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