<html><body style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space; "><blockquote type="cite" class=""><span class="Apple-style-span" style="color: rgb(0, 0, 0); ">Date: Wed, 25 Feb 2009 21:23:15 -0500 (EST)<br>From: ProMED-mail <<a href="mailto:promed@promed.isid.harvard.edu">promed@promed.isid.harvard.edu</a>><br>Subject: PRO/AH/EDR> Leishmaniasis - Argentina: epidemic potential<br><br>LEISHMANIASIS - ARGENTINA: EPIDEMIC POTENTIAL<br>***********************************************<br>A ProMED-mail post<br><<a href="http://www.promedmail.org/">http://www.promedmail.org</a>><br>ProMED-mail is a program of the<br>International Society for Infectious Diseases<br><<a href="http://www.isid.org/">http://www.isid.org</a>><br><br>Date: Tue 24 Feb 2009<br>Source: Datachaco.com [trans. Mod JGM, edited]<br><<a href="http://datachaco.com/noticia.php?numero=17399">http://datachaco.com/noticia.php?numero=17399</a>><br><br><br>The occurrence of cases of yellow fever made people pay attention to <br>mosquito-borne diseases, and dengue fever, which is currently <br>attacking with unusual strength in Paraguay, set another alarm in <br>Chaco, Corrientes, and Misiones provinces, which share borders with <br>Paraguay and Bolivia.<br><br>However, a new emerging disease has become the main epidemic threat <br>in Argentina: Visceral leishmaniasis. This little known disease is <br>being analyzed now as a cause for a sanitary red alert in Argentina.<br><br>Visceral leishmaniasis is also caused by a mosquito-borne parasite. <br>There is no vaccine for this disease, and therapy is instituted only <br>once a case is clearly defined. Its mortality rate is around 8 per <br>cent, and it has a particular feature: Dogs may act as reservoirs for <br>the parasite.<br><br>A summary of the life cycle of the parasite indicates that <br>_Lutzomyia_ insects infect dogs. These animals develop the disease <br>and transmit the parasite to another insect vector, which now is <br>capable of transmitting visceral leishmaniasis to humans. There is no <br>human-to-human transmission.<br><br>Since the very 1st case was reported in 2006, 36 persons have been <br>affected, and there are 4 deceased patients. The possibility of a <br>rapid increase in the number of cases is a reason for concern.<br><br>Last week 2 cases of visceral leishmaniasis were reported in Posadas. <br>One is an 18-year-old woman, and the other is a 21-year-old man, who <br>separately developed the symptoms of the disease. Some personnel from <br>the army are currently collaborating with municipal authorities in <br>Posadas for cleaning wastelands, which are considered breeding places <br>for insect vectors.<br><br>This health problem has become quite dangerous and important in the <br>main cities in Misiones province, and specialists warn that the <br>disease may reach other provinces in the short term.<br><br>"We are observing that the vector is spreading fast, and 2 corridors <br>have been established, one directing towards Resistencia and the <br>other one towards Corrientes. Also, the northern area of Entre Rios, <br>as well as Santa Fe, and Cordoba are vulnerable places. The mosquito <br>vector for visceral leishmaniasis has become an urban-living insect, <br>so there is a substantial risk for its presence in big urban <br>centers," explained Dr. Daniel Salomon, from the National Center for <br>Epidemics in Argentina's Ministry of Health.<br><br>"It is quite difficult to implement preventive measures, because <br>people are so in love with their pets," commented Dr. Salomon. There <br>are very few options for controlling the spread of the disease apart <br>from sacrificing sick animals.<br><br>In 2004, the 1st dog infected with the causative agent of visceral <br>leishmaniasis was detected. When 40 cases were reported in Misiones <br>province, the Ministry of Health issued a red alert. Nonetheless, the <br>current situation is much worse. In Posadas, it was determined that <br>7000 dogs actually have the parasite. Additionally, there are 300 <br>infected dogs in Corrientes, and it is worth mentioning that in its <br>capital city, there are thousands of homeless dogs considered to be <br>infected with the parasite.<br><br>The analysis of the experience from Brazil and Paraguay indicates <br>that there is a probability of having one person infected for every <br>60 infected dogs. There is a high risk for an epidemic.<br><br>Sanitary authorities recommend that pets must not be carried to the <br>areas considered to be at risk. It is also advisable not to transport <br>dogs from the affected regions to other areas in the country. The <br>idea is to cut the transmission cycle of the parasite. Those persons <br>who may visit the northern part of Argentina must be immunized <br>against yellow fever as an ordinary preventive measure, and they must <br>leave their pets at home as an additional preventive measure.<br><br>"Visceral leishmaniasis was present in the northern part of South <br>America until migrating workers started moving it towards the south. <br>In early 2000, there were some important outbreaks in Campo Grande do <br>Sul and in Asuncion, where the average number of persons infected is <br>around 70 per year. In Brazil there are around 4000 cases and 200 <br>deaths per year," pointed out Dr. Salomon, who had been doing some <br>field work during the past few weeks in the Litoral provinces.<br><br>He also added: "There is a trend for an increase in visceral <br>leishmaniasis, so the disease may spread, and it is expected to have <br>more cases."<br><br>Climate changes and deforesting seem to be the main explanations for <br>the migration of mosquito-borne diseases. However, trying to justify <br>the occurrence of emergent diseases only because of reasons inherent <br>to nature itself may exonerate provincial and municipal authorities <br>for not complying with their obligations with respect to the <br>implementation of disease control programs and cleaning empty lots.<br><br>Consequently, now there are many public accusations between Misiones, <br>Corrientes, and Chaco health officers. These persons, now that there <br>are cases of visceral leishmaniasis, immediately try to explain that <br>transmission may have taken place outside their respective <br>jurisdictions. The clear point is that the mosquito vector appears <br>because of lack of public hygiene.<br><br>- --<br>Communicated by:<br>ProMED-mail <<a href="mailto:promed@promedmail.org">promed@promedmail.org</a>><br><br>[Leishmaniasis has been slowly spreading in northern Argentina over <br>the past decades (Salomon O et al. First visceral leishmaniasis focus <br>in Argentina. Mem Inst Oswaldo Cruz. 2008;103:109-11<br><<a href="http://www.ncbi.nlm.nih.gov/pubmed/18368242?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum">http://www.ncbi.nlm.nih.gov/pubmed/18368242?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum</a>>).<br><br>The ecology of the vector has been changing, and increasing <br>urbanization has been suggested as one of the explanations (Salomon <br>OD et al. Phlebotominae (Diptera: Psycodidae) fauna in the Chaco <br>region and Cutaneous Leishmaniasis transmission patterns in <br>Argentina. Mem Inst Oswaldo Cruz. 2008;103:578-84<br><<a href="http://www.ncbi.nlm.nih.gov/pubmed/18949328?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum">http://www.ncbi.nlm.nih.gov/pubmed/18949328?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum</a>>).<br> - Mod.EP]</span></blockquote></body></html>