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<div dir="ltr"><font face="Times New Roman" color="#000000" size="3">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
<strong><em><font color="#ff0000">Lutzomyia</font></em></strong> as mentioned correctly below or a
<em>Phlebotomus</em><em>.</em> The environmental or climatic changes that affect mosquitoes might have affected the sand flies and lead to the emergence of the disease.</font></div>
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<div dir="ltr"><font face="times new roman">Prof. Laila Nimri</font></div>
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<font face="Tahoma" size="2"><b>From:</b> leish-l-bounces@lineu.icb.usp.br [leish-l-bounces@lineu.icb.usp.br] On Behalf Of fred opperdoes [fred.opperdoes@uclouvain.be]<br>
<b>Sent:</b> Thursday, February 26, 2009 8:21 AM<br>
<b>To:</b> Leish-l@lineu.icb.usp.br<br>
<b>Subject:</b> [Leish-l] Leishmaniasis - Argentina: epidemic potential<br>
</font><br>
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<blockquote class="" type="cite"><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/" target="_blank">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/" target="_blank">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" target="_blank">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 <strong><font color="#ff0000">caused by a mosquito-borne parasite</font></strong>. <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>
_<strong><font color="#ff0000"><em>Lutzomyia</em>_ insects</font></strong> <font color="#ff0000">
<strong>infect </strong></font>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 <strong><font color="#ff0000">mosquito <br>
vector for visceral leishmaniasis</font></strong> 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 <strong><u><font color="#ff0000">mosquito-borne diseases</font></u></strong>. 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 <font color="#ff0000"><strong>mosquito vector</strong></font> 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" target="_blank">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 <em>et al</em>. 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" target="_blank">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>
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