<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:st1="urn:schemas-microsoft-com:office:smarttags" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=us-ascii">
<meta name=Generator content="Microsoft Word 11 (filtered medium)">
<!--[if !mso]>
<style>
v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style>
<![endif]--><o:SmartTagType
namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="PlaceType"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="PlaceName"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="City"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="country-region"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="place"/>
<!--[if !mso]>
<style>
st1\:*{behavior:url(#default#ieooui) }
</style>
<![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman";}
a:link, span.MsoHyperlink
{color:blue;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{color:blue;
text-decoration:underline;}
p
{margin:0in;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman";}
span.EmailStyle21
{mso-style-type:personal-reply;
font-family:Arial;
color:navy;}
@page Section1
{size:8.5in 11.0in;
margin:1.0in 1.25in 1.0in 1.25in;}
div.Section1
{page:Section1;}
-->
</style>
</head>
<body lang=EN-US link=blue vlink=blue ocsi=x>
<div class=Section1>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>To: Prof. Laila Nimri and all<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>The issue appears to be a language
translation problem. I was told that all blood sucking flies are referred to as
“mosquito” in Spanish.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>KP<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'>
leish-l-bounces@lineu.icb.usp.br [mailto:leish-l-bounces@lineu.icb.usp.br] <b><span
style='font-weight:bold'>On Behalf Of </span></b>Laila Nimri<br>
<b><span style='font-weight:bold'>Sent:</span></b> Thursday, February 26, 2009
1:53 AM<br>
<b><span style='font-weight:bold'>To:</span></b> fred opperdoes;
Leish-l@lineu.icb.usp.br<br>
<b><span style='font-weight:bold'>Subject:</span></b> Re: [Leish-l]
Leishmaniasis - <st1:country-region w:st="on"><st1:place w:st="on">Argentina</st1:place></st1:country-region>:
epidemic potential</span></font><o:p></o:p></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'>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 </span></font><em><b><i><font
color=red face="Times New Roman"><span style='color:red;font-weight:bold'>Lutzomyia</span></font></i></b></em><font
color=black><span style='color:black'> as mentioned correctly below or a <em><i><font
face="Times New Roman">Phlebotomus.</font></i></em> The environmental or
climatic changes that affect mosquitoes might have affected the sand flies and
lead to the emergence of the disease.</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Prof. Laila Nimri<o:p></o:p></span></font></p>
</div>
<div id=divRpF415679>
<div class=MsoNormal align=center style='text-align:center'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal style='margin-bottom:12.0pt'><b><font size=2 face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma;font-weight:bold'>From:</span></font></b><font
size=2 face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> 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><span style='font-weight:bold'>Sent:</span></b> Thursday, February 26, 2009
8:21 AM<br>
<b><span style='font-weight:bold'>To:</span></b> Leish-l@lineu.icb.usp.br<br>
<b><span style='font-weight:bold'>Subject:</span></b> [Leish-l] Leishmaniasis -
<st1:country-region w:st="on"><st1:place w:st="on">Argentina</st1:place></st1:country-region>:
epidemic potential</span></font><o:p></o:p></p>
</div>
<div>
<blockquote style='margin-top:5.0pt;margin-bottom:5.0pt' type=cite>
<p class=MsoNormal><span class=apple-style-span><font size=3 color=black
face="Times New Roman"><span style='font-size:12.0pt;color:black'>Date: Wed, 25
Feb 2009 21:23:15 -0500 (EST)</span></font></span><font color=black><span
style='color:black'><br>
<span class=apple-style-span>From: ProMED-mail <<a
href="mailto:promed@promed.isid.harvard.edu">promed@promed.isid.harvard.edu</a>></span><br>
<span class=apple-style-span>Subject: PRO/AH/EDR> Leishmaniasis - <st1:country-region
w:st="on"><st1:place w:st="on">Argentina</st1:place></st1:country-region>:
epidemic potential</span><br>
<br>
<span class=apple-style-span>LEISHMANIASIS - <st1:country-region w:st="on"><st1:place
w:st="on">ARGENTINA</st1:place></st1:country-region>: EPIDEMIC POTENTIAL</span><br>
<span class=apple-style-span>***********************************************</span><br>
<span class=apple-style-span>A ProMED-mail post</span><br>
<span class=apple-style-span><<a href="http://www.promedmail.org/"
target="_blank">http://www.promedmail.org</a>></span><br>
<span class=apple-style-span>ProMED-mail is a program of the</span><br>
<span class=apple-style-span>International Society for Infectious Diseases</span><br>
<span class=apple-style-span><<a href="http://www.isid.org/" target="_blank">http://www.isid.org</a>></span><br>
<br>
<span class=apple-style-span>Date: Tue 24 Feb 2009</span><br>
<span class=apple-style-span>Source: Datachaco.com [trans. Mod JGM, edited]</span><br>
<span class=apple-style-span><<a
href="http://datachaco.com/noticia.php?numero=17399" target="_blank">http://datachaco.com/noticia.php?numero=17399</a>></span><br>
<br>
<br>
<span class=apple-style-span>The occurrence of cases of yellow fever made
people pay attention to </span><br>
<span class=apple-style-span>mosquito-borne diseases, and dengue fever, which
is currently </span><br>
<span class=apple-style-span>attacking with unusual strength in <st1:country-region
w:st="on">Paraguay</st1:country-region>, set another alarm in </span><br>
<span class=apple-style-span>Chaco, <st1:City w:st="on">Corrientes</st1:City>,
and Misiones provinces, which share borders with </span><br>
<st1:country-region w:st="on"><span class=apple-style-span>Paraguay</span></st1:country-region><span
class=apple-style-span> and <st1:country-region w:st="on"><st1:place w:st="on">Bolivia</st1:place></st1:country-region>.</span><br>
<br>
<span class=apple-style-span>However, a new emerging disease has become the
main epidemic threat </span><br>
<span class=apple-style-span>in <st1:country-region w:st="on"><st1:place w:st="on">Argentina</st1:place></st1:country-region>:
Visceral leishmaniasis. This little known disease is </span><br>
<span class=apple-style-span>being analyzed now as a cause for a sanitary red
alert in <st1:place w:st="on"><st1:country-region w:st="on">Argentina</st1:country-region></st1:place>.</span><br>
<br>
<span class=apple-style-span>Visceral leishmaniasis is also </span></span></font><strong><b><font
color=red face="Times New Roman"><span style='color:red'>caused by a
mosquito-borne parasite</span></font></b></strong><span class=apple-style-span><font
color=black><span style='color:black'>. </span></font></span><font
color=black><span style='color:black'><br>
<span class=apple-style-span>There is no vaccine for this disease, and therapy
is instituted only </span><br>
<span class=apple-style-span>once a case is clearly defined. Its mortality rate
is around 8 per </span><br>
<span class=apple-style-span>cent, and it has a particular feature: Dogs may act
as reservoirs for </span><br>
<span class=apple-style-span>the parasite.</span><br>
<br>
<span class=apple-style-span>A summary of the life cycle of the parasite
indicates that </span><br>
<span class=apple-style-span>_</span></span></font><em><b><i><font color=red
face="Times New Roman"><span style='color:red;font-weight:bold'>Lutzomyia</span></font></i></b></em><strong><b><font
color=red face="Times New Roman"><span style='color:red'>_ insects</span></font></b></strong><span
class=apple-style-span><font color=black><span style='color:black'> </span></font></span><strong><b><font
color=red face="Times New Roman"><span style='color:red'>infect </span></font></b></strong><span
class=apple-style-span><font color=black><span style='color:black'>dogs. These
animals develop the disease </span></font></span><font color=black><span
style='color:black'><br>
<span class=apple-style-span>and transmit the parasite to another insect
vector, which now is </span><br>
<span class=apple-style-span>capable of transmitting visceral leishmaniasis to
humans. There is no </span><br>
<span class=apple-style-span>human-to-human transmission.</span><br>
<br>
<span class=apple-style-span>Since the very 1st case was reported in 2006, 36
persons have been </span><br>
<span class=apple-style-span>affected, and there are 4 deceased patients. The
possibility of a </span><br>
<span class=apple-style-span>rapid increase in the number of cases is a reason
for concern.</span><br>
<br>
<span class=apple-style-span>Last week 2 cases of visceral leishmaniasis were
reported in <st1:City w:st="on"><st1:place w:st="on">Posadas</st1:place></st1:City>. </span><br>
<span class=apple-style-span>One is an 18-year-old woman, and the other is a
21-year-old man, who </span><br>
<span class=apple-style-span>separately developed the symptoms of the disease.
Some personnel from </span><br>
<span class=apple-style-span>the army are currently collaborating with
municipal authorities in </span><br>
<st1:City w:st="on"><st1:place w:st="on"><span class=apple-style-span>Posadas</span></st1:place></st1:City><span
class=apple-style-span> for cleaning wastelands, which are considered breeding
places </span><br>
<span class=apple-style-span>for insect vectors.</span><br>
<br>
<span class=apple-style-span>This health problem has become quite dangerous and
important in the </span><br>
<span class=apple-style-span>main cities in Misiones province, and specialists
warn that the </span><br>
<span class=apple-style-span>disease may reach other provinces in the short
term.</span><br>
<br>
<span class=apple-style-span>"We are observing that the vector is
spreading fast, and 2 corridors </span><br>
<span class=apple-style-span>have been established, one directing towards <st1:City
w:st="on">Resistencia</st1:City> and the </span><br>
<span class=apple-style-span>other one towards <st1:City w:st="on"><st1:place
w:st="on">Corrientes</st1:place></st1:City>. Also, the northern area of Entre
Rios, </span><br>
<span class=apple-style-span>as well as <st1:City w:st="on">Santa Fe</st1:City>,
and <st1:City w:st="on"><st1:place w:st="on">Cordoba</st1:place></st1:City> are
vulnerable places. The </span></span></font><strong><b><font color=red
face="Times New Roman"><span style='color:red'>mosquito </span></font></b></strong><b><font
color=red><span style='color:red;font-weight:bold'><br>
<strong><b><font face="Times New Roman">vector for visceral leishmaniasis</font></b></strong></span></font></b><span
class=apple-style-span><font color=black><span style='color:black'> has become
an urban-living insect, </span></font></span><font color=black><span
style='color:black'><br>
<span class=apple-style-span>so there is a substantial risk for its presence in
big urban </span><br>
<span class=apple-style-span>centers," explained Dr. Daniel Salomon, from
the <st1:PlaceName w:st="on">National</st1:PlaceName> <st1:PlaceType w:st="on">Center</st1:PlaceType>
for </span><br>
<span class=apple-style-span>Epidemics in <st1:country-region w:st="on"><st1:place
w:st="on">Argentina</st1:place></st1:country-region>'s Ministry of Health.</span><br>
<br>
<span class=apple-style-span>"It is quite difficult to implement
preventive measures, because </span><br>
<span class=apple-style-span>people are so in love with their pets,"
commented Dr. Salomon. There </span><br>
<span class=apple-style-span>are very few options for controlling the spread of
the disease apart </span><br>
<span class=apple-style-span>from sacrificing sick animals.</span><br>
<br>
<span class=apple-style-span>In 2004, the 1st dog infected with the causative
agent of visceral </span><br>
<span class=apple-style-span>leishmaniasis was detected. When 40 cases were
reported in Misiones </span><br>
<span class=apple-style-span>province, the Ministry of Health issued a red
alert. Nonetheless, the </span><br>
<span class=apple-style-span>current situation is much worse. In <st1:City
w:st="on"><st1:place w:st="on">Posadas</st1:place></st1:City>, it was
determined that </span><br>
<span class=apple-style-span>7000 dogs actually have the parasite.
Additionally, there are 300 </span><br>
<span class=apple-style-span>infected dogs in <st1:City w:st="on"><st1:place
w:st="on">Corrientes</st1:place></st1:City>, and it is worth mentioning that
in its </span><br>
<span class=apple-style-span>capital city, there are thousands of homeless dogs
considered to be </span><br>
<span class=apple-style-span>infected with the parasite.</span><br>
<br>
<span class=apple-style-span>The analysis of the experience from <st1:country-region
w:st="on">Brazil</st1:country-region> and <st1:country-region w:st="on"><st1:place
w:st="on">Paraguay</st1:place></st1:country-region> indicates </span><br>
<span class=apple-style-span>that there is a probability of having one person
infected for every </span><br>
<span class=apple-style-span>60 infected dogs. There is a high risk for an
epidemic.</span><br>
<br>
<span class=apple-style-span>Sanitary authorities recommend that pets must not
be carried to the </span><br>
<span class=apple-style-span>areas considered to be at risk. It is also
advisable not to transport </span><br>
<span class=apple-style-span>dogs from the affected regions to other areas in
the country. The </span><br>
<span class=apple-style-span>idea is to cut the transmission cycle of the
parasite. Those persons </span><br>
<span class=apple-style-span>who may visit the northern part of <st1:country-region
w:st="on"><st1:place w:st="on">Argentina</st1:place></st1:country-region> must
be immunized </span><br>
<span class=apple-style-span>against yellow fever as an ordinary preventive
measure, and they must </span><br>
<span class=apple-style-span>leave their pets at home as an additional
preventive measure.</span><br>
<br>
<span class=apple-style-span>"Visceral leishmaniasis was present in the
northern part of <st1:place w:st="on">South <br>
America</st1:place> until migrating workers started moving it towards the
south. </span><br>
<span class=apple-style-span>In early 2000, there were some important outbreaks
in <st1:City w:st="on">Campo Grande</st1:City> do </span><br>
<span class=apple-style-span>Sul and in <st1:City w:st="on"><st1:place w:st="on">Asuncion</st1:place></st1:City>,
where the average number of persons infected is </span><br>
<span class=apple-style-span>around 70 per year. In <st1:country-region w:st="on"><st1:place
w:st="on">Brazil</st1:place></st1:country-region> there are around 4000 cases
and 200 </span><br>
<span class=apple-style-span>deaths per year," pointed out Dr. Salomon,
who had been doing some </span><br>
<span class=apple-style-span>field work during the past few weeks in the
Litoral provinces.</span><br>
<br>
<span class=apple-style-span>He also added: "There is a trend for an
increase in visceral </span><br>
<span class=apple-style-span>leishmaniasis, so the disease may spread, and it
is expected to have </span><br>
<span class=apple-style-span>more cases."</span><br>
<br>
<span class=apple-style-span>Climate changes and deforesting seem to be the
main explanations for </span><br>
<span class=apple-style-span>the migration of </span></span></font><strong><b><u><font
color=red face="Times New Roman"><span style='color:red'>mosquito-borne
diseases</span></font></u></b></strong><span class=apple-style-span><font
color=black><span style='color:black'>. However, trying to justify </span></font></span><font
color=black><span style='color:black'><br>
<span class=apple-style-span>the occurrence of emergent diseases only because
of reasons inherent </span><br>
<span class=apple-style-span>to nature itself may exonerate provincial and
municipal authorities </span><br>
<span class=apple-style-span>for not complying with their obligations with
respect to the </span><br>
<span class=apple-style-span>implementation of disease control programs and
cleaning empty lots.</span><br>
<br>
<span class=apple-style-span>Consequently, now there are many public
accusations between Misiones, </span><br>
<st1:City w:st="on"><span class=apple-style-span>Corrientes</span></st1:City><span
class=apple-style-span>, and <st1:place w:st="on">Chaco</st1:place> health
officers. These persons, now that there </span><br>
<span class=apple-style-span>are cases of visceral leishmaniasis, immediately
try to explain that </span><br>
<span class=apple-style-span>transmission may have taken place outside their
respective </span><br>
<span class=apple-style-span>jurisdictions. The clear point is that the </span></span></font><strong><b><font
color=red face="Times New Roman"><span style='color:red'>mosquito vector</span></font></b></strong><span
class=apple-style-span><font color=black><span style='color:black'>
appears </span></font></span><font color=black><span style='color:black'><br>
<span class=apple-style-span>because of lack of public hygiene.</span><br>
<br>
<span class=apple-style-span>- --</span><br>
<span class=apple-style-span>Communicated by:</span><br>
<span class=apple-style-span>ProMED-mail <<a
href="mailto:promed@promedmail.org">promed@promedmail.org</a>></span><br>
<br>
<span class=apple-style-span>[Leishmaniasis has been slowly spreading in
northern <st1:country-region w:st="on"><st1:place w:st="on">Argentina</st1:place></st1:country-region>
over </span><br>
<span class=apple-style-span>the past decades (Salomon O et al. First visceral
leishmaniasis focus </span><br>
<span class=apple-style-span>in <st1:country-region w:st="on"><st1:place w:st="on">Argentina</st1:place></st1:country-region>.
Mem Inst Oswaldo Cruz. 2008;103:109-11</span><br>
<span class=apple-style-span><<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>>).</span><br>
<br>
<span class=apple-style-span>The ecology of the vector has been changing, and
increasing </span><br>
<span class=apple-style-span>urbanization has been suggested as one of the
explanations (Salomon </span><br>
<span class=apple-style-span>OD </span><em><i><font face="Times New Roman">et
al</font></i></em><span class=apple-style-span>. Phlebotominae (Diptera:
Psycodidae) fauna in the Chaco </span><br>
<span class=apple-style-span>region and Cutaneous Leishmaniasis transmission
patterns in </span><br>
<st1:country-region w:st="on"><st1:place w:st="on"><span
class=apple-style-span>Argentina</span></st1:place></st1:country-region><span
class=apple-style-span>. Mem Inst Oswaldo Cruz. 2008;103:578-84</span><br>
<span class=apple-style-span><<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>>).</span><br>
<span class=apple-style-span> - Mod.EP]</span></span></font><o:p></o:p></p>
</blockquote>
</div>
</div>
</body>
</html>