Epidemiology of canine leishmaniasis: prevalence, incidence and basic reproduction number calculated from a cross-sectional serological survey on the island of Gozo, Malta

The Program for the Control of Visceral Leishmaniasis in Brazil: The Effect of the Systematic Euthanasia of Seropositive Dogs as a Single Control Action in Porteirinha, a Brazilian City with an Intense Transmission of Visceral Leishmaniasis

BACKGROUND

Porteirinha is endemic for visceral leishmaniasis (VL), with intense disease transmission of the disease. We evaluated the impact of canine euthanasia as a single control measure on the incidence of VL in humans and canines.

METHODS

A prospective observational cohort study was carried out over four years (1998-2002) in 8 of the 12 neighborhoods of the city. The dynamics of canine visceral leishmaniasis (CVL) transmission were evaluated for 2 years, before beginning the screening-culling intervention. The comparative morbidity index (CMI) was used to stratify areas with the greatest risk of CVL, and the spatial distribution of human and canine VL cases was compared using univariate and bivariate K-functions.

RESULTS

Human cases conglomerated in three neighborhoods. Spatial clusters were detected for CVL in 1998, 2000, and 2001, but not in 1999, when greater spatial dispersion occurred. The screening and culling intervention reduced the number of human VL cases and decreased the incidence of CVL, mainly in neighborhoods with a high CMI.

CONCLUSIONS

The systematic euthanasia of seropositive dogs was shown to be an effective control action of the Program for Control of Visceral Leishmaniasis (PCLV) in Brazil. The fundamental role of domestic dogs in the epidemiological chain of VL was reaffirmed.

First molecular detection of Leishmania (Leishmania) infantum chagasi in a domestic cat (Felis catus) from an urban area in eastern Amazon

Background

Domestic cats have been implicated as accidental hosts of Leishmania sp. However, in recent years, the recurrent description of new cases in endemic and nonendemic areas draw attention to the potential epidemiological role of cats as reservoir hosts. Although dogs are considered urban reservoirs, cats could act as a secondary natural reservoirs in these areas. Thus, feline leishmaniasis has become an emerging disease in several countries worldwide.

Case presentation

This study aimed to describe the first case of feline leishmaniasis in a stray animal that presented lesions compatible with the disease in Belém, Pará, Brazil, an important urban area in eastern Amazon. Serological tests for Leishmania infantum (ELISA and IFA) were nonreactive, whereas histopathological examination indicated infectious dermatitis caused by Leishmania spp. or Toxoplasma gondii. Cytopathological study of lesion aspirate confirmed the presence of Leishmania sp. amastigotes within macrophages. Finally, molecular analyses revealed that the feline infection was caused by Leishmania (Leishmania) infantum chagasi.

Conclusion

To the best of the authors' knowledge, this study reports the first case of natural infection by Leishmania (Leishmania) infantum chagasi in a feline from eastern Amazon. These findings suggest domestic cats as potential secondary reservoir hosts of Leishmania spp. in Belém, which reinforces the importance of further epidemiological investigation of feline leishmaniasis, especially in urban areas with human cases.

Nanomedicine-based strategies to improve treatment of cutaneous leishmaniasis

Nanomedicine strategies were first adapted and successfully translated to clinical application for diseases, such as cancer and diabetes. These strategies would no doubt benefit unmet diseases needs as in the case of leishmaniasis. The latter causes skin sores in the cutaneous form and affects internal organs in the visceral form. Treatment of cutaneous leishmaniasis (CL) aims at accelerating wound healing, reducing scarring and cosmetic morbidity, preventing parasite transmission and relapse. Unfortunately, available treatments show only suboptimal effectiveness and none of them were designed specifically for this disease condition. Tissue regeneration using nano-based devices coupled with drug delivery are currently being used in clinic to address diabetic wounds. Thus, in this review, we analyse the current treatment options and attempt to critically analyse the use of nanomedicine-based strategies to address CL wounds in view of achieving scarless wound healing, targeting secondary bacterial infection and lowering drug toxicity.

Control of Canine Visceral Leishmaniasis: A Success Case Based on Deltamethrin 4% Collars

The effect of employing collars impregnated with deltamethrin 4% (DM4) to control canine visceral leishmaniasis (CVL) was evaluated. as were the individual factors associated with this infection. A cohort study that included household dogs was conducted between 2002 and 2006. The presence of pathognomonic signals, peridomiciliary sleep habits and breed were the main factors associated with the infection. The use of DM4 collars contributed to the reduction of CVL with an effectiveness of 66%, and the dogs' survival rate was greater than 90% at 50 months. In conclusion, the adoption of DM4 collars reduced the number of euthanized canines and in the incidence of CVL, and this reduction was sustained for one year after discontinuing the use of the collar.

A Comparative Assessment of Epidemiologically Different Cutaneous Leishmaniasis Outbreaks in Madrid, Spain and Tolima, Colombia: An Estimation of the Reproduction Number via a Mathematical Model

Leishmaniasis is a neglected tropical disease caused by the Leishmania parasite and transmitted by the Phlebotominae subfamily of sandflies, which infects humans and other mammals. Clinical manifestations of the disease include cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL) and visceral leishmaniasis (VL) with a majority (more than three-quarters) of worldwide cases being CL. There are a number of risk factors for CL, such as the presence of multiple reservoirs, the movement of individuals, inequality, and social determinants of health. However, studies related to the role of these factors in the dynamics of CL have been limited. In this work, we (i) develop and analyze a vector-borne epidemic model to study the dynamics of CL in two ecologically distinct CL-affected regions—Madrid, Spain and Tolima, Colombia; (ii) derived three different methods for the estimation of model parameters by reducing the dimension of the systems; (iii) estimated reproduction numbers for the 2010 outbreak in Madrid and the 2016 outbreak in Tolima; and (iv) compared the transmission potential of the two economically-different regions and provided different epidemiological metrics that can be derived (and used for evaluating an outbreak), once R₀ is known and additional data are available. On average, Spain has reported only a few hundred CL cases annually, but in the course of the outbreak during 2009–2012, a much higher number of cases than expected were reported and that too in the single city of Madrid. Cases in humans were accompanied by sharp increase in infections among domestic dogs, the natural reservoir of CL. On the other hand, CL has reemerged in Colombia primarily during the last decade, because of the frequent movement of military personnel to domestic regions from forested areas, where they have increased exposure to vectors. In 2016, Tolima saw an unexpectedly high number of cases leading to two successive outbreaks. On comparing, we estimated reproduction number of the Madrid outbreak to be 3.1 (with range of 2.8–3.9), which was much higher than reproduction number estimates of the Tolima first outbreak 1.2 (with range of 1.1–1.3), and the estimate for the second outbreak in Tolima of 1.019 (with range of 1.018–1.021). This suggests that the epidemic outbreak in Madrid was much more severe than the Tolima outbreak, even though Madrid was economically better-off compared to Tolima. It indicates a potential relationship between urban development and increasing health disparities.

Modeling and comparative study of the spread of zoonotic visceral leishmaniasis from Northern to Central Tunisia

During the last twenty years, zoonotic visceral leishmaniasis (ZVL) spread from the north characterized by humid, sub-humid, and semi-arid bio-climates to the arid areas located in Central Tunisia. In order to understand the eco-epidemiological factors involved in the distribution of ZVL, both a sero-epidemiological and an entomological investigation were performed in two governorates situated in two different bio-geographical areas: Bizerte in the north and Kairouan in the center. A mathematical model for transmission of ZVL was built, describing the disease dynamic in these areas. Among 108 sera collected from clinically healthy owned dogs used for guarding houses in the governorate of Bizerte and tested for anti-L. infantum antibodies by indirect immune-fluorescence antibody test (IFAT), 8.3% were positive. From a total of 191 serum samples collected from clinically healthy owned dogs used for guarding houses in the governorate of Kairouan and tested for anti-L. infantum antibodies by IFAT, 26.7% were sero-positive. The cumulative incidences of ZVL in humans in the governorates of Bizerte and Kairouan were 39.17/100,000 and 0.2/100,000 inhabitants, respectively. The infection rates of sand flies with Leishmania DNA in the governorate of Bizerte and Kairouan were 3.8% and 9.4%, respectively. It is important to point out that ZVL epidemic in humans is preceded or concomitant to a high prevalence of Leishmania infantum in dogs and in sand flies. The model showed also a non-linear relationship between dog infection and ZVL in humans. These results suggest an important force of infection (R0) in emerging foci such as the governorate of Kairouan leading to an increased incidence of ZCL in humans. A high prevalence of L. infantum in dogs will result in high prevalence in the vector and obviously high probability to infect human; that it is a key factor for triggering transmission to humans, and subsequently it is an important parameter in the control of ZVL transmission.

Challenges in modeling complexity of neglected tropical diseases: a review of dynamics of visceral leishmaniasis in resource limited settings

OBJECTIVES

Neglected tropical diseases (NTD), account for a large proportion of the global disease burden, and their control faces several challenges including diminishing human and financial resources for those distressed from such diseases. Visceral leishmaniasis (VL), the second-largest parasitic killer (after malaria) and an NTD affects poor populations and causes considerable cost to the affected individuals. Mathematical models can serve as a critical and cost-effective tool for understanding VL dynamics, however, complex array of socio-economic factors affecting its dynamics need to be identified and appropriately incorporated within a dynamical modeling framework. This study reviews literature on vector-borne diseases and collects challenges and successes related to the modeling of transmission dynamics of VL. Possible ways of creating a comprehensive mathematical model is also discussed.

METHODS

Published literature in three categories are reviewed: (i) identifying non-traditional but critical mechanisms for VL transmission in resource limited regions, (ii) mathematical models used for dynamics of Leishmaniasis and other related vector borne infectious diseases and (iii) examples of modeling that have the potential to capture identified mechanisms of VL to study its dynamics.

RESULTS

This review suggests that VL elimination have not been achieved yet because existing transmission dynamics models for VL fails to capture relevant local socio-economic risk factors. This study identifies critical risk factors of VL and distribute them in six categories (atmosphere, access, availability, awareness, adherence, and accedence). The study also suggests novel quantitative models, parts of it are borrowed from other non-neglected diseases, for incorporating these factors and using them to understand VL dynamics and evaluating control programs for achieving VL elimination in a resource-limited environment.

CONCLUSIONS

Controlling VL is expensive for local communities in endemic countries where individuals remain in the vicious cycle of disease and poverty. Smarter public investment in control programs would not only decrease the VL disease burden but will also help to alleviate poverty. However, dynamical models are necessary to evaluate intervention strategies to formulate a cost-effective optimal policy for eradication of VL.

Semi-quantitative measurement of asymptomatic L. infantum infection and symptomatic visceral leishmaniasis in dogs using Dual-Path Platform® CVL

Infection with Leishmania causes diseases with variable presentation. The most severe form is visceral leishmaniasis (VL), caused by either L. donovani or L. infantum. Despite efforts to eliminate VL, to date, molecular detection in resource-poor settings have lacked the accuracy and rapidity that would enable widespread field use and the need for accurate, sensitive assays to detect asymptomatic Leishmania infection has become apparent. The domestic dog serves as the primary reservoir host of L. infantum. Study of this reservoir population provides an opportunity to evaluate the sensitivity and specificity of diagnostics for well-defined, symptomatic, canine visceral leishmaniasis (CVL) and asymptomatic L. infantum infection. Blood samples from an L. infantum-endemic population of US hunting dogs were evaluated with Dual-Path Platform (DPP®) CVL compared to those obtained via direct detection methods (culture- and Leishmania-specific quantitative polymerase chain reaction, qPCR) and immunofluorescence anti-Leishmania antibody test (IFAT). Statistically significant correlations were found between DPP® CVL development time and clinical status, culture status, circulating DNA levels, and IFAT titer. DPP® CVL results correlated with both clinical severity of disease and serological evidence of asymptomatic L. infantum infection. By precisely documenting the minimum time required for the development of a clear positive result in DPP® CVL, this test could be used in a rapid, semi-quantitative manner for the evaluation of asymptomatic and symptomatic CVL. Our results also indicate that a similar test could be used to improve our understanding of human VL.

Xenodiagnosis on dogs with visceral leishmaniasis: Canine and sand fly aspects related to the parasite transmission

One of the main limitations for the effective control of canine leishmaniasis in endemic areas is the difficulty in identifying infectious dogs. The objective of this study was to determine factors, related to dogs and to parasite detection in sand flies, which are associated with the positive xenodiagnosis of Leishmania infantum using the vector Lutzomyia longipalpis. The xenodiagnosis was performed in 50 owned dogs residing in endemic areas, which were divided into three different groups: G1-26 dogs proved to be infected and classified by severity of VL clinical signs on physical examination; G2-15 dogs proved to be infected and classified by severity of clinical signs and intensity of laboratory abnormalities; G3-nine dogs that were seropositive for anti-Leishmania IgG in ELISA tests. Parasite search in the sand flies after having fed on dogs in the xenodiagnosis was performed by both methodologies, PCR and dissection followed by microscopy. In G1, 58% (15/26) of dogs were able to transmit Leishmania to the vector, when parasite detection in sand flies were performed by PCR technique, 5 days after blood meal, whereas in G2, 53% (8/15) transmitted the parasite to the vector, however, confirmation was performed by direct observation of parasite through optical miscroscopy held 10 days after blood meal. Rate of infectiousness of dogs to sand flies was positively associated to severity of disease (p=0.042 and p=0.040), regardless the method used for clinical classification or for parasite detection in sand flies after xenodiagnosis. In G1 30% (3/10) of dogs with subclinical infection were infectious to the vector, while 80% (12/16) of dogs with clinical disease were also infectious. Even more, 17% (1/6) of dogs that had moderate disease were infectious to the sand flies, while 78% (7/9) of dogs with severe disease were infectious in G2. Still in G2, the proportion of sand flies infected (grade of infectiousness) was significantly lower (p=0.0098) when they fed on dogs with moderate disease (1%) in comparison with dogs with severe disease (38%). The dogs from G3 presented a rate of infectiousness of 11% (1/9), demonstrating that the indirect ELISA is not a good indicator of infectiousness and, therefore, should not be used as a confirmatory test for the euthanasia of dogs, as it is currently done in Brazil.

Expression of a recombinant protein, A2 family, from Leishmania infantum (Jaboticabal strain) and its evaluation in Canine Visceral Leishmaniasis serological test

This study aimed to express a recombinant A2 family protein of Leishmania chagasi, Jaboticabal strain; test this protein as an antigen in serological assays; and investigate its antigenicity and immunogenicity. A protein coded by an allele of the A2 gene isolated from L. chagasi was expressed in three different strains of Escherichia coli. We used 29 sera samples from Leishmune-vaccinated dogs, 482 sera samples from dogs from endemic areas (positive controls), and 170 sera samples from dogs from non-endemic areas (negative controls) in ELISA tests using soluble Leishmaniaantigen (SLA) and His-A2 as antigen. Expressed proteins showed, by western blotting, the expression of an 11 KDa protein. Sixty-three percent (303/482) of the samples from endemic areas were positive by ELISA His-A2, whereas 93.1% (27/29) of Leishmune®-vaccinated animals were negative by His-A2-ELISA. Anti-A2 antibodies from mice inoculated with the A2 protein were detected in slides containing amastigote forms, but not in slides containing promastigote forms. The A2 recombinant protein from L. chagasi may be a useful tool in the diagnosis of CVL, and further tests regarding the infection stage and the specie of parasite at which the dogs are sampled should provide a better understanding of our results.

Estimated effects of projected climate change on the basic reproductive number of the Lyme disease vector Ixodes scapularis

BACKGROUND

The extent to which climate change may affect human health by increasing risk from vector-borne diseases has been under considerable debate.

OBJECTIVES

We quantified potential effects of future climate change on the basic reproduction number (R0) of the tick vector of Lyme disease, Ixodes scapularis, and explored their importance for Lyme disease risk, and for vector-borne diseases in general.

METHODS

We applied observed temperature data for North America and projected temperatures using regional climate models to drive an I. scapularis population model to hindcast recent, and project future, effects of climate warming on R0. Modeled R0 increases were compared with R0 ranges for pathogens and parasites associated with variations in key ecological and epidemiological factors (obtained by literature review) to assess their epidemiological importance.

RESULTS

R0 for I. scapularis in North America increased during the years 1971-2010 in spatio-temporal patterns consistent with observations. Increased temperatures due to projected climate change increased R0 by factors (2-5 times in Canada and 1.5-2 times in the United States), comparable to observed ranges of R0 for pathogens and parasites due to variations in strains, geographic locations, epidemics, host and vector densities, and control efforts.

CONCLUSIONS

Climate warming may have co-driven the emergence of Lyme disease in northeastern North America, and in the future may drive substantial disease spread into new geographic regions and increase tick-borne disease risk where climate is currently suitable. Our findings highlight the potential for climate change to have profound effects on vectors and vector-borne diseases, and the need to refocus efforts to understand these effects.

Culling dogs in scenarios of imperfect control: realistic impact on the prevalence of canine visceral leishmaniasis

Background

Visceral leishmaniasis belongs to the list of neglected tropical diseases and is considered a public health problem worldwide. Spatial correlation between the occurrence of the disease in humans and high rates of canine infection suggests that in the presence of the vector, canine visceral leishmaniasis is the key factor for triggering transmission to humans. Despite the control strategies implemented, such as the sacrifice of infected dogs being put down, the incidence of American visceral leishmaniasis remains high in many Latin American countries.

Methodology/Principal Findings

Mathematical models were developed to describe the transmission dynamics of canine leishmaniasis and its control by culling. Using these models, imperfect control scenarios were implemented to verify the possible factors which alter the effectiveness of controlling this disease in practice.

Conclusions/Significance

A long-term continuous program targeting both asymptomatic and symptomatic dogs should be effective in controlling canine leishmaniasis in areas of low to moderate transmission (R₀ up to 1.4). However, the indiscriminate sacrifice of asymptomatic dogs with positive diagnosis may jeopardize the effectiveness of the control program, if tests with low specificity are used, increasing the chance of generating outrage in the population, and leading to lower adherence to the program. Therefore, culling must be planned accurately and implemented responsibly and never as a mechanical measure in large scale. In areas with higher transmission, culling alone is not an effective control strategy.

Visceral leishmaniasis is listed as a neglected tropical disease and is considered a public health problem worldwide. The disease has been documented since 1885, the first case being reported in India. After over 120 years, the incidence of the disease remains high despite control strategies implemented. In areas where the disease is zoonotic, such as in Brazil, identification as well as removal of infected dogs is recommended in highly endemic areas for they are considered to be the reservoir of the Leishmania chagasi parasite. The theoretical basis that supports the culling of infected dogs is the assumption that the incidence of human infection is directly related to the number of infectious dogs. However, there is no consensus among researchers on the effectiveness of this strategy for controlling either human or canine visceral leishmaniasis. In this context, mathematical models can provide a basis for determining the strategies with the greatest potential for success. This paper aims to contribute to this discussion by introducing further complexities into the problem, in particular, the imperfect diagnosis of this infection and the time gap between laboratory diagnosis and culling and the presence of asymptomatic infections.

Experimental infection of dogs with Leishmania and saliva as a model to study Canine Visceral Leishmaniasis

Background

Canine Visceral Leishmaniasis (CVL) is a zoonotic disease caused by Leishmania infantum, transmitted by the bite of Lutzomyia longipalpis sand flies. Dogs are the main domestic reservoir of the parasite. The establishment of an experimental model that partially reproduces natural infection in dogs is very important to test vaccine candidates, mainly regarding those that use salivary proteins from the vector and new therapeutical approaches.

Methodology/Principal Findings

In this report, we describe an experimental infection in dogs, using intradermal injection of Leishmania infantum plus salivary gland homogenate (SGH) of Lutzomyia longipalpis. Thirty-five dogs were infected with 1×10⁷ parasites combined with five pairs of Lutzomyia longipalpis salivary glands and followed for 450 days after infection and clinical, immunological and parasitological parameters were evaluated. Two hundred and ten days after infection we observed that 31,4% of dogs did not display detectable levels of anti-Leishmania antibodies but all presented different numbers of parasites in the lymph nodes. Animals with a positive xenodiagnosis had at least 3,35×10⁵ parasites in their lymph nodes. An increase of IFN-γ and IL-10 levels was detected during infection. Twenty two percent of dogs developed symptoms of CVL during infection.

Conclusion

The infection model described here shows some degree of similarity when compared with naturally infected dogs opening new perspectives for the study of CVL using an experimental model that employs the combination of parasites and sand fly saliva both present during natural transmission.

Seroepidemiological aspects ofLeishmania spp. in dogs in the Itaguai micro-region, Rio de Janeiro, Brazil

This study evaluated factors associated with the frequency ofLeishmania spp. antibodies in dogs residing in the Itaguai micro-region, State of Rio de Janeiro, Brazil. Blood samples were collected from 524 dogs. The serum samples were submitted to indirect fluorescent antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA) forLeishmania spp. The frequency of seropositive dogs was 28.24% (n = 148) in the micro-region, and among the three municipalities within that region, the highest frequency (p < 0.05) was observed in Seropedica (59.46%), followed by Itaguai (29.05%) and Mangaratiba (11.49%). Regarding factors associated with the host, mongrel dogs and those over the age of two presented higher frequency of antibodies to Leishmaniaspp. (p < 0.05). Concerning factors related to the environment and habits of the animal, dogs residing in rural areas (FR = 1.67, p = 0.0002), living outside the residence (FR = 1.42, p = 0.0197), with access to forest, streams and pastures (FR = 2.81, p = 0.0007), remaining loose (FR = 1.66, p = 0.0073), and those that had no shelter (FR = 2.16, p < 0.0001) were more likely to be seropositive. Canine leishmaniasis is a disease with high occurrence in the Itaguai micro-region, and aspects such as the definition of breed, age, habits and care by owners showed significant association in this micro-region.

Treatment of visceral leishmaniasis: model-based analyses on the spread of antimony-resistant L. donovani in Bihar, India

Background

Pentavalent antimonials have been the mainstay of antileishmanial therapy for decades, but increasing failure rates under antimonial treatment have challenged further use of these drugs in the Indian subcontinent. Experimental evidence has suggested that parasites which are resistant against antimonials have superior survival skills than sensitive ones even in the absence of antimonial treatment.

Methods and Findings

We use simulation studies based on a mathematical L. donovani transmission model to identify parameters which can explain why treatment failure rates under antimonial treatment increased up to 65% in Bihar between 1980 and 1997. Model analyses suggest that resistance to treatment alone cannot explain the observed treatment failure rates. We explore two hypotheses referring to an increased fitness of antimony-resistant parasites: the additional fitness is (i) disease-related, by causing more clinical cases (higher pathogenicity) or more severe disease (higher virulence), or (ii) is transmission-related, by increasing the transmissibility from sand flies to humans or vice versa.

Conclusions

Both hypotheses can potentially explain the Bihar observations. However, increased transmissibility as an explanation appears more plausible because it can occur in the background of asymptomatically transmitted infection whereas disease-related factors would most probably be observable. Irrespective of the cause of fitness, parasites with a higher fitness will finally replace sensitive parasites, even if antimonials are replaced by another drug.

The protozoan flagellate Leishmania donovani causes the neglected, life-threatening disease visceral leishmaniasis. Parasites are transmitted from man to man by the bite of the sand fly Phlebotomus argentipes, the vector of the disease. Pentavalent antimonials have been the mainstay of antileishmanial therapy for decades but rapidly increasing failure rates up to 65% observed between 1980 and 1997 in the state of Bihar, India, have challenged further use of these drugs. Comparative in vitro and in vivo experiments indicate that antimony-resistant parasites have a higher fitness than antimony-sensitive ones even in the absence of antimonial treatment. Simulation studies based on a previously published mathematical L. donovani transmission model suggest that resistance to antimonial treatment alone cannot explain the Bihar observations but that resistance together with higher fitness offers the potential to explain the data. After an antimony-resistant parasite with higher fitness has emerged, it will finally replace the antimony-sensitive ones, even in complete absence of antimonial treatment.

The effect of removing potentially infectious dogs on the numbers of canine Leishmania infantum infections in an endemic area with high transmission rates

To assess the effect of the rapid removal of potentially infectious dogs on the prevalence and incidence of canine infections, a prospective study was undertaken in an area endemic for Leishmania infantum. We used serological testing based on the rapid DPP rK28 fusion protein chromatographic immunoassay for this dog screening-and-culling intervention trial. The outcome was evaluated by measuring seropositivity and sero-conversion/-reversion rates for canine infection. Our estimates indicated that concomitant detection and elimination of seropositive dogs with active disease may affect the numbers of canine infections and disease burden temporarily, although it is insufficient as a measure to interrupt the zoonotic L. infantum transmission. However, most of the asymptomatic, seropositive dogs continuously exhibit low levels of antibodies and/or reverted, remaining seronegative thereafter. In the process of waiting for an effective vaccine, one option for canine reservoir control may be to identify these possibly genetically resistant animals and promote their expansion in the population.

Visceral leishmaniasis in the Indian subcontinent: modelling epidemiology and control

BACKGROUND

In the Indian subcontinent, about 200 million people are at risk of developing visceral leishmaniasis (VL). In 2005, the governments of India, Nepal and Bangladesh started the first regional VL elimination program with the aim to reduce the annual incidence to less than 1 per 10,000 by 2015. A mathematical model was developed to support this elimination program with basic quantifications of transmission, disease and intervention parameters. This model was used to predict the effects of different intervention strategies.

METHODS AND FINDINGS

Parameters on the natural history of Leishmania infection were estimated based on a literature review and expert opinion or drawn from a community intervention trial (the KALANET project). The transmission dynamic of Leishmania donovani is rather slow, mainly due to its long incubation period and the potentially long persistence of parasites in infected humans. Cellular immunity as measured by the Leishmanin skin test (LST) lasts on average for roughly one year, and re-infection occurs in intervals of about two years, with variation not specified. The model suggests that transmission of L. donovani is predominantly maintained by asymptomatically infected hosts. Only patients with symptomatic disease were eligible for treatment; thus, in contrast to vector control, the treatment of cases had almost no effect on the overall intensity of transmission.

CONCLUSIONS

Treatment of Kala-azar is necessary on the level of the individual patient but may have little effect on transmission of parasites. In contrast, vector control or exposure prophylaxis has the potential to efficiently reduce transmission of parasites. Based on these findings, control of VL should pay more attention to vector-related interventions. Cases of PKDL may appear after years and may initiate a new outbreak of disease; interventions should therefore be long enough, combined with an active case detection and include effective treatment.

Integrated mapping of establishment risk for emerging vector-borne infections: a case study of canine leishmaniasis in southwest France

Background

Zoonotic visceral leishmaniasis is endemic in the Mediterranean Basin, where the dog is the main reservoir host. The disease's causative agent, Leishmania infantum, is transmitted by blood-feeding female sandflies. This paper reports an integrative study of canine leishmaniasis in a region of France spanning the southwest Massif Central and the northeast Pyrenees, where the vectors are the sandflies Phlebotomus ariasi and P. perniciosus.

Methods

Sandflies were sampled in 2005 using sticky traps placed uniformly over an area of approximately 100 by 150 km. High- and low-resolution satellite data for the area were combined to construct a model of the sandfly data, which was then used to predict sandfly abundance throughout the area on a pixel by pixel basis (resolution of c. 1 km). Using literature- and expert-derived estimates of other variables and parameters, a spatially explicit R₀ map for leishmaniasis was constructed within a Geographical Information System. R₀ is a measure of the risk of establishment of a disease in an area, and it also correlates with the amount of control needed to stop transmission.

Conclusions

To our knowledge, this is the first analysis that combines a vector abundance prediction model, based on remotely-sensed variables measured at different levels of spatial resolution, with a fully mechanistic process-based temperature-dependent R₀ model. The resulting maps should be considered as proofs-of-principle rather than as ready-to-use risk maps, since validation is currently not possible. The described approach, based on integrating several modeling methods, provides a useful new set of tools for the study of the risk of outbreaks of vector-borne diseases.

Leishmania infection: laboratory diagnosing in the absence of a "gold standard"

There is no gold standard for diagnosing leishmaniases. Our aim was to assess the operative validity of tests used in detecting Leishmania infection using samples from experimental infections, a reliable equivalent to the classic definition of gold standard. Without statistical differences, the highest sensitivity was achieved by protein A (ProtA), immunoglobulin (Ig)G2, indirect fluorescenece antibody test (IFAT), lymphocyte proliferation assay, quantitative real-time polymerase chain reaction of bone marrow (qPCR-BM), qPCR-Blood, and IgG; and the highest specificity by IgG1, IgM, IgA, qPCR-Blood, IgG, IgG2, and qPCR-BM. Maximum positive predictive value was obtained simultaneously by IgG2, qPCR-Blood, and IgG; and maximum negative predictive value by qPCR-BM. Best positive and negative likelihood ratios were obtained by IgG2. The test having the greatest, statistically significant, area under the receiver operating characteristics curve was IgG2 enzyme-linked immunosorbent assay (ELISA). Thus, according to the gold standard used, IFAT and qPCR are far from fulfilling the requirements to be considered gold standards, and the test showing the highest potential to detect Leishmania infection is Leishmania-specific ELISA IgG2.

Transmission, reservoir hosts and control of zoonotic visceral leishmaniasis

Zoonotic 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.

Interferon-gamma (INF-gamma), IL4 expression levels and Leishmania DNA load as prognostic markers for monitoring response to treatment of leishmaniotic dogs with miltefosine and allopurinol

In this study, we searched for a connection between Leishmania load and cytokine expression levels in the tissues of Leishmaniainfantum naturally infected dogs and the efficacy of treatment with miltefosine and allopurinol. To this purpose, we exploited a real-time PCR system to detect Leishmania load and the expression levels of IFN-gamma and IL-4 mRNAs at the time of diagnosis and during the follow up post-treatment. In particular, we measured the amount of parasites in blood and lymph node samples, while the expression levels of IFN-gamma and IL-4 cytokines were assessed in the blood of the animals. We employed different targeted real-time PCR assays on 20 naturally infected dogs with clinical signs. Three healthy dogs living in a non-endemic area were selected as negative controls. The overall results obtained demonstrate that the simultaneous evaluation of parasites and cytokine levels in different kinds of tissue might represent a reliable tool to evaluate the immune response, the efficacy of the therapy and to predict the relapses during the treatment.

[Estimation of the basic reproducibility number for American tegumentary leishmaniasis in two sites in northeastern Salta Province, Argentina]

A SIR-type deterministic mathematical model for three hosts is applied to analyze the transmission process for American tegumentary leishmaniasis in Río Blanco and Las Carmelitas, located in northeastern Salta Province, Argentina, and to derive the expression for the baseline reproducibility number Ro. The model is implemented in the MATLAB environment, and based on data from endemic areas, simulations are performed and numerical estimations of Ro are obtained. Río Blanco shows Ro = 4.689 and Las Carmelitas Ro = 1.948. By studying the model numerically, we also estimate the force of infection, namely 0.239 and 0.171 (unit 1/year), respectively. The simulations show that in Río Blanco, the endemic phase was more sustained than the inter-epidemic phase in Las Carmelitas. The estimations of these epidemiological parameters indicate where the Ministry of Health and Provincial Health Department will experience greater difficulty in controlling and eradicating the disease.

Infectivity of seropositive dogs, showing different clinical forms of leishmaniasis, to Lutzomyia longipalpis phlebotomine sand flies

Visceral leishmaniasis (VL) is a growing zoonosis with an increasing number of new cases and a rapid geographical spreading of the disease. In the present study, a canine survey was carried out in the city of Montes Claros (320,000 inhabitants), an endemic area of American visceral leishmaniasis in the state of Minas Gerais, Brazil. A total number of 4795 dogs were examined by serology, which showed a rate of seropositivity of 5%. Isoenzymatic analysis confirmed Leishmania infantum chagasi as the local aetiological agent of CVL. Canine tissues were assayed for the presence of Leishmania parasite DNA using different techniques. The infectivity of asymptomatic, oligosymptomatic and symptomatic seropositive dogs was tested by xenodiagnosis using laboratory reared Lutzomyia longipalpis. Rates of infection of 5.4%, 5.1% and 28.4% were found for the phlebotomine sand flies that fed in asymptomatic, oligosymptomatic and symptomatic dogs, respectively. Our results indicate that, under experimental conditions, symptomatic dogs are about four times more infective to VL vectors than oligosymptomatic or asymptomatic animals. The lower infectivity rates of dogs displaying any of the last two clinical forms of leishmaniasis, however, must be taken into account in the epidemiology of CVL.

A leishmaniosis surveillance system among stray dogs in the region of Madrid: ten years of serodiagnosis (1996–2006)

Two seroepidemiological surveys on canine leishmaniosis in stray dogs were performed annually in the Madrid region for 10 years (November 1996-April 2006). The presence of anti-Leishmania antibodies was detected by immunofluorescence antibodies test (cut off 1:100). The overall seroprevalence found in the 1,803 dogs studied was 7.8% (141 positive dogs). Seropositivity was not associated with either breed or sex. Statistical analysis revealed greater seroprevalence in groups of older dogs, indicating that the probability of exposure to the bite of sand flies infected with Leishmania infantum increased with age. The most important result was a high proportion of seropositivity for leishmaniosis (79.5%) among dogs without clinical signs of canine leishmaniosis. These data are very important because stray dogs can play an important role in the epidemiology of this zoonotic disease. Furthermore, the stray population could be useful sentinels to follow the progress of the disease in endemic areas.

Comparative evaluation of enzyme-linked immunosorbent assays based on crude and recombinant leishmanial antigens for serodiagnosis of symptomatic and asymptomatic Leishmania infantum visceral infections in dogs

The diagnosis of visceral leishmaniasis remains difficult in rural areas where the disease is endemic, and serologic methods still need assessment, as they are not very sensitive for the detection of asymptomatic infectious dogs. Here we present data on the development of enzyme-linked immunosorbent assay (ELISA)-based methods for the detection of antibodies against recombinant leishmanial antigens (namely, the recombinant K26 [rK26] and rK39 antigens from Leishmania infantum and the rA2 protein from Leishmania donovani) in comparison to ELISAs employing crude soluble antigen (CSA). The assays utilized sera from known negative controls (n=25) and clinically asymptomatic (n=50) and symptomatic (n=50) dogs with confirmed L. infantum infections. Additional studies were also done using sera from animals harboring other infections (n=14) for the evaluation of cross-reactivity. Our study indicated that rK26 and rK39 used in ELISAs provided very high sensitivities for the detection of symptomatic dogs (94% and 100%, respectively), followed by CSA (88%) and rA2 (70%). Conversely, rA2 was more sensitive for asymptomatic dogs (88%) than rK39 and rK26 (both 66%) and CSA (30%). Some cross-reactivity in sera from dogs with other infections (Leishmania braziliensis and Leptospira interrogans) was identified, but the rA2 protein provided the greatest specificity (98%). Data further indicate that all three recombinant proteins must be used in parallel to detect essentially all infected dogs. Efforts should be made to develop a cheap and reliable serologic test based on epitope selection from these diagnostic markers for the sensitive detection of L. infantum-infected dogs.

Leishmania DNA load and cytokine expression levels in asymptomatic naturally infected dogs

The factors responsible for the clinical progress of visceral leishmaniasis (VL) in dogs have not been yet established. The starting hypothesis was the possibility of associating the changing level of a specific type of cytokines with the evolution of the infection towards infection-manifested disease or resistant behaviour. For this purpose the authors have established a connection between Leishmania load, cytokine mRNA accumulation, and the progression of the disease in naturally infected asymptomatic dogs. We made use of real-time (RT) PCR system to detect the expression of cytokine mRNA levels during all the phases of the infection. In particular, we measured the amount of parasites in samples such as blood, lymph nodes and skin, and the expression levels of IFN-gamma, IL-2, IL-4, IL-10, IL-12 and IL-18 cytokines in the blood. We employed different targeted real-time PCR assay on 40 naturally infected dogs, initially asymptomatic; 20 of these progressed to overt disease, and the 20 remaining dogs remained asymptomatic throughout the period of study (2 years). Two other groups included: 20 naturally infected dogs with clinical signs of VL, and 20 healthy dogs living in a non-endemic area. All these animals were employed as positive and negative controls, respectively. The overall results obtained demonstrate that the simultaneous evaluation of parasites and cytokine levels represents a reliable tool for predicting disease development, and thus for choosing the best treatment for the asymptomatic form of the disease.

Serological survey of Leishmania infection in dogs from the municipality of Peso da Régua (Alto Douro, Portugal) using the direct agglutination test (DAT) and fast agglutination screening test (FAST)

Leishmaniasis caused by Leishmania infantum is a prevalent disease in dogs and humans. A serological survey of Leishmania infection in dogs was carried out in the endemic region of Alto Douro (north Portugal). Two hundred and ninety-four dogs from the municipality of Peso da Régua were examined for clinical signs of canine leishmaniasis (CanL), and sera samples were evaluated by the direct agglutination test (DAT) and the fast agglutination screening test (FAST). The sero-prevalence of infection was 20.4%, after screening the study population by FAST and subsequent confirmation by DAT. The overall prevalence of disease was 3.1%. Only 15.0% of the sero-positive dogs had clinical signs of CanL. A high degree of agreement (88.4%; kappa value = 0.71) was found between DAT and FAST. This study further demonstrates that FAST can be used as a simple, rapid and sensitive screening test for canine Leishmania infection in areas of high endemicity and, together with DAT, is a valuable tool in the assessment of CanL.

Epidemiology of canine visceral leishmaniosis in the endemic area of Montes Claros Municipality, Minas Gerais State, Brazil

The Montes Claros City is located in an endemic area for visceral leishmaniosis in the Minas Gerais State, Brazil. With the implementation of a program for the control of visceral leishmaniosis in 1994, a sectional study was carried out to evaluate the infection by viscerotropic Leishmania in the population of dogs from Montes Claros, basically using indirect immunofluorescence antibody test (IFAT). Blood samples were collected on filter paper from 33,937 dogs, representing 96.1% of the canine local population. The prevalence for visceral leishmaniosis was found to be 9.7% in the municipality, being 9.9% in the urban area and 8.8% in the rural area. The annual incidence showed to be 64.3/1000 dogs. Prevalence of infection was not correlated with dogs age. The most affected breeds were: Boxer (24.6%) and Cocker (26.9%); Mongrel dogs had a prevalence of 7.8%. Short-hair animals had a prevalence of 11.9%, while long-furred animals had a prevalence of 8.9%. The isoenzymatic profile indicated that Leishmania (Leishmania) chagasi was the visceral leishmaniosis etiological agent in Montes Claros City, Minas Gerais State, Brazil. The main geographical areas for the parasite transmission were identified, and control measures were immediately started. The role of the dog as a reservoir for L. chagasi was confirmed. It was demonstrated that short-furred animals are at a higher risk of acquiring visceral leishmaniosis than the long-furred dogs.

A cross-sectional study of Leishmania spp. infection in clinically healthy dogs with polymerase chain reaction and serology in Greece

A total of 73 clinically healthy hunting dogs, experiencing an outdoor lifestyle and originating from an area where canine leishmaniasis is endemic, were included in the study. Polymerase chain reaction (PCR) and indirect immunofluorescent antibody test (IFAT) for Leishmania spp. were done on bone marrow and serum samples, respectively, obtained from all 73 dogs, just before the beginning of the sandfly season. PCR was found positive in 46/73 (63%) whereas, IFAT only in 9/73 (12.3%) of the dogs. The prevalence and the incidence of Leishmania infection by PCR were 61.9 and 47.1%, respectively. No association was found between the breed, age, sex, length of hair coat of the dog, urban or rural life and the presence of ample vegetation and water collections in the proximity of their living quarters, and the result of PCR. These findings clearly demonstrate that most of the dogs residing areas where leishmaniasis is endemic become infected but usually remain seronegative. Serological screening of the general canine population in these areas may result in an underestimation of the true prevalence of the infection rate.

Diagnosis of leishmaniasis in Maltese dogs with the aid of the polymerase chain reaction

Visceral leishmaniasis due to infection with Leishmania infantum (a member of the L. donovani complex) has been known in Malta since the beginning of the century. In 1946, when human diseases became compulsorily notifiable on the islands, the leishmaniasis figures were 1264 visceral cases, 36 cutaneous cases and 5 unspecified. Five cases of cutaneous infection were reported in 1997 and 23 cases of cutaneous and 3 of visceral infection in January-October 1998. There may be considerable under-reporting of the disease. Figures of between 18% and 47% have been reported for canine leishmaniasis. This large discrepancy between reservoir and human hosts suggests that the canine reservoir could be a serious threat and is worthy of careful examination. This pilot study was carried out to determine the proportion of dogs serologically positive for leishmaniasis in order to assess the necessity for a possible control programme in Malta. Using 60 canine blood samples from the Maltese islands, we tested for deoxyribonucleic acid (DNA) of the L. donovani complex using the polymerase chain reaction (PCR). The samples had all been subjected to the indirect immunofluorescent antibody test (IFAT) and a direct comparison was made. DNA was extracted using the phenol/chloroform method and amplified with primers specific for kinetoplast mini-circle DNA of the L. donovani complex and L. major, Southern blotted and hybridized with a radio-labelled probe specific for the L. donovani complex. Twelve of the samples gave positive results in the IFAT, whilst 37 (62%) were positive by PCR and hybridization. All samples from 36 dogs from a non-endemic area in the UK were negative by PCR. Five of the 12 samples positive by IFAT gave negative PCR results.

Evidence for an impact on the incidence of canine leishmaniasis by the mass use of deltamethrin-impregnated dog collars in southern Italy

Dogs are the domestic reservoir of Leishmania infantum Nicolle (Kinetoplastida: Trypanosomatidae), the agent of zoonotic human visceral leishmaniasis. In southern Europe, where canine leishmaniasis (CanL) is widespread due to L. infantum, killing seropositive dogs is considered unacceptable and drug treatment has low efficacy in preventing transmission. We made a field evaluation of the efficacy of deltamethrin dog collars in a CanL focus of southern Italy, Mount Vesuvius area of Campania region, where the vector is Phlebotomus perniciosus Newstead (Diptera: Psychodidae), by assessing their impact on the incidence of CanL in an intervention town, compared to that in dogs of control towns where no collars were fitted. During two consecutive transmission seasons, collars were fitted to 350 (1998) and 354 (1999) dogs from San Sebastiano al Vesuvio (70% of the canine population). Control dogs (371 and 264 in the 2 years, respectively) were from four towns of the same area. Before each transmission season, the CanL seroprevalence in the intervention and control towns was evaluated by cross-sectional surveys and found to be similar (about 15% in 1998 and 10% in 1999, respectively). After each transmission period, incidence rates of seroconversions were determined in adult dogs that were serologically negative before the season under evaluation, and in puppies. After the 1998 season, 2.7% of the dogs in the intervention town seroconverted compared to 5.4% in the control towns (50% protection, P = 0.15). After the 1999 season, 3.5% of collared dogs seroconverted compared to 25.8% of control dogs (86% protection, P < 0.001). The increase in seroconversion rates recorded in control dogs suggests an increase in the Leishmania force of infection in the canine reservoir during the 1999 sandfly season, as supported by the concomitant increase of human cases in control towns and in the whole Campania region. Our results suggest that the impact of mass use of deltamethrin-impregnated dog collars on the incidence of CanL may be negligible during low transmission seasons, or probably in low endemic foci, but can be very strong when the force of transmission is high.

Prevalence of Leishmania infantum infection in dogs living in an area of canine leishmaniasis endemicity using PCR on several tissues and serology

We studied and compared the prevalence of Leishmania infection and the seroprevalence and the prevalence of canine leishmaniasis in an area where canine leishmaniasis is endemic. One hundred dogs living on the island of Mallorca (Spain) were studied. In this study, we clinically examined each dog for the presence of symptoms compatible with leishmaniasis, determined the titer of anti-Leishmania antibodies, and investigated the presence of Leishmania DNA by PCR in skin, conjunctiva, and bone marrow samples of each dog. The prevalence of the disease and the seroprevalence were 13 and 26%, respectively. In 63% of the dogs, Leishmania DNA could be detected by PCR in at least one of the tissues studied. The results of positive PCR in the bone marrow, the conjunctiva, and the skin were 17.8, 32, and 51%, respectively. The prevalence of the infection, 67%, was calculated using all animals that were seropositive and/or positive by PCR with any tissue. The results showed that the majority of dogs living in an area where canine leishmaniasis is endemic are infected by Leishmania and that the prevalence of infection is much greater than the prevalence of overt Leishmania-related disease.

Epidemiology of canine leishmaniosis in Catalonia (Spain) the example of the Priorat focus

An epidemiological survey of canine leishmaniosis was conducted in the Priorat, a rural region in the Northeast of Spain, for 10 years (1985-1994). Seroprevalence throughout the region, determined by dot-ELISA and IFI, was 10.2% (8-12%). Forty percent of the dogs studied had a low level of anti-Leishmania antibodies, whereas only 50% were seronegative. Only one-third of the seropositive dogs had evident symptoms of the disease. Annual incidence of the disease was 5.7% and the level of endemicity was stable during the study. Four Leishmania zymodemes (MON-1, MON-29, MON-77, MON-105) were present in the focus, and their distribution in the different hosts is discussed. Apart from dogs and foxes, no other reservoir host has been found in the region.

Asymptomatic canine leishmaniasis in Greater Athens area, Greece

Leishmania (L.) infantum is the etiological agent of human and canine visceral leishmaniasis in the Mediterranean subregion. Domestic dogs are the main reservoir of the parasite in most urban areas. A survey of 1638 asymptomatic dogs registered in Greater Athens area was carried out in the Hellenic Pasteur Institute during the period 1986-1994 to investigate the prevalence of canine visceral leishmaniasis in apparently healthy dogs. Dog sera was tested using the indirect fluorescent antibody technique (IFAT). Of the 1638 dogs, 366 (22.4%) had anti-Leishmania infantum antibodies at titre greater than or equal to 1/200 which were considered positive; 53 (3.2%) had antibody titres of 1/100 and were considered uncertain; and 1219 (74.4%) dogs were seronegative. From the 366 seropositive dogs, 212 were positive at 1/1600 serum dilution, 57 at 1/800, 38 at 1/400 and 59 at 1/200. The results were plotted according the site of residence, breed and age. The rate of asymptomatic infections with L. infantum dogs in Greater Athens area appears to be significantly high. Although there is an apparent lack of clinical symptoms in these dogs, asymptomatic animals harbor a chronic L. infantum infection and as such consist a 'dangerous' reservoir with regard to the spread of the disease.

Epidemiological patterns of canine leishmaniasis [correction of leishmaniosis] in Western Liguria (Italy)

An epidemiological survey was carried out on the distribution of canine leishmaniasis in Western Liguria (Northern Italy). Blood sera from 21146 dogs collected from 1990 to 1996 were subjected to the indirect immunofluorescence test (IFAT). From 1990 to 1994 (16690 dogs), only monthly seroprevalences were calculated (min 14%-max 60.5%). Dog sera sampled from October 1994 to May 1996 (4456 dogs) were divided into two subgroups (I: October 1994-May 1995; II: October 1995-May 1996). Seroprevalence was 30.3% and 22.1% in these two groups, respectively. Data analysis by log-linear models revealed that serological positivity to Leishmania sp. was significantly associated with a dog's outdoor lifestyle, with a rural environment and with the male sex. Of the 218 dogs which were tested twice seroconversion rates were also higher in outdoor, rural and male dogs while negativization rates were lower in the same groups. Basic reproductive numbers (R0) were 1.53 (subgroup I) and 1.28 (subgroup II).

The immunology of canine leishmaniosis: strong evidence for a developing disease spectrum from asymptomatic dogs

Asymptomatic mixed breed dogs (49) from a region of high incidence of visceral leishmaniosis in Portugal were examined for the presence of Leishmania-specific cellular immunity using a proliferation assay and humoral immunity using an indirect antibody fluorescent test (IFAT) and an ELISA. The results were compared directly with 25 mixed breed dogs permanently residing in a non-endemic region (Scotland). Unlike similar studies in humans from non-endemic areas, there was no evidence of any immunological response against leishmanial antigen whatsoever from the latter group of animals. Of the 49 dogs from Portugal, however, 20 had demonstrable parasite-specific cellular immunity. Depending on the assay and criteria used to measure a positive humoral response, 11, 16 or 24 dogs had a Leishmania-specific humoral response with the ELISA being the most sensitive assay system. While 16, 12 or 8 of the dogs had clearly only a cellular response (depending on which criterion was used to constitute a true antibody response) and 7, 8 or 12 had only humoral response, other 4, 8 or 12 of the dogs had both cellular and humoral responses. This study clearly demonstrates that the infection rate of canine leishmaniosis is not only higher than previously thought using serological tests alone but that the response to infection is already highly polarised in many asymptomatic dogs. It is postulated that an individual dog's position within the immunological spectrum is likely to indicate how the disease will progress.

The design of veterinary vaccination programmes

The optimal design of a veterinary vaccination programme depends on both the characteristics of the vaccine and the epidemiology of the pathogen or parasite. Relevant vaccine characteristics are the proportion of those vaccinated that are initially protected, the duration of protection and the coverage achieved by the vaccination programme. The most important epidemiological parameter is the basic reproduction number, R0. Mathematical theory can integrate this information to address such questions as: whether it is possible to eliminate an infection; what proportion of hosts must be vaccinated to achieve this: what age should hosts first be vaccinated; and at what interval should hosts be revaccinated? Examples of rabies in foxes and foot-and-mouth disease in cattle suggest that theory can be used to guide the design of vaccination programmes.

Visceral leishmaniasis

Visceral leishmaniasis presents a serious problem in endemic regions that is difficult to treat or prevent. Several epidemiologic problems make the disease particularly troublesome to manage. These include the facts that classic visceral leishmaniasis is fatal if untreated and there is not reliable access to medical care in many endemic regions. When available, treatment has associated toxicity and requires the use of intravenous medications with careful monitoring for toxicity, which are complex to administer in underdeveloped nations. There is an increasing incidence of the disease in HIV-infected individuals in southern Europe, in part because of the fact that eradication of the organism from infected persons using currently available drugs appears to be difficult if not impossible. Furthermore, chronic cutaneous forms of the disease allow humans and animals to maintain the organism long-term in a bodily site that is easily accessible to the sandfly vector. More effective and less toxic treatment modalities as well as a protective vaccine are badly needed to manage this disease.

Leishmaniasis eco-epidemiology in the Alpujarra region (Granada Province, southern Spain)

An eco-epidemiological study was carried out in the region of the Alpujarras (southern Spain, Granada province). Nine villages were chosen at random in 5 bioclimatic zones. A study of leishmaniasis in the canine and human populations, was carried out concentrating especially upon schoolchildren. A total of 615 dogs were screened, which represents almost 100% of the canine census. Of the screened dogs, 33 showed an antibody titer > or = 1/160 when tested by IFA (seroprevalence of 5.3%). Age, sex, activity, and clinical symptoms of each dog were taken into account. Among the human population, infection from Leishmania was studied using the Leishmanin skin test (LST). Of 1286 people who were tested, 568 (44.16%) were positive. Most of the subjects were schoolchildren (878; practically 100% of the pupils), of whom 288 (32.8%) tested positive. A close relation was seen to exist between the percentage of positive LST's and age. Finally, a close relationship was also observed between canine seroprevalence and percentage of schoolchildren who tested positive in the LST, in the 5 bioclimatic zones under consideration.

The role of dogs in the epidemiology of human visceral leishmaniasis in northern Pakistan

Infantile visceral leishmaniasis (VL) was first reported from north Pakistan over 3 decades age in the remote valleys of the western Himalayas. These foci were reported as being completely devoid of domestic dogs. The later emergence of sporadic cases of infantile VL in the sub-Himalayan region of the country, where dogs are abundant, enabled us to investigate the prevalence of canine disease and study its relation with disease in humans. A serological survey in dogs by direct agglutination test (DAT) and enzyme-linked immunosorbent assay (ELISA) indicated that 18% (DAT) and 26.6% (ELISA) harboured anti-Leishmania antibodies, with older dogs showing higher prevalence; 10% of the infected dogs had no clinical signs of leishmaniasis. Deoxyribonucleic acid (DNA) probing by 32P-labelled Lmet 2 cDNA probe showed high sensitivity with aspirates obtained from the popliteal lymph nodes of dogs but not with skin snips. Parasites isolated from dogs in these foci were identified as L. infantum by isoenzyme characterization.

Epidemiology of canine leishmaniasis in the Madrid region, Spain

A cross-sectional serological survey was carried out in the Madrid Autonomous Region (Comunidad de Madrid) in order to study and describe canine leishmaniasis epidemiology. The presence of leishmaniasis-specific antibodies was ascertained by immunofluorescence testing, 591 dogs were screened, revealing a prevalence of 5.25% (95% confidence interval 7.4-3.6), with no difference being encountered between rural and periurban areas. Age-specific prevalence exhibits a peak at 2-3 years and another at 7-8 years. Incidence or force of infection by occupation is as follows: pet dogs 0.059 (95% confidence interval 0.009-0.108) and working dogs 0.035 (95% confidence interval 0.012-0.057), there being a ratio between infection rates of 1.7, viz., indicating a 70% greater risk of infection among pet than among working dogs. The basic case reproduction number R0 is 1.06, suggesting that very intense control measures would not be needed for a drop in prevalence and incidence of infection to be achieved.

Investigations on naturally occurring Trypanosoma evansi infections in horses, cattle, dogs and capybaras (Hydrochaeris hydrochaeris) in Pantanal de Poconé (Mato Grosso, Brazil)

The prevalence of Mal de Cadeiras--Portuguese for Trypanosoma (T.) evansi infections in horses--as well as the prevalence of T.evansi infections in cattle, dogs and free-ranging capybaras (Hydrochaeris hydrochaeris) was investigated in Pantanal de Poconé (Mato Grosso, Brazil). In 0.3, 8.6 and 8.0% of the horses, dogs and capybaras, respectively, infection was detected using standard parasitological methods. A seroprevalence of 4.1, 2.3, 7.1 and 22.0% was found in horses, cattle, dogs and capybaras, respectively, using an enzyme-linked immunosorbent assay for the detection of T.evansi antigen (Ag-ELISA), whereas 9.6, 4.2, 18.6 and 14.0% of the animals investigated were reactive in a T.evansi antibody (Ab-) ELISA. Positive ELISA results ('high responders') were identified using computer-assisted mixture analysis (C.A.MAN). Agglutinating antibodies were detected by the T.evansi card agglutination test for trypanosomiasis (CATT/T.evansi) in 14.6%, 1.3%, 15.7% and 22.0% of the horses, cattle, dogs and capybaras, respectively. A moderate but significant (kappa test; p < 0.05) agreement beyond chance level was observed between Ab-ELISA and CATT results but generally not between antibody and antigen detection tests. Therefore, in an attempt to maximize the information yield of the three serodiagnostic tests, their results were numerically scored (negative = 0, intermediate = 1, positive = 2) and added up to a total score (TS) which was considered indicative for infection when TS > or = 4 (results of the Ag-ELISA received double weight). Estimates of seroprevalence according to TS were 13.2, 4.7, 30.0 and 24.0% for horses, cattle, dogs and capybaras, respectively. Identical isoenzyme profiles, known as zymodeme 58 (T.evansi MCAN/BR/86/H), were found in all T.evansi stocks isolated in the study area (six from dogs, one from a horse and one from a capybara). From the results of this study it can be inferred that Mal de Cadeiras is endemic in Pantanal de Poconé. Although clinical and parasitological findings support the possible role of the capybara as a reservoir host of T.evansi, dogs and cattle--due to their close contact with horses--should rather be regarded as efficient reservoir hosts for Mal de Cadeiras in the study area.

Epidemiology of canine leishmaniasis: a comparative serological study of dogs and foxes in Amazon Brazil

The paper describes a longitudinal field study of canine leishmaniasis in sympatric domestic dog and crab-eating fox (Cerdocyon thous) populations. Dogs were studied in house-to-house surveys, and foxes were studied by live-trapping and radio-telemetry. Because serological tests (IFAT in this case) for leishmaniasis are often of uncertain sensitivity and specificity, we draw conclusions comparatively. Both cross-sectional (age-prevalence) and longitudinal analyses indicate that incidence in dogs was highest in the dry season. Seasonal changes in the age-prevalence relationship for dogs suggest that serological conversion and recovery rates decline with prior exposure to infection, where 'recovery' may be due to loss of a positive antibody titre or death from leishmaniasis. The mean incidence in dogs was higher in the rural than in the urban population and higher in hunting dogs than pet dogs. Cross-sectional and longitudinal analyses of fox serological data suggest that foxes remain positive for longer than dogs on average, either because detectable antibody is more persistent or because they experience a lower mortality rate due to leishmaniasis.

Approaches to vector control: new and trusted. 5. The epidemiological context of vector control

This paper discusses 2 prominent, contemporary issues in the epidemiological context of insect vector control: (i) the magnitude of the control problem, and (ii) non-linear processes influencing vector control. It concludes that we still cannot reliably measure the scale of some important control problems; e.g., there is considerable uncertainty about the basic reproduction number of malaria. The emergence of new concepts such as strain-specific immunity, and a growing emphasis on disease control as distinct from infection control, mean that some quantitative problems are being redefined more quickly than they are being solved. Population biologists have urged exploration of density-dependent processes which may help or hinder new methods of vector control. This brief review of non-linear phenomena such as facilitation and limitation finds little evidence that they will significantly influence, e.g., the introduction of some novel refractory mechanism into a vector population.

Construction of an intrinsic cut-off value for the sero-epidemiological study of Trypanosoma evansi infections in a canine population in Brazil: a new approach towards an unbiased estimation of prevalence

In the serodiagnosis of tropical infectious diseases, cut-off values are often established by using sera from individuals living under moderate climatic conditions, not exposed to the risk of infection (non-endemic controls). This approach guarantees the disease-free status of the individuals within that control group but leads to an assembly of samples which are not representative for the disease-free individuals of the target population (selection bias). Using data from an epidemiological study of Trypanosoma evansi infection in dogs, two alternative methods to construct cut-off values for a T. evansi antibody ELISA are described which are solely based on a distribution analysis of the data from the endemic animals. By cluster analysis these data could be divided into 'high', 'intermediate' and 'low responders'. High responders could also be identified by using the computer-assisted analysis of mixtures (C.A.MAN). Conventional cut-offs were calculated from a group of non-endemic individuals. A receiver operating characteristic (ROC) analysis was performed to demonstrate the impact of the choice of cut-offs on the test specificity and on the estimated seroprevalence among the endemic population. The data indicate that distribution analysis, especially the mixture analysis (C.A.MAN), are valuable tools for the unbiased estimation of seroprevalence when representative negative controls are not available.

Cellular and humoral immune responses in dogs experimentally and naturally infected with Leishmania infantum

In this paper we describe a number of immunological parameters for dogs with a chronic Leishmania infantum infection which exhibit patterns of progressive disease or apparent resistance. The outcome of infection was assessed by isolation of parasites, serum antibody titers to Leishmania antigen, and development of clinical signs of leishmaniasis. Our studies show that 3 years after experimental infection, asymptomatic or resistant dogs responded to L. infantum antigen both in lymphocyte proliferation assays in vitro and in delayed-type hypersensitivity reaction, whereas no serum antibodies to parasite antigen were shown. In contrast, symptomatic or susceptible animals failed to respond to parasite antigen in cell-mediated assays both in vitro and in vivo and showed considerably higher serum antibodies to leishmanial antigens. In addition, significantly higher level of interleukin 2 (IL-2) and tumor necrosis factor were found in supernatants from stimulated peripheral mononuclear cells from asymptomatic dogs compared with those from symptomatic and control uninfected dogs. IL-6 production did not vary significantly among the groups studied. Finally, we observed similar results with a group of mixed-breed dogs with natural Leishmania infections also grouped as asymptomatic or symptomatic on the basis of clinical signs of canine visceral leishmaniasis. These results demonstrate that serum antibody titers, antigen-specific proliferative responses, delayed-type hypersensitivity skin reactions, and IL-2 and tumor necrosis factor production by peripheral mononuclear cells can be used as markers of disease progression.