[Leish-l] Fwd:Leishmaniasis, human - Spain

[fred opperdoes]

> Date: Sat, 12 Jun 2010 13:37:18 -0400 (EDT)
> From: ProMED-mail <promed-ahead-edr at promed.isid.harvard.edu>
> Subject: PRO/AH/EDR> Leishmaniasis, human - Spain
> 
> LEISHMANIASIS, HUMAN - SPAIN
> ****************************
> A statement by ProMED-mail
> <http://www.promedmail.org>
> ProMED-mail is a program
> International Society for Infectious Diseases
> <http://www.isid.org>
> 
> Date: 10 Jun 2010
> Source: Lukoran, Spain [in Spanish, trans. Corr.SB, edited]
> <http://www.lukor.com/ciencia/noticias/1006/09162234.htm>
> 
> 
> Leishmaniasis is increasing in Spain
> - ------------------------------------
> Between 20 and 80 people each year suffer from a severe infection of  
> leishmaniasis, a disease that is transmitted from animal -- mostly  
> dogs -- to humans, causing fever and swollen liver and spleen and is  
> fatal in up to 5 percent of cases experts said this Wednesday at the  
> Infectopatología Course II, held this week in Madrid.
> 
> As explained by the representative of the Center for Infectious  
> Diseases and International Health in Malaga and co-coordinator of the  
> conference, Dr. Fernando Farinas, this disease has become in recent  
> years on a "forgotten disease" despite the sandfly which transmits it  
> being endemic in Spain and infecting 5 of every hundred dogs per year  
> (possibly more).
> 
> Leishmaniasis is a zoonotic disease -- a condition shared by dogs and  
> humans, not transmitted by direct contact between man and animal but  
> through insect vectors which become infected after biting the main  
> reservoir of the parasite, the dog.
> 
> On the human side, leishmaniasis is particularly virulent in  
> immunocompromised patients (HIV, cancer or malnutrition mainly) and  
> may occur in 2 forms: the visceral, more serious and the cutaneous,  
> more benign and prevalent, that manifests itself through skin ulcers,  
> which are often confused with psoriasis.
> 
> The latter option is worryingly under-diagnosed in Spain, says Dr  
> Farinas, something that is making it easier for parasites to develop  
> "hyper-resistance" to the drugs most commonly used against them.  
> However, Spain has effective new medicines to eliminate these  
> pathogens [but see comment below].
> 
> This infectious disease specialist has said you cannot neglect the  
> research side of this disease, "it has been detected in patients with  
> HIV [infection] when the human is both reservoir and victim, without  
> the dog."
> 
> An extended illness all over Spain
> - ----------------------------------
> Regarding the incidence of canine leishmaniasis, regions in Spain most  
> affected so far are Andalusia, Palme Mallorca, Valencia and Catalonia.  
> However, in recent years it has been shown that not only the typical  
> Mediterranean climate zones are prone to the disease. According to the  
> latest data, areas of northern Spain are registering more and more  
> cases of dogs affected by leishmaniasis. In the Basque Country,  
> Galicia and Madrid, infections in dogs have increased 50 percent in  
> the last 15 years.
> 
> The head of the Department of Parasitology and Parasitic Diseases of  
> the Universidad Complutense de Madrid, Guadalupe Miro, stressed that  
> "only 5 percent of dogs are diagnosed with this disease, when in fact  
> about 60 percent are infected.
> 
> - --
> Communicated by:
> ProMED-mail
> <promed at promedmail.org>
> 
> [Leishmaniasis is endemic in Spain with dogs as the main reservoir, as  
> is also the case in Portugal, southern France, Italy, Malta and  
> Greece. A special concern is the association between clinical  
> leishmaniasis and immunosuppression e.g. HIV-infection or organ  
> transplants. A recent review reported more than 2000 such cases from  
> southern Europe over the past 10 years (Alvar J et al. The  
> relationship between leishmaniasis and AIDS: the second 10 years. Clin  
> Microbiol Rev. 2008;21:334-59). The role of dogs as reservoir in Spain  
> has also recently been reviewed (Miro G et al. Canine  
> leishmaniasis--new concepts and insights on an expanding zoonosis:  
> part two. Trends Parasitol. 2008;24:371-7).
> 
> Clearly, leishmaniasis is a increasing zoonotic infection in southern  
> Europe, which must be considered in cases with unexplained cutaneous  
> symptoms, long term low grade fever, weight loss and splenomegaly. -  
> Mod.EP]
> 
> ["[The disease is] under-diagnosed in Spain ... something that is  
> making it easier for parasites to develop "hyper-resistance" to the  
> drugs most commonly used against them" seems to be a non sequitur. If  
> the disease is not being diagnosed, it is not being treated with  
> specific drugs (pentavalent antimonials, pentamidine) therefore cannot  
> develop resistance to them. - Mod.JW]
> 
> [see also:
> 2009
> - ----
> Leishmaniasis - UK: imported 20091125.4049
> 2004
> - ----
> Leishmaniasis, dog reservoir - Spain 20040524.1388
> 2000
> - ----
> Leishmaniasis - Germany ex Spain 20000725.1236
> 1999
> - ----
> Leishmaniasis, visceral & HIV - Europe (SW) 19991106095248
> Leishmaniasis, visceral & HIV - Europe (SW) (03) 19991118221651
> 1997
> - ----
> Leishmaniasis, canine - Italy (02) 970411151032]
> ...................sb/ep/ejp/jw
> 
> ------------------------------
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