Spatial distribution and cluster analysis of a leishmaniasis outbreak in the south-western Madrid region, Spain, September 2009 to April 2013

Gómez‐Barroso, Diana; Herrador, Zaida; Martín, Juan San; Gherasim, Alin; Aguado, Marta; Romero‐Maté, Alberto; Molina, Laura; Aparicio, Pilar; Benito, Agustín

doi:10.2807/1560-7917.es2015.20.7.21037

Cited by 27 publications

(18 citation statements)

References 21 publications

(34 reference statements)

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“…Spatial distribution of CL cases was mapped and spatial cluster analysis methods such as nearest neighbour analysis, Ripley's K function analysis and kernel density estimation was performed using the ArcGIS 10-Desktop and the CrimeStat, with logistic regression analysis based on maximum likelihood estimation. [40][41][42] Kernel density estimate provides an estimate of the prevalence that can occur in any given map location. Nearest neighbour analysis and the Ripley's K function were used to screen the study area for existence of case clustering followed by nearest neighbour hierarchical analysis routine to detect the actual places of case clustering.…”

Section: Discussionmentioning

confidence: 99%

Characterisation of cutaneous leishmaniasis in Matara district, southern Sri Lanka: evidence for case clustering

Kariyawasam

Edirisuriya

Senerath

et al. 2015

Pathogens and Global Health

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Leishmaniasis is a neglected tropical disease transmitted by Phlebotomus spp. sand flies. Cutaneous leishmaniasis (CL) in Sri Lanka is caused by Leishmania donovani. Transmission patterns are different in Southern and Northern Sri Lanka. Current study examined the prevalence, risk factors and distribution of CL in Matara District, Southern Sri Lanka. Total of 2260 individuals from four District Secretariat divisions (DSDs) were screened by house to house surveys using an interviewer administered questionnaire. The study population had an age range of 1-90 years (median 5 43 + 17.31), low monthly income (v20 000 LKR, 52.8%) and a male to female ratio of 1 : 2. Thirty eight patients were diagnosed by light microscopy, culture and/or PCR with a disease prevalence of 1.68%. Spatial mapping provided evidence for significant case clustering, which tended to be more prominent with proximity to forest areas. The risk factors identified were un-plastered brick walls, absence or low usage of protective measures against insect bites, low income and excessive time (w4 hours/day) spent outdoors. However, exposure of limbs while outdoors, unawareness about the disease, type of occupation, common water source as the mode of water supply and presence of animal shelters within 200 m were not associated with the risk of acquiring the disease. Peri-domestic transmission is likely to contribute to the observed case clustering with all age groups at risk of acquiring the infection. Human behavioural habits coinciding with that of the vector, sand fly are likely to enable host-vector contact promoting its spread. Appropriate vector control measures, improvement of housing conditions, public education regarding preventive measures are required to contain the spread of disease.

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Section: Discussionmentioning

confidence: 99%

Characterisation of cutaneous leishmaniasis in Matara district, southern Sri Lanka: evidence for case clustering

Kariyawasam

Edirisuriya

Senerath

et al. 2015

Pathogens and Global Health

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“…Leishmaniasis remains endemic in Spain, the country with the highest rate of deceased‐donor organ donation in the world . Since July 2009, an ongoing epidemic outbreak of leishmaniasis is affecting the southwest area of the region of Madrid (cities of Fuenlabrada, Leganés, Getafe, and Humanes de Madrid, with an overall population exceeding half a million) . About 15% of the patients diagnosed with VL in this epidemic setting showed some form of immunosuppression, and the annual incidence rate among SOT recipients has nearly reached 3000 cases per 100 000 population (unpublished data).…”

Section: Introductionmentioning

confidence: 99%

Experience with miltefosine for persistent or relapsing visceral leishmaniasis in solid organ transplant recipients: A case series from Spain

Asín

Carrasco-Antón

Fernández‐Ruiz

et al. 2017

Transplant Infectious Dis

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The incidence of visceral leishmaniasis (VL) after solid organ transplantation (SOT) is increasing. The optimal therapy for post-transplant VL remains unclear, as relapses after liposomal amphotericin B (L-AmB) are common. Miltefosine has been shown to be effective for treating VL in immunocompetent patients, although data in the specific population of SOT recipients are lacking. In the setting of an outbreak of leishmaniasis occurring in Southwest Madrid, we reviewed our experience in 6 SOT recipients with persistent or relapsing VL who received a 28-day course of miltefosine (2.5 mg/kg/day) as salvage therapy. All patients had been treated previously with L-AmB as first-line therapy. The incident episode of VL occurred at a median of 14 months after transplantation. Two patients experienced persistent infection and the remaining 4 had a relapse after a median interval of 168 days since the completion of the course of L-AmB. All the patients had an apparent initial clinical improvement with miltefosine. However, VL relapsed in 3 of them (after a median interval of 46 days), which required retreatment with L-AmB-based regimens. Miltefosine therapy was followed by a prolonged secondary prophylaxis with L-AmB in the only 2 cases with sustained clinical response and ongoing immunosuppression. No adverse effects associated with miltefosine were observed. Albeit limited, our experience suggests that miltefosine monotherapy likely has a limited utility to obtain a long-lasting clinical response in complicated (persistent or relapsing) forms of post-transplant VL, although its role in association with L-AmB-based secondary prophylaxis may merit further investigation.

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“…; Gomez‐Barroso et al . ) demonstrated the potential role that rabbits and hares may have as competent reservoirs for the disease. L. infantum infection was evidenced in the population of lagomorphs in the area of the outbreak using PCR and indirect immunofluorescence antibody test (IFAT), with up to 74.1% and 45.7% of seropositive hares and rabbits, respectively (Moreno et al .…”

Section: Introductionmentioning

confidence: 99%

Assessment of the sensitivity and specificity of serological (IFAT) and molecular (direct‐PCR) techniques for diagnosis of leishmaniasis in lagomorphs using a Bayesian approach

Cruz

Pérez

Domínguez

et al. 2016

Veterinary Medicine & Sci

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Leishmaniasis, caused by Leishmania infantum, is a vector‐borne zoonotic disease that is endemic to the Mediterranean basin. The potential of rabbits and hares to serve as competent reservoirs for the disease has recently been demonstrated, although assessment of the importance of their role on disease dynamics is hampered by the absence of quantitative knowledge on the accuracy of diagnostic techniques in these species. A Bayesian latent‐class model was used here to estimate the sensitivity and specificity of the Immuno‐fluorescence antibody test (IFAT) in serum and a Leishmania‐nested PCR (Ln‐PCR) in skin for samples collected from 217 rabbits and 70 hares from two different populations in the region of Madrid, Spain. A two‐population model, assuming conditional independence between test results and incorporating prior information on the performance of the tests in other animal species obtained from the literature, was used. Two alternative cut‐off values were assumed for the interpretation of the IFAT results: 1/50 for conservative and 1/25 for sensitive interpretation. Results suggest that sensitivity and specificity of the IFAT were around 70–80%, whereas the Ln‐PCR was highly specific (96%) but had a limited sensitivity (28.9% applying the conservative interpretation and 21.3% with the sensitive one). Prevalence was higher in the rabbit population (50.5% and 72.6%, for the conservative and sensitive interpretation, respectively) than in hares (6.7% and 13.2%). Our results demonstrate that the IFAT may be a useful screening tool for diagnosis of leishmaniasis in rabbits and hares. These results will help to design and implement surveillance programmes in wild species, with the ultimate objective of early detecting and preventing incursions of the disease into domestic and human populations.

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Spatial distribution and cluster analysis of a leishmaniasis outbreak in the south-western Madrid region, Spain, September 2009 to April 2013

Abstract: Binary file ES_Abstracts_Final_ECDC.txt matches

Cited by 27 publications

References 21 publications

Characterisation of cutaneous leishmaniasis in Matara district, southern Sri Lanka: evidence for case clustering

Characterisation of cutaneous leishmaniasis in Matara district, southern Sri Lanka: evidence for case clustering

Experience with miltefosine for persistent or relapsing visceral leishmaniasis in solid organ transplant recipients: A case series from Spain

Assessment of the sensitivity and specificity of serological (IFAT) and molecular (direct‐PCR) techniques for diagnosis of leishmaniasis in lagomorphs using a Bayesian approach

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