Competence of the Human Host as a Reservoir for<i>Leishmania chagasi</i>

Costa, Carlos Henrique Nery; Gomes, Régis; Silva, Mauro R.B.; Garcez, Lourdes Maria; Ramos, Patrícia Karla Santos; Santos, Regina Silva; Shaw, Jeffrey Jon; David, John R.; Maguire, James H.

doi:10.1086/315795

Cited by 89 publications

(76 citation statements)

References 10 publications

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“…For unclear reasons, age appears to be a risk factor in VL in two other circumstances: the risk of developing illness after infection 1 and the infectivity for the vector Lutzomyia longipalpis 8 . Since the risk of unsatisfactory response is five to ten times greater in children, the principal victims of the illness in periods of epidemics, special attention should be given to the treatment of VL in children.…”

Section: Discussionmentioning

confidence: 99%

Predictors of an unsatisfactory response to pentavalent antimony in the treatment of American visceral leishmaniasis

Santos

Marques

Farias

et al. 2002

Rev. Soc. Bras. Med. Trop.

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Although treatment of visceral leishmaniasis with pentavalent antimony is usually successful, some patients require second-line drug therapy, most commonly with amphotericin B. To identify the clinical characteristics that predict an inadequate response to pentavalent antimony, a case-control study was undertaken in Teresina, Piaui, Brazil. Over a two-year period, there were 19 cases of VL in which the staff physicians of a hospital prescribed second-line therapy with amphotericin B after determining that treatment with pentavalent antimony had failed. The control group consisted of 97 patients that were successfully treated with pentavalent antimony. A chart review using univariate and multivariate analysis was performed. The cure rate was 90% with amphotericin B. The odds ratio for the prescription of amphotericin B was 10.2 for children less than one year old, compared with individuals aged over 10 years. Patients who presented coinfection had an OR of 7.1 while those on antibiotics had an OR of 2.8. These data support either undertaking a longer course of therapy with pentavalent antimony for children or using amphotericin B as a first-line agent for children and individuals with coinfections. It also suggests that chemoprophylaxis directed toward bacterial coinfection in small children with VL may be indicated. Key-words: Visceral leishmaniasis. Antimony. Amphotericin B. Therapy.Resumo Embora o tratamento da leishmaniose visceral com antimoniato pentavalente seja normalmente bem sucedido, alguns pacientes requerem uma terapêutica de segunda linha, habitualmente com anfotericina B. Para identificar as características clínicas que possam indicar uma resposta inadequada ao antimônio pentavalente, realizou-se um estudo caso-controle em Teresina, Piauí, Brasil. Em um período de dois anos ocorreram 19 casos de LV para quem os médicos de um hospital prescreveram o tratamento de segunda linha com anfotericina B após determinarem falha com o uso de antimônio pentavalente. O grupo controle foi constituído por 97 pacientes que tiveram o tratamento com antimônio bem sucedido. Foi feita uma análise de prontuários, utilizando-se análise univariada e multivariada. A porporção de cura após o uso de anfotericina B foi 90%. A razão de odds para a prescrição de anfotericina B foi 10,2 para crianças com menos de um ano, quando comparadas com pessoas com mais de 10 anos. Pacientes que tinham tido co-infecção tinham uma RO de 7,1 e aqueles que tinham utilizado antibióticos tinham uma razão de odds de 2,8. Estes dados estão de acordo com o uso mais prolongado de antimônio pentavalente para crianças ou com a recomendação de anfotericina B como droga de primeira escolha para crianças e para pessoas com co-infecções. Sugerem também que se pode indicar a quimioprofilaxia para infecções bacterianas em crianças menores com LV. Palavras-chaves: Leishmaniose visceral. Antimônio. Anfotericina B. Terapêutica.

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Section: Discussionmentioning

confidence: 99%

Predictors of an unsatisfactory response to pentavalent antimony in the treatment of American visceral leishmaniasis

Santos

Marques

Farias

et al. 2002

Rev. Soc. Bras. Med. Trop.

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“…1b), the known primary reservoir of ZVL. Asymptomatic people infected with L. infantum have not been shown to be infectious, although parasites can be demonstrated in the skin (Costa et al 2000). Given the low incidence of symptomatic human infection, the relative contribution of symptomatic humans to transmission will be much less than that of infected dogs.…”

Section: Prevalence Of L Infantum Infection In Potential Reservoir Hmentioning

confidence: 99%

Transmission, reservoir hosts and control of zoonotic visceral leishmaniasis

2009

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S U M M A R YZoonotic visceral leishmaniasis (ZVL) caused by Leishmania infantum is an important disease of humans and dogs. Here we review aspects of the transmission and control of ZVL. Whilst there is clear evidence that ZVL is maintained by sandfly transmission, transmission may also occur by non-sandfly routes, such as congenital and sexual transmission. Dogs are the only confirmed primary reservoir of infection. Meta-analysis of dog studies confirms that infectiousness is higher in symptomatic infection ; infectiousness is also higher in European than South American studies. A high prevalence of infection has been reported from an increasing number of domestic and wild mammals ; updated host ranges are provided. The crab-eating fox Cerdocyon thous, opossums Didelphis spp., domestic cat Felis cattus, black rat Rattus rattus and humans can infect sandflies, but confirmation of these hosts as primary or secondary reservoirs requires further xenodiagnosis studies at the population level. Thus the putative sylvatic reservoir(s) of ZVL remains unknown. Review of intervention studies examining the effectiveness of current control methods highlights the lack of randomized controlled trials of both dog culling and residual insecticide spraying. Topical insecticides (deltamethrin-impregnated collars and pour-ons) have been shown to provide a high level of individual protection to treated dogs, but further community-level studies are needed.

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“…In order to achieve this, it is essential to conduct specifically designed cohort studies. While it is intuitive to believe that dogs are significant reservoirs because they are more competent at infecting sand flies than people 47,[63][64][65][66][67][68] , other parameters that depend on the vectors (vectorial capacity) are much more significant for the basic reproductive number of the disease (e.g., the number of secondary cases emerging from an infectious case) and, therefore, for the incrimination of reservoirs. For example, some observations and mathematical models show that the importance of a reservoir is regulated not only by its competence in infecting vectors, but also by the parameters that measure a) the degree of exposure of vertebrate hosts to vectors and b) the vector daily mortality.…”

Section: The Importance Of Dog Infection For Human Kala-azarmentioning

confidence: 99%

How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

Costa

2011

Rev. Soc. Bras. Med. Trop.

127

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How effective is dog culling in controlling zoonotic visceral leishmaniasis? A critical evaluation of the science, politics and ethics behind this public health policyQuanto é efetivo o abate de cães para o controle do calazar zoonótico? Uma avaliação crítica da ciência, política e ética por trás desta política de saúde pública Carlos Henrique Nery Costa 1,2 ABSTRACT Introduction: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. Methods: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. Results: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. Conclusions: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence

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Competence of the Human Host as a Reservoir forLeishmania chagasi

Cited by 89 publications

References 10 publications

Predictors of an unsatisfactory response to pentavalent antimony in the treatment of American visceral leishmaniasis

Predictors of an unsatisfactory response to pentavalent antimony in the treatment of American visceral leishmaniasis

Transmission, reservoir hosts and control of zoonotic visceral leishmaniasis

How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

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