Leishmaniose Visceral Americana: (Relatorio dos trabalhos realisados pela commissão encarregada do estudo da Leishmaniose Visceral Americana em 1937)

Toxicity of Trixis vauthieri DC essential oil on Lutzomyia longipalpis (Diptera, Psychodidae, Phlebotominae), a proven vector of visceral leishmaniasis in Brazil

BACKGROUND OBJECTIVES

In Brazil, one of the visceral leishmaniasis control measures in urban environments is the elimination of Lutzomyia longipalpis, which occurs through the application of pyrethroid insecticides with residual action in homes and outbuildings. Due to the loss of sensitivity of this vector to these insecticides, the search for more efficient insecticide compounds against L. longipalpis has been intensified. The objective of this work was to evaluate the toxicity of Trixis vauthieri essential oil on adult sandflies of the species L. longipalpis, and identify the phytochemical composition of these essential oils.

METHODS

Essential oils from leaves collected from T. vauthieri at different times were obtained at concentrations of 5, 10 and 20 mg/mL. Twenty sandflies were exposed to the essential oils and the mortality was evaluated after 1, 2, 4, 16, 24, 48 and 72 h. The chemical constituents of the essential oil were also identified.

RESULTS

The essential oils of T. vauthieri at a concentration of 20 mg/mL were the most toxic to sandflies, reaching a mortality rate of 98.33% and 95%, respectively, after 72 h of exposure. The analysis of chemical constituents revealed the presence of triterpenes and/or steroids, tannins, flavonoids, alkaloids, saponins and coumarins.

INTERPRETATION CONCLUSION

The results obtained suggest that T. vauthieri essential oil is fairly promising as an insecticidal potential against L. longipalpis. A more detailed analysis of the oil's phytochemical composition is necessary to identify active and pure compounds that can be used in vector control of visceral leishmaniasis.

Identification of infection by Leishmania spp. in wild and domestic animals in Brazil: a systematic review with meta-analysis (2001-2021)

Leishmaniasis is a zoonosis caused by protozoan species of the genus Leishmania. It generates different clinical manifestations in humans and animals, and it infects multiple hosts. Leishmania parasites are transmitted by sandfly vectors. The main objective of this systematic review was to identify the host, or reservoir animal species, of Leishmania spp., with the exception of domestic dogs, that were recorded in Brazil. This review included identification of diagnostic methods, and the species of protozoan circulating in the country. For this purpose, a literature search was conducted across index journals. This study covered the period from 2001 to 2021, and 124 studies were selected. Eleven orders possible hosts were identified, including 229 mammalian species. Perissodactyla had the highest number of infected individuals (30.69%, 925/3014), with the highest occurrence in horses. In Brazil, the most commonly infected species were found to be: horses, domestic cats, rodents, and marsupials. Bats, that were infected by one or more protozoan species, were identified as potential reservoirs of Leishmania spp. Molecular tests were the most commonly used diagnostic methods (94 studies). Many studies have detected Leishmania spp. (n = 1422): Leishmania (Leishmania) infantum (n = 705), Leishmania (Viannia) braziliensis (n = 319), and Leishmania (Leishmania) amazonensis (n = 141). Recognizing the species of animals involved in the epidemiology and biological cycle of the protozoan is important, as this allows for the identification of environmental biomarkers, knowledge of Leishmania species can improve the control zoonotic leishmaniasis.

Leishmania infantum Infection in a Domestic Cat: A Real Threat or an Occasional Finding?

PURPOSE

Visceral Leishmaniasis (VL) has been considered one of the most important neglected zoonosis in the world. In Brazil, this disease passed for an urbanization process and currently pets (dogs and cats) animals have acquired a great importance on its epidemiology. Studies on dogs have been extensively performed throughout the country, but information about infection in cats has been concentrated in few areas. Therefore, the aim of this study was to investigate the occurrence of infection by Leishmania infantum in domestic cats living in endemic areas for Canine Visceral Leishmaniasis (CVL) in the state of Pernambuco, Northeastern Brazil.

METHODS

Domiciled cats (n = 128) were sampled for different biological samples (i.e., blood, conjunctival swab and fine needle aspiration of lymph nodes) that were microscopically and molecularly analyzed through PCR and sequencing.

RESULTS

Amastigote forms of Leishmania sp. were detected in a single animal (fine needle aspiration of lymph node). This same animal scored positive at molecular examination (blood and lymph node) and the sequence analysis revealed an identity higher than 99% with L. infantum sequences DNA available in Genbank database.

CONCLUSION

This is the first molecular characterization of L. infantum infecting domestic cats in Pernambuco. Therefore, veterinary practitioners should consider this putative infection in cats living in areas where canine and human Leishmaniasis has been reported.

O uso de um instrumento de política de saúde pública controverso: a eutanásia de cães contaminados por leishmaniose no Brasil

Resumo A leishmaniose visceral é uma zoonose transmitida por vetor, de importância mundial, que envolve os cães como reservatórios. A "eliminação dos reserva tórios" está prevista expressamente como medida de controle no Manual de Vigilância e Controle da Leishmaniose Visceral elaborado pela Secretaria de Vigilância em Saúde, órgão do Ministério da Saúde. Contudo, a eliminação de cães soropositivos no Brasil, usada para controlar a leishmaniose vis ceral, tem sido pouco efetiva. Este trabalho levanta questionamentos sobre esse instrumento de política nacional de saúde pública com base em evidências científicas atuais e análises do ordenamento jurí dico brasileiro, realizadas a partir do princípio da precaução e do reconhecimento dos animais como seres sencientes. Conclui-se pela imediata suspen são e revisão da prática de extermínio animal em um Estado Constitucional de Direito, e a adoção de métodos preventivos e mais eficazes que garantam a saúde pública sem proporcionar elevados custos emocionais aos proprietários de cães e financeiros aos cofres públicos.

Canine visceral leishmaniasis due to Leishmania (L.) infantum chagasi in Amazonian Brazil: comparison of the parasite density from the skin, lymph node and visceral tissues between symptomatic and asymptomatic, seropositive dogs

Canine visceral leishmaniasis (CVL) is recognizable by characteristic signs of disease and is highly lethal. The infection, however, may be quite inapparent in some seropositive dogs, and this has raised the polemic question as to whether or not such animals can be a source of infection for Lutzomyia longipalpis, the vector of American visceral leishmaniasis (AVL). In this study we have examined 51 dogs with acute CVL from an AVL area in Pará State, northern Brazil, and compared the parasite density, amastigotes of Leishmania (L.) infantum chagasi, in the skin, lymph node and viscera of symptomatic with that of nine asymptomatic but seropositive dogs (IFAT-IgG). Post-mortem biopsy fragments of these tissues were processed by immunohistochemistry, using a polyclonal antibody against Leishmania sp. The X² and Mann Whitney tests were used to evaluate the means of infected macrophage density (p < 0.05). There was no difference (p > 0.05) in the skin (10.7/mm² x 15.5/mm²) and lymph node (6.3/mm² x 8.3/mm²), between asymptomatic and symptomatic dogs, respectively. It was higher (p < 0.05), however, in the viscera of symptomatic (5.3/mm²) than it was in asymptomatic (1.4/mm²) dogs. These results strongly suggest that asymptomatic or symptomatic L. (L.) i. chagasi-infected dogs can serve as a source of infection, principally considering the highest (p < 0.05) parasite density from skin (10.7/mm² x 15.5/mm²), the place where the vetor L. longipalpis takes its blood meal, compared with those from lymph node (6.3/mm² x 8.3/mm²) and viscera (1.4/mm²x 5.3/mm²).

G, Ferreira AL, Falqueto A. American visceral leishmaniasis dissociated from Lutzomyia longipalpis (Diptera, Psychodidae) in the State of Espírito Santo, Brazil

The occurrence of American visceral leishmaniasis in the State of Espírito Santo, Brazil has always been associated with the presence of the Lutzomyia longipalpis vector. The geographic distribution of this vector in this state is related to the presence of specific geoclimatic characteristics, such as a dry climate, low elevations (< 450m), steep slopes and rocky outcrops. The occurrence of human autochthonous cases of American visceral leishmaniasis in municipalities without these geoclimatic characteristics justifies the present study and our main goal was to test the association between the occurrence of American visceral leishmaniasis and the presence of the Lu. longipalpis. Sand flies were captured monthly from July 2006 to August 2007 using Shannon and CDC traps in two municipalities with records of autochthonous American visceral leishmaniasis and one with no record. We captured 13,112 sand flies, but no Lu. longipalpis was found. The absence of Lu. longipalpis and the possible role of another American visceral leishmaniasis vector in these localities were discussed.

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.

The first records of Leishmania (Leishmania) amazonensis in dogs (Canis familiaris) diagnosed clinically as having canine visceral leishmaniasis from Araçatuba County, São Paulo State, Brazil

Two cases of Leishmania (Leishmania) amazonensis are reported in the domestic dog (Canis familiaris). These are the first records of this parasite in this species. The animals lived in the endemic visceral leishmaniasis area of Araçatuba, São Paulo State, Brazil and were initially diagnosed, on clinical grounds, as having visceral leishmaniasis. Attempted parasite isolation from inguinal lymph node aspirates was unsuccessful and the indirect immunofluorescent test for visceral leishmaniasis was negative in both cases. Parasites were seen in cytological preparations of their lymph nodes and the DNA obtained from these same tissues produced the expected fragment in a Leishmania specific rDNA based PCR assay. The products only hybridized with the L. (L.) amazonensis specific probe S8. No human cases of L. (L.) amazonensis have been reported in this region. These results suggest that L. (L.) amazonensis is being transmitted in the peridomestic habitat and that this parasite is responsible for a clinical condition that is similar to visceral leishmaniasis caused by L. (L.) i. chagasi that is present in the same area.

Lutzomyia longipalpis and the eco-epidemiology of American visceral leishmaniasis, with particular reference to Brazil: a review

An historical review is given of American visceral leishmaniasis (AVL), with particular reference to the eco-epidemiology of the disease in Brazil. Following the first records of AVL in this country, in 1934, the sandfly Lutzomyia longipalpis (Lutz and Neiva, 1912) was incriminated as the principal vector. It is now generally accepted, however, that there exist a number of cryptic species under the name of Lu. longipalpis s.l. and that variations in the quantity of the vasodilatory peptide maxadilan in the saliva of flies from different populations of Lu. longipalpis s.l., may account for the variable clinical manifestations of AVL seen in different geographic regions. Distribution of AVL has been shown to extend throughout most of South and Central America, with the domestic dog serving as the principal reservoir of infection for man. However, while one hypothesis suggests that the causative parasite is Leishmania infantum, imported from Europe with the Portuguese and Spanish colonists, the demonstration of a high rate of benign, inapparent infection in foxes in Amazonian Brazil raised an opposing suggestion that the parasite is indigenous to the Americas. Recent reports of similar infections in native marsupials, and possibly rodents, tend to support this view, particularly as Lu. longipalpis is primordially a silvatic sandfly. Although effective control measures in foci of the disease will diminish the number of canine and human infections, the presence of such an enzootic in a variety of native animals will render the total eradication of AVL unlikely.

Canine visceral leishmaniasis in São José de Ribamar, Maranhão State, Brazil

Here, we describe the situation of canine visceral leishmaniasis in two villages of São José de Ribamar in Maranhão State/Brazil, where human cases have been registered. Blood samples of 36 household crossbred dogs from Sergio Tamer village and 43 dogs from Quinta village were collected and the serum used for serological diagnosis. An Indirect Fluorescent Antibody Test (IFAT) and enzyme-linked immunosorbent assay (ELISA) were used to detect antibodies against Leishmania. The clinical examination showed that 25% of the canine population of Quinta presented a poor body condition and in 39%, ectoparasites (ticks and fleas) were detected. In both tests, serology revealed that 21% (9 out of 43) of the dogs presented antibodies against Leishmania (55% were asymptomatic and 45% were symptomatic). In the Vila Sérgio Tamer, 25% (9 out of 36) of the dogs were seropositive for Leishmania (66.67% were asymptomatic and 33.33% were symptomatic), 33% presented poor body condition, and 22% have ectoparasites. The clinical signs more frequent were skin lesions. The statistical analysis showed that there was no statistical difference (p>0.05) between the seropositivity of the dogs from the two villages. The same was observed when the clinical signs were compared (p>0.05). Both villages have favorable conditions to maintain the cycle of leishmaniasis.

A sensitive flow cytometric methodology for studying the binding of L. chagasi to canine peritoneal macrophages

BACKGROUND

The Leishmania promastigote-macrophage interaction occurs through the association of multiple receptors on the biological membrane surfaces. The success of the parasite infection is dramatically dependent on this early interaction in the vertebrate host, which permits or not the development of the disease. In this study we propose a novel methodology using flow cytometry to study this interaction, and compare it with a previously described "in vitro" binding assay.

METHODS

To study parasite-macrophage interaction, peritoneal macrophages were obtained from 4 dogs and adjusted to 3 x 10(6) cells/mL. Leishmania (Leishmania) chagasi parasites (stationary-phase) were adjusted to 5 x 10(7) cells/mL. The interaction between CFSE-stained Leishmania chagasi and canine peritoneal macrophages was performed in polypropylene tubes to avoid macrophage adhesion. We carried out assays in the presence or absence of normal serum or in the presence of a final concentration of 5% of C5 deficient (serum from AKR/J mice) mouse serum. Then, the number of infected macrophages was counted in an optical microscope, as well as by flow citometry. Macrophages obtained were stained with anti-CR3 (CD11b/CD18) antibodies and analyzed by flow citometry.

RESULTS

Our results have shown that the interaction between Leishmania and macrophages can be measured by flow cytometry using the fluorescent dye CFSE to identify the Leishmania, and measuring simultaneously the expression of an important integrin involved in this interaction: the CD11b/CD18 (CR3 or Mac-1) beta2 integrin.

CONCLUSION

Flow cytometry offers rapid, reliable and sensitive measurements of single cell interactions with Leishmania in unstained or phenotypically defined cell populations following staining with one or more fluorochromes.

Leishmaniose visceral entre índios no Estado de Roraima, Brasil: aspectos clínicoepidemiológicos de casos observados no período de 1989 a 1993

Descreve-se o perfil epidemiológico da leishmaniose visceral entre índios no estado de Roraima, Brasil, baseado na ocorrência de casos humanos observados e nos inquéritos caninos e entomológicos realizados no período de 1989 a 1993. Foram registrados 82 casos humanos de leishmaniose visceral em seis dos oito municípios então existentes no estado; houve predomínio de 69,5% para o sexo masculino entre os casos observados. A maioria (52,4%) dos casos foi entre crianças de zero a dez anos de idade. Registrou-se o índice de 10,3% de infecção canina natural, entre 3.773 cães examinados em 74 localidades pesquisadas. A Lutzomyia longipalpis foi encontrada nas áreas de maior prevalência da doença, em 31 localidades diferentes. Os casos humanos, caninos e vetores estão concentrados em regiões onde predominam serras e lavrados, áreas características de ocorrência da leishmaniose visceral americana. A introdução e intensificação das atividades garimpeiras na região podem ter contribuído para a introdução da doença.

American cutaneous leishmaniasis in two cats from Rio de Janeiro, Brazil: first report of natural infection with Leishmania (Viannia) braziliensis

We describe the isolation of Leishmania (Viannia) braziliensis from two female cats with American cutaneous leishmaniasis in Rio de Janeiro, Brazil. The isolates were identified as L. (V.) braziliensis by isoenzyme electrophoresis.

Lutzomyia longipalpis (Diptera: Psychodidae: Phlebotominae): a review

Lutzomyia longipalpis is the most important vector of AmericanVisceral Leishmaniasis (AVL) due to Leishmania chagasi in the New World. Despite its importance, AVL, a disease primarily of rural areas, has increased its prevalence and became urbanized in some large cities in Brazil and other countries in Latin America. Although the disease is treatable, other control measures include elimination of infected dogs and the use of insecticides to kill the sand flies. A better understanding of vector biology could also account as one more tool for AVL control. A wide variety of papers about L. longipalpis have been published in the recent past years. This review summarizes our current information of this particular sand fly regarding its importance, biology, morphology, pheromones genetics, saliva, gut physiology and parasite interactions.

Comparative vectorial efficiency of Lutzomyia evansi and Lu. longipalpis for transmitting Leishmania chagasi

The infection rates and development of Leishmania chagasi in two sandfly species, Lutzomyia evansi and Lutzomyia longipalpis, were evaluated under natural and experimental conditions. Natural infection rates of Lu. evansi in San Andrés de Sotavento (Colombia) and Montañas de Peraza (Venezuela) (0.05 and 0.2%, respectively) were similar to those previously recorded for this species in Colombia and Venezuela and for Lu. longipalpis in many foci of American Visceral Leishmaniasis (AVL). Both sand fly species were able to support the development of two Colombian strains of L. chagasi experimentally acquired from dogs, hamsters or membrane feeders. However, the experimental infection rates and the sequence of parasite development in the guts of these sand flies revealed that parasite colonisation, differentiation, migration and attachment were more frequent and uniform in Lu. longipalpis than in Lu. evansi. This is consistent with a more recent association between L. chagasi and Lu. evansi, and these results might help to explain the irregularity of AVL outbreaks in foci where Lu. evansi has been reported as the sole vector.

Diffusion and prediction of Leishmaniasis in a large metropolitan area in Brazil with a Bayesian space-time model

We present results from an analysis of human visceral Leishmaniasis cases based on public health records of Belo Horizonte, Brazil, from 1994 to 1997. The main emphasis in this study is on the development of a spatial statistical model to map and project the rates of visceral Leishmaniasis in Belo Horizonte. The model allows for space-time interaction and it is based on a hierarchical Bayesian approach. We assume that the underlying rates evolve in time according to a polynomial trend specific to each small area in the region. The parameters of these polynomials receive a spatial distribution in the form of an autonormal distribution. While the raw rates are extremely noisy and inadequate to support decisions, the resulting smoothed rates estimates are considerably less affected by small area issues and provide very clear directions to implement public health actions.

Canine visceral leishmaniosis: a remarkable histopathological picture of one case reported from Brazil

This report describes a remarkable histopathological presentation of a symptomatic dog naturally infected with Leishmania (Leishmania) chagasi from Brazil. An intense inflammatory granulomatous reaction was observed in the liver and spleen associated with hypertrophy and hyperplasia of the mononuclear system (the classical histopathological picture of the disease). In addition, a spectrum of vascular lesions was observed in many organs. However, we did not find parasites (amastigotes of Leishmania) in any skin fragments of the ear, nose and or abdominal tissue. In fact, this animal had severe clinical signs, showed parasites in many organs, but no parasites in the skin. It appears that the presence or absence of parasites in the skin is not a good indicator of parasites in other organs or vice versa.

[Canine visceral leishmaniasis: evaluation of the serologic method used in epidemiologic studies]

A comparative study was made of eluates of the blood of dogs experimentally infected with different trypanosomatids. Using antigens prepared from promastigotes of Leishmania mexicana, L. braziliensis and L. chagasi, assessments were made by the indirect immunofluorescence test. The results showed a sensitivity of 87.5% in the diagnosis of canine visceral leishmaniasis, independent of antigen used. Cross-reactions occurred in 75% of cases of cutaneous leishmaniasis and 83.3% of dogs with chagas' disease. An epidemiological survey in an area of leishmaniasis confirmed that immunofluorescence tests on eluates of dogs' blood give cross-reactions between L. braziliensis and L. chagasi. The results suggest that such testing could be useful in public health campaigns but attention is drawn to the fact that the level of positive reactions cannot be used as an indicator of the prevalence of canine kala-azar.

Leishmaniasis in Bolivia. I. Lutzomyia longipalpis (Lutz & Neiva, 1912) as the vector of visceral leishmaniasis in Los Yungas

A relatively high leishmanial infection rate was found in the phlebotomine sandfly Lutzomyia longipalpis collected from three villages of the Los Yungas region (Department of La Paz, Bolivia). 2,578 female sandflies were dissected. In three houses surveyed in Santa Barbara promastigote infection rates of Lu. longipalpis were 4.2, 2.2 and 3.2% respectively. Anatomical localization of the infection in the insect, and biochemical characterization of the strains indicate that the parasite belongs to the Leishmania donovani complex. The geographical area and the biotopes of Lu. longipalpis are discussed in relation to the vector-parasite relationship.

Leishmaniasis in Brazil. XXI. Visceral leishmaniasis in the Amazon Region and further observations on the role of Lutzomyia longipalpis (Lutz & Neiva, 1912) as the vector

Further evidence is presented incriminating the sandfly Lutzomyia longipalpis as the vector of Leishmania chagasi, the causative agent of American visceral leishmaniasis, in the Amazon Region of Brazil. During an outbreak of the disease in Santarém, Pará State, this insect was shown to be the only species of sandfly consistently present in and around the patient's homes, where it often occurred in very large numbers. Of 491 specimens dissected, 35 (7.14%) proved to be infected, and isolates of L. chagasi were made from 16 of 27 of these sandflies following the inoculation of the promastigotes into hamsters. Finally, the parasite was transmitted to four other hamsters which had been subjected to the bites of large numbers of wild-caught Lu. longipalpis. Isolates of Leishmania from Lu. longipalpis captures in Santarém, and in another focus of visceral leishmaniasis on the Island of Marajó, Pará, have been shown to be biologically and biochemically indistinguishable from the parasite infecting man, dogs and foxes in Pará, and from stocks obtained from man elsewhere in Brazil (Bahia and Ceará States).

Leishmaniasis in Brazil. XIX: visceral leishmaniasis in the Amazon Region, and the presence of Lutzomyia longipalpis on the Island of Marajó, Pará State

Sporadic cases of visceral leishmaniasis in Amazonian Brazil appear limited to Pará State, in the lower Amazon valley and principally near the Atlantic coast. The fox Cerdocyon thous (L.) has been incriminated as a natural host of the causative parasite, Leishmania donovani chagasi, but past doubts have existed over the identification of the most likely vector as Lutzomyia (Lutzomyia) longipalpis (Lutz & Neiva, 1912). Investigations on two of five recent cases of visceral leishmaniasis of man in the Districts of Cachoeira do Arari and Salvaterra, on the eastern part of the Island of Marajó, Pará showed undoubted Lu. longipalpis to be abundant in one house and in numerous chicken-houses. This is the first record of Lu. longipalpis on Marajó Island, and the finding supports previous implication of this sandfly in the epidemiology of visceral leishmaniasis in other parts of Pará. Morphological differences have been noted between this insect from Marajó and other specimens from more highly endemic regions in the States of Ceará and Minas Gerais, Brazil.

The American leishmaniases: some observations on their ecology and epidemiology

As the first species of Leishmania encountered were the agents of human visceral and cutaneous leishmaniasis, it is understandable that studies on these parasites for a long time concentrated on those organisms commonly causing disease in man. Epidemiological studies over the past 20 years or so, however, have led to the inescapable conclusion that the genus Leishmania is comprised of numerous species of well adapted parasites, in a wide range of mammals, throughout most of those tropical and subtropical regions of the world where phlebotomine sandflies exist (Diptera: Psychodidae). Many of the leishmanias probably never gain entrance into man: due either to an incapacity to survive in his tissues, or (more likely) because the natural sandfly vectors do not feed on him. The leishmanias that do infect man are, nevertheless, among the greatest protozoological scourges of mankind, and a better understanding of their life-cycles may well help in future prevention or control of the diseases they cause. With few exceptions the leishmaniases are zoonoses, with a major source of infection in wild or domestic animals. In the Americas, the disease is essentially a rural one, and most commonly acquired by those penetrating forested or wooded regions. The following paper deals with the better known human leishmaniases of the New World, and some new ones, and discusses the major historical events in the laborious task of elucidating their ecology and epidemiology.

Leishmaniasis in Brazil: XVIII. Further evidence incriminating the fox Cerdocyon thous (L) as a reservoir of Amazonian visceral leishmaniasis

Major endemic areas of visceral leishmaniasis in Brazil are located in the drier, poorly forested regions, principally in the northeastern States such as Ceará and Bahia. Cases of the human disease in the Amazon Region are rare, very sporadic, and seldom present opportunities for epidemiological study. Following the report of a fatal case near Salvaterra, the Island of Marajó, Pará State, a preliminary investigation has resulted in the isolation of a parasite regarded as Leishmania donovani chagasi from the viscera and skin of an apparently healthy fox, Cerdocyon thous, captured in the same locality. This represents the third recorded isolation of the parasite from this species of fox in the Amazon Region. The inapparent nature of the infections supports the suggestion that this canid may represent the primitive natural host of L. d. chagasi. C. thous is commonly associated with forested or wooded areas, and enzymic profiles for the enzymes ASAT, ALAT, PGM, GPI, MDH, MPI, G6PD, PEP and ACP failed to distinguish an isolate of L. d. chagasi from this animal in Pará from others obtained from cases of human visceral leishmaniasis in the neighbouring States of Maranhão, Ceará and Bahia. This suggests that the major, present-day endemics may have originated from a primary silvatic enzootic.

Epidemiology and ecology of leishmaniasis in Latin-America

Of the diseases caused by protozoal parasites, leishmaniasis is probably second in importance only to malaria. Chemotherapeutic drugs are toxic, expensive and not 100% effective. This, and the absence of any non-living vaccine against the disease, means that control depends on eliminating either reservoirs or insect vectors, or both. Recently, a greatly increased knowledge of the Leishmania species involved, and of their natural hosts, has helped to define the nature and extent of the problem.