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Dantas-Torres F. Canine leishmaniasis in the Americas: etiology, distribution, and clinical and zoonotic importance. Parasit Vectors 2024; 17:198. [PMID: 38689318 PMCID: PMC11061994 DOI: 10.1186/s13071-024-06282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
Canine leishmaniasis is a widespread disease on the American continent, with cases reported from Uruguay to the USA and Canada. While numerous Leishmania spp. have been reported in dogs in this region, Leishmania infantum and Leishmania braziliensis are the most common etiological agents of canine leishmaniasis from a continental perspective. Nonetheless, other species may predominate locally in some countries. The participation of dogs in the transmission cycle of various Leishmania spp. has long been speculated, but evidence indicates that their role as reservoirs of species other than L. infantum is negligible. Various native wildlife (e.g., small rodents, marsupials, sloths, and monkeys) are, in fact, the primary hosts of Leishmania spp. in the Americas. In this review, an updated list of Leishmania spp. infecting dogs in the Americas is presented, along with their distribution and clinical and zoonotic importance.
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Montaner-Angoiti E, Llobat L. Is leishmaniasis the new emerging zoonosis in the world? Vet Res Commun 2023; 47:1777-1799. [PMID: 37438495 DOI: 10.1007/s11259-023-10171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
Leishmania is a genus of parasitic protozoa that causes a disease called leishmaniasis. Leishmaniasis is transmitted to humans through the bites of infected female sandflies. There are several different species of Leishmania that can cause various forms of the disease, and the symptoms can range from mild to severe, depending on species of Leishmania involved and the immune response of the host. Leishmania parasites have a variety of reservoirs, including humans, domestic animals, horses, rodents, wild animals, birds, and reptiles. Leishmaniasis is endemic of 90 countries, mainly in South American, East and West Africa, Mediterranean region, Indian subcontinent, and Central Asia. In recent years, cases have been detected in other countries, and it is already an infection present throughout the world. The increase in temperatures due to climate change makes it possible for sandflies to appear in countries with traditionally colder regions, and the easy movement of people and animals today, facilitate the appearance of Leishmania species in new countries. These data mean that leishmaniasis will probably become an emerging zoonosis and a public health problem in the coming years, which we must consider controlling it from a One Health point of view. This review summarizes the prevalence of Leishmania spp. around the world and the current knowledge regarding the animals that could be reservoirs of the parasite.
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Affiliation(s)
- Esperanza Montaner-Angoiti
- Molecular Mechanisms of Zoonotic Disease (MMOPS) Group, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities Valencia, Valencia, Spain
| | - Lola Llobat
- Molecular Mechanisms of Zoonotic Disease (MMOPS) Group, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities Valencia, Valencia, Spain.
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Jaimes-Dueñez J, Castillo-Castañeda A, Jiménez-Leaño Á, Duque JE, Cantillo-Barraza O, Cáceres-Rivera DI, Granada Y, Triana-Chávez O, Ramírez JD. Epidemiological features of Leishmania infantum in dogs (Canis lupus familiaris) suggest a latent risk of visceral leishmaniasis in the metropolitan area of Bucaramanga, Santander, Eastern Colombia. Prev Vet Med 2023; 219:106021. [PMID: 37738753 DOI: 10.1016/j.prevetmed.2023.106021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/24/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Abstract
Visceral leishmaniasis (VL) is a disease caused by species of the Leishmania donovani complex that is mainly transmitted through the urban cycle involving dogs as the primary reservoir. In Colombia, the incidence of VL is increasing, along with the spread of potential vectors. This study aims to investigate the eco-epidemiological factors associated with Leishmania spp. infection in dogs from the Metropolitan Area of Bucaramanga (MAB), Santander, eastern Colombia, which is a region at risk for VL. We conducted molecular and serological surveillance of Leishmania spp. in 207 dogs from MAB to determine the epidemiological factors associated with infection. Subsequently, we carried out a molecular and serological analysis of phlebotomine and humans, respectively, in areas with a higher prevalence of infection, aiming to describe the main features associated with the transmission cycle. Out of the 207 dogs tested, 37 (17.8%, 95% CI = 12.6-23.1%) were positive for the presence of Leishmania antibodies by the IFAT test, and only 9 (4.3%, 95% CI = 1.55-7.15%) were positive for L. infantum by PCR. Multivariate analyses indicated that canine shelters and dogs with clinical signs commonly associated with canine VL had a higher prevalence of infection (P < 0.05). In the entomological survey, 69 blood-fed female phlebotomine of the genus Lutzomyia were captured in canine shelters, among them, 55% were identified as Lutzomyia camposi, 29% as Lu. ovallesi, 7% as Lu. dubitans, 6% as Lu. torvida, and 3% as Lu. cayennensis. The identified meal sources of the phlebotomine included human, pig, avian, cattle, and porcupine (Coendou quichua) blood. However, no phlebotomine positive for Leishmania spp. were detected by molecular analyses. Finally, 14 humans who had frequent contact with L. infantum-positive dogs were analyzed through rK39 test, but none tested was positive for IgG/IgM antibodies. The molecular and serological analyses indicate the circulation of L. infantum in dogs from MAB, with canine shelters having the highest prevalence of infection. The entomological survey of canine shelters showed a significant diversity of phlebotomine without potential vectors of L. infantum, suggesting the presence of infection in dogs from these areas could take place in other locations or through other transmission routes. The circulation of L. infantum in multiple dogs from MAB suggests a latent risk of zoonotic transmission of VL in these cities.
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Affiliation(s)
- Jeiczon Jaimes-Dueñez
- Grupo de Investigación en Ciencias Animales GRICA, Facultad de Medicina Veterinaria y Zootecnia, Universidad Cooperativa de Colombia UCC, Bucaramanga, Colombia.
| | - Adriana Castillo-Castañeda
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Ángela Jiménez-Leaño
- Grupo de Investigación en Ciencias Animales GRICA, Facultad de Medicina Veterinaria y Zootecnia, Universidad Cooperativa de Colombia UCC, Bucaramanga, Colombia
| | - Jonny E Duque
- Centro de Investigaciones en Enfermedades Tropicales, CINTROP, Facultad de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Omar Cantillo-Barraza
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Diana Isabel Cáceres-Rivera
- Grupo de Investigación para el fortalecimiento de la salud y el bienestar GIFOSABI, Facultad de Enfermería, Universidad Cooperativa de Colombia UCC, Bucaramanga, Colombia
| | - Yurany Granada
- Grupo Biología y Control de Enfermedades Infecciosas, BCEI, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Colombia
| | - Omar Triana-Chávez
- Grupo Biología y Control de Enfermedades Infecciosas, BCEI, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Colombia
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia; Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York city, NY, USA
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Patino LH, Muskus C, Muñoz M, Ramírez JD. Genomic analyses reveal moderate levels of ploidy, high heterozygosity and structural variations in a Colombian isolate of Leishmania (Leishmania) amazonensis. Acta Trop 2020; 203:105296. [PMID: 31836281 DOI: 10.1016/j.actatropica.2019.105296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022]
Abstract
Leishmania amazonensis is one of the causative agents of the different forms of cutaneous leishmaniasis present in Latin America. This species has been isolated from humans and animals (canine/feline) in some endemic regions of Colombia. Therefore, L. amazonensis is of great relevance at the clinical and epidemiological levels in medicine and veterinary science. Until now, very few genomes from this species are available. Here, we report the complete genome sequence of a laboratory-adapted L. amazonensis strain isolated from a human patient with clinical manifestation of cutaneous leishmaniasis in Colombia. The genome sequence not only allowed inter and intra-species comparative analyses to be performed with the sequenced genomes of L. amazonensis strains from different geographical regions, but also increased our knowledge about the genomic behavior of this L. amazonensis Colombian strain. This isolate was also characterized in terms of single nucleotide polymorphisms, chromosome and gene copy number variations (CNVs). The results revealed moderate aneuploidy, CNVs in genes involved in the virulence, growth, and survival of the parasite, and in the distributions of the multicopy genes on some chromosomes, as well as a high level of heterozygosity. The data confirmed previous reports that identified unique variations in L. amazonensis, suggesting aneuploidy may not have a high fitness cost and may allow the rapid generation of diversity in Leishmania parasites growing normally.
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Affiliation(s)
- Luz H Patino
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Muskus
- Programa de Control y Estudio de Enfermedades Tropicales (PECET), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Marina Muñoz
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Juan David Ramírez
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia..
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Molecular Characterization of Visceral Leishmaniasis in Asymptomatic Dogs in North Khorasan, Northeastern Iran. Jundishapur J Microbiol 2020. [DOI: 10.5812/jjm.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Herrera G, Castillo A, Ayala MS, Flórez C, Cantillo-Barraza O, Ramirez JD. Evaluation of four rapid diagnostic tests for canine and human visceral Leishmaniasis in Colombia. BMC Infect Dis 2019; 19:747. [PMID: 31455227 PMCID: PMC6712844 DOI: 10.1186/s12879-019-4353-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/02/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Leishmaniasis caused by different species of Leishmania affect 98 countries worldwide. Visceral Leishmaniasis (VL) is the mortal clinical presentation of the disease that causes the dead to more than 90% of the patients who suffer it. The diagnosis of VL is made by the direct observation of the parasite in bone marrow, spleen and/or liver aspirates that requires complex proceedings. Therefore, serum samples are submitted to Indirect Immunofluorescence to identify the presence of anti-Leishmania antibodies. Despite the variability in the diagnostic performance of the Immunochromatographic Tests (ICTs), there are many evidences that suggest that ICTs can be used for epidemiological screening. However, in Colombia there are not any evidence about the performance of the ICTs for VL diagnosis, both for human and canine serum samples. Therefore, this study evaluated the diagnostic performance of 4 ICTs for VL (2 ICTs in human sera and 2 ICTs in canine sera) in samples from endemic areas of Colombia. METHODS We selected a total of 156 human serum samples (82 positive and 74 negative for VL) and 126 canine serum samples (71 positive and 54 negative) diagnosed by in house Indirect Immunofluorescence (IIF). The samples were submitted to the ICTs following the manufacturers' instructions. Statistical analysis was performed to evaluate the diagnostic performance of each ICT in comparison with the IIF. PCR for HSP70 gene and sanger sequencing was performed in samples with negative results for both ICTs. RESULTS The sensitivity (S) of both ICTs for human samples (Ad-bio Leishmania IgG/IgM Combo Rapid Test and Kalazar Detect™) was 91.5% and specificity (E) were 93.2 and 89.2% respectively, while for the ICTs tested on canine samples (Kalazar Detect™ Rapid Test, Canine and DPP® CVL rapid test) we found S values between 82.9 and 85.7% and E values between 79.6 and 92.6%. We found L. infantum by PCR and sequencing in 2 human samples, and L. braziliensis and L. amazonensis in canine serum samples that were negative by both ICTs. CONCLUSIONS We conclude that both tests evaluated on human samples have a similar diagnostic performance, while the Kalazar Detect™ Rapid Test, Canine showed a better diagnostic performance than the DPP® CVL rapid test evaluated on canine samples. Also, we suggest that it is necessary to design tests with antigens of the circulating strains to increase its diagnostic utility.
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Affiliation(s)
- Giovanny Herrera
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Adriana Castillo
- Grupo de Parasitología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Martha S. Ayala
- Grupo de Parasitología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carolina Flórez
- Grupo de Parasitología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Omar Cantillo-Barraza
- Grupo Biología y Control de Enfermedades Infecciosas (BCEI), Sede de Investigación Universitaria, Universidad de Antioquia, Medellín, Colombia
| | - Juan David Ramirez
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
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Paniz Mondolfi AE, Colmenares Garmendia A, Mendoza Pérez Y, Hernández-Pereira CE, Medina C, Vargas F, Sandoval D, Agüero J, Román D, Forlano-Riera M, Salas Y, Peraza M, Romero P, Aldana F, Castillo T, Santeliz S, Perez G, Suarez-Alvarado MJ, Morales-Panza RJ, Kato H. Autochthonous cutaneous leishmaniasis in urban domestic animals (Felis catus / Canis lupus familiaris) from central-western Venezuela. Acta Trop 2019; 191:252-260. [PMID: 30633896 DOI: 10.1016/j.actatropica.2019.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 11/18/2022]
Abstract
Leishmaniasis is a zoonotic disease caused by intracellular protozoa of the Leishmania genus that are spread and transmitted by sandflies. Natural infection and clinical disease in domestic cats and dogs appear to be rare or perhaps largely under-reported in endemic areas. However, previous reports on infected domestic animals usually implicate the same Leishmania species that affect humans in tropical and subtropical areas of the world suggesting a potential role for zoonotic transmission. In the present study we assessed a representative sample of cats and dogs from endemic urban / suburban areas of Lara state in central western Venezuela. In both dogs and cats, cutaneous disease exhibits a spectrum of manifestations that range from single papules or nodules, which may evolve into ulcerative, plaque-like or scaly lesions. Cytochrome b (cyt b) PCR gene sequence analysis revealed L. mexicana as the causative agent in all cases, including two human cases proceeding from the same study area at the same time the study was carried out. In order to improve our understanding on feline/canine infection with Leishmania mexicana, and address potential zoonotic concerns it is necessary to characterize its enzootic reservoirs and vectors as well as the possible anthropophilic players linking to the peridomestic and domestic cycles.
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Affiliation(s)
- A E Paniz Mondolfi
- Clínica IDB Cabudare, Instituto de Investigaciones Biomédicas IDB, Department of Tropical Medicine and Infectious Diseases, Cabudare, Lara State 3023, Venezuela; Instituto Venezolano de los Seguros Sociales (IVSS), Caracas, Venezuela.
| | - A Colmenares Garmendia
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Clínica IDB Cabudare, Instituto de Investigaciones Biomédicas IDB, Cabudare, Lara State 3023, Venezuela; Health Sciences Department, School of Veterinary Medicine, Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - Y Mendoza Pérez
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Clínica IDB Cabudare, Instituto de Investigaciones Biomédicas IDB, Cabudare, Lara State 3023, Venezuela; Health Sciences Department, School of Veterinary Medicine, Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - C E Hernández-Pereira
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Clínica IDB Cabudare, Instituto de Investigaciones Biomédicas IDB, Cabudare, Lara State 3023, Venezuela; Health Sciences Department, College of Medicine. Universidad Centrooccidental Lisandro Alvarado. Barquisimeto, Lara State 3001, Venezuela
| | - C Medina
- Department of Public Health, Epidemiology and Zoonoses, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - F Vargas
- Department of Medicine and Surgery, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - D Sandoval
- Health Sciences Department, School of Veterinary Medicine, Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - J Agüero
- Departments of Small Animals and Dermatology, "Dr. Luis de Leon Clinic", Barquisimeto, Lara State 3023, Venezuela
| | - D Román
- Department of Surgery of Small Animals, INSUAGRO, Barquisimeto, Lara State, 3023, Venezuela
| | - M Forlano-Riera
- Department of Public Health, Veterinarian Parasitology, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - Y Salas
- Department of Medicine, Surgery and Pathology, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - M Peraza
- Department of Small Animals, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - P Romero
- Department of Medicine and Surgery, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - F Aldana
- Department of Small Animals, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - T Castillo
- Department of Medicine and Surgery, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - S Santeliz
- Department of Medicine and Surgery, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - G Perez
- Department of Medicine and Surgery, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - M J Suarez-Alvarado
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Clínica IDB Cabudare, Instituto de Investigaciones Biomédicas IDB, Cabudare, Lara State 3023, Venezuela; Health Sciences Department, College of Medicine. Universidad Centrooccidental Lisandro Alvarado. Barquisimeto, Lara State 3001, Venezuela
| | - R J Morales-Panza
- Department of Medicine and Surgery, School of Veterinary Medicine Universidad Centrooccidental Lisandro Alvarado, Cabudare, Lara State 3023, Venezuela
| | - H Kato
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
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Beiter KJ, Wentlent ZJ, Hamouda AR, Thomas BN. Nonconventional opponents: a review of malaria and leishmaniasis among United States Armed Forces. PeerJ 2019; 7:e6313. [PMID: 30701136 PMCID: PMC6348955 DOI: 10.7717/peerj.6313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/19/2018] [Indexed: 01/10/2023] Open
Abstract
As the United States military engage with different countries and cultures throughout the world, personnel become exposed to new biospheres as well. There are many infectious pathogens that are not endemic to the US, but two of particular importance are Plasmodium and Leishmania, which respectively cause malaria and leishmaniasis. These parasites are both known to cause significant disease burden in their endemic locales, and thus pose a threat to military travelers. This review introduces readers to basic life cycle and disease mechanisms for each. Local and military epidemiology are described, as are the specific actions taken by the US military for prevention and treatment purposes. Complications of such measures with regard to human health are also discussed, including possible chemical toxicities. Additionally, poor recognition of these diseases upon an individual's return leading to complications and treatment delays in the United States are examined. Information about canine leishmaniasis, poorly studied relative to its human manifestation, but of importance due to the utilization of dogs in military endeavors is presented. Future implications for the American healthcare system regarding malaria and leishmaniasis are also presented.
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Affiliation(s)
- Kaylin J Beiter
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States of America
| | - Zachariah J Wentlent
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States of America
| | - Adrian R Hamouda
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States of America
| | - Bolaji N Thomas
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States of America
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