis even if  2 forms 
are known as synonyms.
- Who is today using "Chicago's disease or Gilchrist's disease   for 
Blastomycosis which is known not only in America  but also African 
continent? nobody : everybody use Blastomycosis

3) clearly "Kala azar" was indicated by the first physicians that  
studied this diseasase  as "Black fever " as a translation of "Kala 
azar" in relationship with the "darkened" skin areas observed ( true 
"hyperpigmentation" histopathologicaly meaning?), even if in fact in the 
original  "feeling" of indian population the terminology could have 
been  in a way for a "lethal" condition?

4) The terminology of kala Azar was "then" imported in mediterranean 
area to described  "mediterranean  kala azar" not because it was a 
"darkening" disease but because it was another  "Visceral disease " 
caused by a very similar agent.

5) However  big differences : 
Not only L infantum cases have not been typically associated with 
darkening ( even it can be present is some cases, is there a role with 
the initial darkening of the skin of the ethnies) of the skin but also 
the disease is "clearly zoonotic" whereas indian disease is  not.

Problably the term was  exported to south  America for Leishmania 
chagasi and popularized as "calazar" but this is certainly not  an 
"original" local term  and, here again,  it is a zoonotic visceral 
disease ( L chagasi = L. infantum). These two similar diseases are  
consequently quite different in many aspects ("history" but also nature 
and epidemiology) from the initial disease in India.

5) So in respect to points 1-2-3      "visceral leismaniasis" is 
probably the best terminology to promote  (followed by the name of 
agent)  and "kala azar"  only a "synonym" to  keep for its specific 
agent L. donovani  (and even only about the indian area because it 
includes all the corresponding epidemiological factors linked not 
necessarily found in other places, and what coule mean a "black" fever 
in sudanese people???) .

It could be consequnetly  clear for everybody that "kal azar"  means 
(equals) "cases of  L. donovani disease in humans in India".

The term "Mediterranean kala azar" is now not recommended or even banned 
from many of parasitologists teams and colleagues working  for a long 
time on this disease in Europe (to avoid all these confusions).

6) Moreover visceral leshmaniAsis should be restricted to the human 
condition whereas in veterinary field 
a) in general terminology recommend and ending with osis and not iasis
b) the disease is not only internal (visceral) but typically also 
"external" (a "skin disease" is even the first or chief complain 
initially ) and is consquently very difrenet and a generalized  disease

This  appropriate name which is now "progressively" accepted by an 
increasing number of clinician or veterinary parasitologists is : Canine 
LeishmaniOsis or even better "Canine Generalized Leishmaniosis".


Patrick BOURDEAU
Prof. Parasitology/Dermatology/Mycology
Dip EVPC - Dip ECVD
Unit of Dermatologye/Parasitology/Mycology
Veterinary school Oniris Nantes




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