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Free Content The northward spread of leishmaniasis in Italy: evidence from retrospective and ongoing studies on the canine reservoir and phlebotomine vectors

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Abstract:

Summary Visceral leishmaniasis (VL) incidence has been increased in Italy in humans and dogs since the 1990s, with new foci being detected within traditional boundaries of endemic transmission but also in northern regions previously regarded as non-endemic. To monitor the putative VL spreading, surveillance was implemented in northern continental Italy comprising: analysis of human cases recorded from 1990 through 2005; retrospective literature analysis of canine leishmaniasis (CanL) and phlebotomine sandfly records through 2002; prospective investigations in dogs from 2003 through 2005 and surveys on sandflies in 2003 and 2004. Two-hundred-thirty human cases (11% of Italian cases) were recorded. Their stratification by age and HIV status disclosed a sharp decrease of HIV/VL co-infections paralleled by concomitant increase of paediatric and HIV-negative adult patients during the study period. Four patients had no travel history. Seven leishmaniasis foci were retrospectively identified since 1990, whereas prospective investigations in dogs disclosed 47 autochthonous clinical cases and 106 autochthonous seropositives among 5442 dogs (2.1%) from 16 foci of six regions. Parasites were typed as MON-1. Four vector species were identified among 1696 () collected specimens. Comparisons with historical data showed that and have increased in density and expanded their geographic range in the study area. Northern continental Italy is now focally endemic for VL and a moderate risk for human disease does exist, although the intensity of transmission seems to be lower than in traditional settings of Mediterranean VL.

French
L’incidence de la leishmaniose viscérale (LV) a été en augmentation en Italie chez l’homme et le chien depuis les années 1990, avec de nouveaux foyers détectés dans les limites traditionnelles de la transmission endémique mais également dans les régions du nord précédemment considérées comme non-endémiques. Afin de surveiller la putative propagation de la LV, une surveillance a été mise en place dans la partie continentale nord de l’Italie avec: analyse des cas humains enregistrés de 1990 à 2005, analyse rétrospective de la littérature sur la leishmaniose canine et des données sur les phlébotomes en 2002, investigations prospectives chez les chiens de 2003 à 2005 et surveillance sur les phlébotomes en 2003 et 2004. 230 cas humains (11% de cas italiens) ont été enregistrés. Leur stratification par âge et statut VIH a révélé une diminution marquée des co-infections HIV/LV mises en parallèle avec une augmentation concomitante de patients pédiatriques et adultes VIH-négatifs durant la période d’étude. Quatre patients n’avaient aucun historique de voyage. Sept foyers de leishmaniose ont été rétrospectivement identifiés en 1990, tandis que les investigations prospectives chez les chiens ont révélé 47 cas cliniques autochtones et 106 séropositifs autochtones sur 5442 chiens (2,1%) provenant de 16 foyers de 6 régions. Les parasites ont été typés comme étant Leishmania infantum MON-1. Quatre espèces de vecteurs ont été identifiées sur 1696 spécimens de phlébotomus (Larroussius) collectés. Les comparaisons avec des données historiques ont révélé que les densités de P. perniciosus et P. neglectus ont augmenté et leur intervalle géographique s’est élargi dans la région étudiée. Le nord de l’Italie continentale est maintenant un foyer endémique pour la LV et un risque modéré pour la maladie humaine existe, bien que l’intensité de la transmission paraisse moins élevée que dans les endroits traditionnels pour la LV méditerranéenne.

Keywords: Leishmania infantum; canine leishmaniasis; leishmaniasis canina; leishmaniasis visceral; leishmaniose canine; leishmaniose viscérale; nord de l’Italie; norte de Italia; northern Italy; phlebotomine vectors; phlébotomes vecteurs; vectores flebotominos; visceral leishmaniasis

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2007.01998.x

Affiliations: 1:  Istituto Superiore di Sanità, Rome, Italy 2:  Department of Animal Production, Epidemiology and Ecology, University of Turin, Turin, Italy 3:  Department of Veterinary Public Health and Animal Pathology, University of Bologna, Bologna, Italy 4:  Istituto Zooprofilattico Sperimentale delle Venezie, Padua, Italy 5:  Department of Animal Pathology, Hygiene and Veterinary Public Health, University of Milan, Milan, Italy 6:  Department of Experimental Veterinary Sciences, University of Padua, Padua, Italy

Publication date: February 1, 2008

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