ARCHITECT Chagas® as a single test candidate for Chagas disease diagnosis: evaluation of two algorithms implemented in a non-endemic setting (Barcelona, Spain)

OBJECTIVES

To evaluate two algorithms for the diagnosis of chronic and congenital Chagas disease (CD), both including the chemiluminescent microparticle immunoassay ARCHITECT Chagas® (CMIA) as a single test but with an amended signal-to-cut-off ratio (S/CO) of ≥6, instead of an S/CO of ≥1 as indicated by the manufacturer.

METHODS

The study encompassed two panels of retrospective samples: 831 sera from 786 adolescents and adults (panel A), and 96 sera from 35 newborn infants with CD-infected mothers (panel B). A CMIA-negative result was deemed conclusive, whereas samples with an S/CO ≥ 0.8 were confirmed by a second test (BioELISA Chagas, ELISAr).

RESULTS

In panel A, seropositivity was 13% (102/786); 10 samples gave discordant results for CMIA and ELISAr, all of which were CMIA positive and had CD confirmed through a previous diagnosis by two positive serological tests. In panel B, all newborns were considered non-infected based on both a progressive decrease in antibody titres over time and negative real-time PCR results. CMIA still gave positive results in two infants aged 10 months but no S/CO values ≥6 were observed from 4 months on.

CONCLUSIONS

CMIA is a firm candidate for use as a single CD diagnostic test in non-endemic countries. The algorithm with the ≥6 S/CO is as an efficient method for chronic CD diagnosis. CMIA could also be used as a single test to screen infants for congenital infection at the age of 10 months or even earlier if applying the corrected cut-off ratio, although further studies are required.

Evaluation of canine leishmaniosis vaccine CaniLeish® under field conditions in native dog populations from an endemic Mediterranean area-A randomized controlled trial

Dog vaccination is considered an effective way of reducing Leishmania infantum infection incidence in the canine population, as well as its transmission to humans. However, the use of partially effective vaccines can have the detrimental effect of "masking" vaccinated asymptomatic carriers, capable of harbouring the parasite and transmitting it to naïve individuals. After eight years on the European market, few studies have been released on CaniLeish® vaccine safety and efficacy. The present study, a one-year randomized CaniLeish® vaccine field trial, was performed in a canine leishmaniosis endemic area and included animals selected from a native dog population (n = 168). No severe adverse reactions were observed in vaccinated dogs (n = 85). Cases of active L. infantum infection were detected by serological, molecular and clinical follow-up of dogs. One-year post-vaccination, no differences in number or severity of L. infantum active infections were observed between study groups (n = 4 in each group). Vaccine-induced cellular immunity, assessed through interferon-γ quantification, showed significantly higher levels of this cytokine one-month post-vaccination in the vaccine group (p < 0.001), but no differences were observed after nine months between trial groups (p = 0.078). These results fail to support the reported CaniLeish® efficacy in the prevention of active L. infantum infection in dogs from endemic areas and naturally exposed to the parasite.

The impact of canine leishmaniosis vaccination with Canileish® in Leishmania infantum infection seroprevalence studies

Effective vaccines against Leishmania parasites are a goal for the scientific community working with both canine and human leishmaniosis. However, possible side effects of vaccination should also be considered and evaluated, preferably before vaccine licensing and marketing. One of these possible effects is the cross-reaction of vaccine-induced antibodies with standard serological tests for detection of Leishmania infantum infection. Longitudinal studies were performed on the type of humoral profile induced by Brazilian marketed canine leishmaniosis vaccines, but little is known regarding the European situation. In this study, an annual follow-up of 85 CaniLeish® vaccinated dogs and 83 non-vaccinated control dogs was performed. Blood samples were taken for all animals at pre-determined time points: before vaccination; immediately before each one of the two following vaccine doses (at 21 days intervals); and then one, four, six, nine and 12 months after finishing the vaccination course. All samples were tested by an in-house ELISA, using a whole promastigote antigen, for the presence of anti-L. infantum antibodies. Humoral response detectable by the used serological diagnostic method was significantly higher in the vaccine group when compared with the control group (p < 0.01) until one-month post-vaccination. Results show that CaniLeish® vaccine-induced antibodies cross-react with a commonly used serological test for diagnosis of L. infantum natural infection. Implications of this interference are discussed, with special emphasis on a possible negative impact on canine leishmaniosis surveillance studies.

Seroprevalence of canine Leishmania infantum infection in the Mediterranean region and identification of risk factors: The example of North-Eastern and Pyrenean areas of Spain

The Mediterranean basin is an endemic region for canine leishmaniosis (CanL), where it represents a major veterinary problem and raises human health concerns. However, the distribution of the disease is heterogeneous and not all countries and locations have been equally studied and characterized. This work describes the situation of CanL in Girona province (Catalonia, Spain), for which no data has been previously reported, and presents a relevant study to exemplify other areas with similar characteristics across the region. Four cross-sectional seroprevalence surveys were performed from 2012 to 2016 throughout the province, including 36 sampling stations in 26 localities and a total of 593 dogs. For each animal, individual and location variables were also collected. Additionally, each dog owner answered a questionnaire about their knowledge of CanL and preventive methods used. Blood samples were analysed by an in-house ELISA and a mixed logistic regression model was used to assess the relationship between pre-determined variables and dog seropositivity. A Spearman's correlation was used to assess the association between dog owners' perceived risk of CanL and Leishmania infantum seropositivity in dogs at a given location. The overall true seroprevalence estimated for Girona province was 19.5% (95%CI: 15.5-23.5), of which only 6.8% (10/146) were considered symptomatic. Age of the dog [OR = 1.21 (95%CI: 1.11-1.31); p < 0.001] and altitude [OR = 0.02 (95%CI: 0.001-0.19); p = 0.001] were identified as risk factors for the infection. The results obtained in this study are expected to aid in the implementation of directed control programmes in CanL endemic areas throughout Europe, as well as to provide suitable data for the design of better risk assessment maps of the disease.

Management, prevention and treatment of canine leishmaniosis in north-eastern Spain: an online questionnaire-based survey in the province of Girona with special emphasis on new preventive methods (CaniLeish vaccine and domperidone)

Knowledge of how canine leishmaniosis (CanL) is being managed clinically and its epidemiology is very important, since dogs are the main reservoir of human leishmaniosis. This study reports the results obtained through a questionnaire-based survey of veterinary practitioners in Girona province, a recognised, but non-documented endemic area in north-eastern Spain. The primary objective was to obtain data on the clinical management of CanL, focusing particularly on new preventive methods and therapeutic tools. The results show an extensive routine management of CanL cases and a widespread use of the CaniLeish (Virbac) vaccine and domperidone (Leisguard, Esteve). Adverse reactions were detected by a vast majority of the vaccine users (82 per cent), the most frequent being local reactions, apathy, fever and gastroenteritis. All the respondents had treated confirmed cases, and the therapeutic protocol most used was the combination of meglumine antimoniate (Glucantime, Merial) and allopurinol (Zyloric, GlaxoSmithKline).

Differential ecological traits of two Phlebotomus sergenti mitochondrial lineages in southwestern Europe and their epidemiological implications

OBJECTIVES

The introduction of leishmaniasis in a new area requires a well-established population of the sandfly vector species of the parasite. No autochthonous cases of anthroponotic cutaneous leishmaniasis have been detected in southwestern Europe, and Leishmania infantum is the only causative agent of leishmaniasis in this area. Phlebotomus sergenti, the main vector of Leishmania tropica, is commonly found in the Iberian Peninsula at sufficient densities to be able to act as a vector. It is characterised by high genetic diversity and classified in four mitochondrial lineages. Our aim was to analyse the composition and distribution of P. sergenti mitochondrial lineages in southwestern Europe given the possibility of phenotypic differences of biomedical importance between them.

METHODS

Sandflies were captured in the Iberian Peninsula and on the Canary and Balearic Islands. Mitochondrial lineage identification of 137 P. sergenti was performed using a novel PCR-RFLP that avoids the necessity of gene sequencing.

RESULTS

Two lineages were evidenced, the typical Iberian one (lineage I) and another, held in common with North Africa (lineage III), that show a distinctive distribution. P. sergenti lineage I shows a better correlation to the bioclimatic diversity in southwestern Europe. Conversely, P. sergenti lineage III prefers warmer temperatures and less precipitation, which are typical of the Mediterranean.

CONCLUSION

Lineage I seems to have adaptive advantages given its wider tolerance to temperature and altitude than lineage III, and it would seem more suitable to lead a potential geographical expansion towards the rest of Europe.

Intradomiciliary and peridomiciliary captures of sand flies (Diptera: Psychodidae) in the leishmaniasis endemic area of Chapare province, tropic of Cochabamba, Bolivia

In South America, cutaneous leishmaniasis is the most frequent clinical form of leishmaniasis. Bolivia is one of the countries with higher incidence, with 33 cases per 100,000 individuals, and the disease is endemic in 70% of the territory. In the last decade, the number of cases has increased, the age range has expanded, affecting children under 5 years old, and a similar frequency between men and women is found. An entomological study with CDC light traps was conducted in three localities (Chipiriri, Santa Elena and Pedro Domingo Murillo) of the municipality of Villa Tunari, one of the main towns in the Chapare province (Department of Cochabamba, Bolivia). A total of 16 specimens belonging to 6 species of the genus Lutzomyia were captured: Lu. aragaoi, Lu. andersoni, Lu. antunesi, Lu. shawi, Lu. yuilli yuilli and Lu. auraensis. Our results showed the presence of two incriminated vectors of leishmaniasis in an urbanized area and in the intradomicile. More entomological studies are required in the Chapare province to confirm the role of vector sand flies, the intradomiciliary transmission of the disease and the presence of autochthonous cases of cutaneous leishmaniasis.

Mitochondrial DNA Intraspecific Variability in Sergentomyia minuta (Diptera: Psychodidae)

Recently, there has been growing interest in analysis of the geographical variation between populations of different Phlebotomus spp. and American sand flies by comparing the sequences of various genes. However, little is known about the genetic structure of the genus Sergentomyia França & Parrot. No study has been carried out on Sergentomyia minuta Rondani. Most authors recognize this as a species with a high degree of morphological polymorphism, and some suspect that there are two subspecies: Se. minuta minuta Rondani in Europe, having about 40 horizontal cibarial teeth (sticks aligned along a straight line in the cibarial cavity), and Se. minuta parroti Adler & Theodor in North Africa, having about 70 cibarial teeth. Here we analyzed phylogeographic patterns using cytochrome b (Cytb) and cytochrome C oxidase I mtDNA for 29 populations from 10 countries: Algeria, Cyprus, France (continental and Corsica), Greece (continental and Crete), Malta, Montenegro, Morocco, Portugal (continental and Atlantic Savage Islands), Spain, and Tunisia. We analyzed intra- and interpopulation patterns of genetic diversity. Our results from Bayesian inference showed a complex genetic structure of Se. minuta with four haplogroups including many different haplotypes. One haplogroup includes all the specimens from North Africa. A second haplogroup includes a few specimens from the south of France, Spain, and one from Portugal. The third includes many specimens from southern France, all the specimens from Corsica, one from Spain, and all specimen from Portugal except one. A fourth branch includes specimens from the Balkans, Malta, Crete, Cyprus, and curiously some from the Atlantic Savage Islands; settlement of the latter population remains unexplained. However, our results suggest that the settlement of the Mediterranean basin could have occurred at the same time for Se. minuta and both Phlebotomus perniciosus Newstead and Phlebotomus ariasi Tonnoir. The spatial distribution of haplotypes was congruent with phylogenetic findings.

Distribution of phlebotomine sand flies (Diptera: Psychodidae) in Andorra: first finding of P. perniciosus and wide distribution of P. ariasi

During July 2007 sand fly captures were carried out in Andorra using sticky castor oil traps set in sand fly resting places for four consecutive nights. The sampling stations were located between 800 and 2400 m above sea level. The specimens captured belong to two species of the genus Phlebotomus subgenus Larroussius, Phlebotomus ariasi and Phlebotomus perniciosus. The results shed new light on the wide geographical and altitudinal distribution of P. ariasi in Andorra, where it was located between 800 and 2200 m a.s.l. The study also identified P. perniciosus in Andorra for the first time, with captures below 1000 m a.s.l. The finding of these species, both proven vectors of human and canine leishmaniasis in the bordering areas of France and Spain, is considered in terms of a possible emergence of leishmaniasis in Andorra, as has occurred in other parts of Europe.

Intraspecific variability (rDNA ITS and mtDNA Cyt b) of Phlebotomus sergenti in Spain and Morocco

Phlebotomus sergenti, the main vector of Leishmania tropica, is widely represented in Spain, whilst L. tropica is not an endemic species in this country. Nevertheless, the important human migrant flow from regions where L. tropica is endemic, the existence of its vector and the anthroponotic cycle of the parasite could lead to its establishment in our country. The vectorial capacity of P. sergenti could depend on the existence of cryptic species or races, which can only be identified by molecular methods. Our aim has been to study the molecular variation on two genes of Spanish populations of P. sergenti, comparing them with Moroccan ones. We have identified 5 ribosomal and 16 mitochondrial haplotypes. The results obtained indicate a high diversity of P. sergenti in Spain and the existence in the country of two P. sergenti lineages, a typically Spanish mitochondrial lineage and another one common in Morocco, where L. tropica is endemic in the south and emergent in the north and centre of the country.

[Acral keratoses and inverted follicular keratosis presenting Cowden disease]

Cowden disease is a rare genetic disorder characterized by the presence of multiple hamartomas in the skin, thyroid, breast, nervous system and gastrointestinal tract. Mucocutaneous lesions are the most constant and characteristic finding. Breast and thyroid neoplasms (benign and malignant) develop in up to two thirds of patients. Inverted follicular keratosis as the presenting feature of Cowden disease is rare as the disease is usually suspected by the appearance of multiple facial trichilemmomas, oral mucosal papillomatosis and acral keratoses.

Pool screen PCR for estimating the prevalence of Leishmania infantum infection in sandflies (Diptera: Nematocera, Phlebotomidae)

Prevalence studies of infection in the sandfly vector can be used as an indicator of a change in the intensity of Leishmania transmission. However, these studies are difficult to carry out as prevalence in the vector is usually low and its estimation requires a large number of sandflies to be dissected. Our objective was to establish whether a L. infantum-specific PCR-ELISA applied to pools of female sandflies and a previously described algorithm could be useful tools to study the prevalence of infection by this parasite in natural vector populations. We collected sandflies from six collection points in two stable foci of leishmaniasis in southern (N=3) and north-eastern (N=3) Spain, following standard procedures. A fraction of the collected females was dissected and morphologically identified. Another fraction was used for pool screening. In total, 127 pools of 30 females (3810 specimens) were studied by PCR-ELISA and 1764 specimens were individually dissected. The prevalence of infection determined by dissection does not differ from that determined by pool screen PCR. The results suggest that pool screen PCR can be of practical use in the epidemiological surveillance of leishmaniasis in European countries of the western Mediterranean basin, associated with control interventions or global change.

Postglacial dispersal of Phlebotomus perniciosus into France

Phlebotomus perniciosus was identified morphologically in samples from France and northeast Spain, and individuals were then characterized at three polymorphic isoenzyme loci (by isoelectrofocusing) and at the mitochondrial DNA locus (by comparative DNA sequence analysis of a fragment of the Cytochrome b gene). The four polymorphic loci gave conflicting patterns of population relationships, which can be explained by hypothesizing different amounts of gene introgression at each locus when two distinctive lineages met in southern France or northeast Spain after isolation in southern Italy and Spain during the Pleistocene Ice Ages. P. perniciosus is an important vector of leishmania infantum and so these population differentiation studies are relevant for predicting the emergence and spread of leishmaniasis in relation to environmental changes, including climate.

Evaluation of a latex agglutination test (KAtex) for detection of Leishmania antigen in urine of patients with HIV-Leishmania coinfection: value in diagnosis and post-treatment follow-up

The usefulness of antigen detection in urine as an alternative tool for diagnosis of leishmaniasis and post-treatment follow-up in patients with Leishmania-HIV coinfection was evaluated with a latex agglutination test (KAtex; Kalon Biological, UK). Forty-nine HIV-infected patients with visceral leishmaniasis were included in the study. Antigen detection in urine (ADU) was positive in 42 of 49 (sensitivity, 85.7%) samples obtained during a primary episode. After treatment, a follow-up study in 23 patients was performed by simultaneous ADU and culture of peripheral blood mononuclear cells in 148 determinations. The two methods gave concordant results in 94 cases, 38 of which were positive and 56 negative. In five cases, ADU was negative and culture of peripheral blood mononuclear cells was positive: two of these cases corresponded to clinical relapses. In 49 cases, culture of peripheral blood mononuclear cells was negative and ADU was positive. In the absence of clinical symptoms, the detection of parasite antigens in 71 of 130 (54.6%) urine samples was not associated with clinical disease. The Kaplan-Meier estimates of the probability of relapse at 6, 12, 18, and 24 months were 16% (95%CI, 15-17%), 20% (95%CI, 18-22%), 31% (95%CI, 27-35%), and 71% (95%CI, 52-89%), respectively, in patients with a positive ADU result. In contrast, when ADU was negative, the probability of relapse was 5% at 6 months (95%CI, 2-8%) (only 2 of 11 patients who relapsed had a negative test). ADU by KAtex is appropriate for primary diagnosis of visceral leishmaniasis, for monitoring the efficacy of treatment, and for detection of subclinical infection.

[Emerging parasitic zoonoses: leishmaniosis]

Leishmanioses are a group of parasitic diseases that affect man and other mammals. They are caused by different species of trypanosomatids of the genus Leishmania Ross, 1903 and have tegumentary and/or visceral manifestations. The distribution of this re-emerging disease, which is found throughout the world (except in Antarctica), is influenced by various factors linked to both human activity and climatic change. The heteroecious life cycle of the Leishmania includes an invertebrate host (sandflies of the Phlebotomidae family). The dog is the main reservoir for many of the Leishmania species, simultaneously presenting both cutaneous and visceral clinical signs. The most frequent signs are skin abnormalities (dry exfoliative dermatitis, ulcers, periorbital alopecia and onychogryphosis), but ocular signs (keratoconjunctivitis and uveitis) and lymphadenomegaly are also common. Clinical diagnosis is difficult because of the great variety of symptoms and should, therefore, be confirmed by parasitological, serological and molecular methods. Several strategies are used to control the disease, including the treatment of infected animals. However, treatment failure is common and there is a risk that drug resistance will develop.

Detection of Leishmania infantum cryptic infection in asymptomatic blood donors living in an endemic area (Eivissa, Balearic Islands, Spain) by different diagnostic methods

The extent of cryptic leishmaniasis in blood donors from a Spanish endemic area, (Eivissa Island) was studied using various immunological and parasitological methods. Sera from 656 blood donors were analysed: 16 (2.4%) were positive by ELISA and 50 (7.6%) by Western blot. Peripheral blood mononuclear cells (PBMC) and buffy coat (BC) samples, were analyzed by culture and nested-PCR. DNA of L. infantum was amplified in 27 (22.1%) of 122 PBMC. Parasites were isolated in 3 (4.5%) of 67 BC cultures and the strains were identified as L. infantum zymodeme MON-28. No parasites were isolated in PBMC culture. After 12 months, a second blood sample was obtained from 18 blood donors who were positive by nested-PCR in the first extraction; nine of them remained positive. Delayed type hypersensitivity (DTH) tests on 15/67 donors (22.3%) were positive. Comparison of results obtained by ELISA, WB and DTH; ELISA, WB and nested-PCR and nested-PCR and BC culture showed a significant association (Pearson test, P < 0.05). L. infantum zyodeme MON-28 was identified in three strains isolated from asymptomatic donors, which suggests a low virulence capacity of these strains. The detection of Leishmania DNA in a high number of asymptomatic subjects supports the need to monitor it in blood donors endemic areas.

Variation of esterase electromorphs associated with bloodmeal digestion in phlebotomine sand flies (Diptera: Psychodidae)

Esterases are often used to measure genetic variation, yet they may be influenced by external factors. Isoelectrofocusing was used to investigate the effects of bloodmeal on the esterase variation in wild populations of Phlebotomus (Larroussius) ariasi Tonnoir and P. (L.) perniciosus Newstead and in a colonized population of P. (Phlebotomus) duboscqi Neveu-Lemaire. Modified electrophoretic profiles were demonstrated to be associated with blood digestion. The bloodmeal-induced esterase electromorphs were only found in the abdomen homogenates of the sand flies. These changes in esterase phenotype were probably due to a proteolysis phenomenon and disappeared at the end of bloodmeal digestion. The effect was eliminated by adding trypsin inhibitors.

A nested polymerase chain reaction for diagnosis and follow-up of human visceral leishmaniasis patients using blood samples

A nested polymerase chain reaction (PCR) assay for the diagnosis of human visceral leishmaniasis (VL) due to Leishmania infantum infection was developed using primers selected from the parasite's genomic deoxyribonucleic acid (DNA). The assay, which is based on the use of leucocytes separated from blood samples by Ficoll-Paque centrifugation, was compared with culture in vitro. Blood samples were collected from 17 patients in Spain with a history of clinical VL, 15 of whom were also infected with human immunodeficiency virus (HIV) (13 samples during the VL episode and 31 samples during post-treatment monitoring) and one sample was collected from each of 28 patients with HIV infection and fever but no history of VL. The nested PCR using blood detected all the cases of parasitologically confirmed, clinically active VL, while culture detected 92%. The nested PCR detected Leishmania DNA in 18% of the HIV-infected patients with fever and no history of VL, none of whom gave a positive culture. Follow-up examination of the VL patients by nested PCR and culture demonstrated the persistence of L. infantum in blood for a long time after treatment.

Isoenzymatic identification of Leishmania isolates from repeated clinical human leishmaniasis episodes in Catalonia (Spain)

Forty human strains of Leishmania infantum isolated in 1985-99 from 17 patients with repeated cutaneous, mucosal or visceral leishmaniasis episodes in Catalonia (Spain) were examined by isoenzyme electrophoresis. Six zymodemes were revealed: MON-1, MON-24, MON-28, MON-29, MON-33 and MON-34. In 2 patients 2 different zymodemes were identified in consecutive episodes.

Nested PCR for diagnosis of canine leishmaniosis in peripheral blood, lymph node and bone marrow aspirates

A nested polymerase chain reaction (PCR) assay was developed using primers selected from the genomic DNA of Leishmania infantum and applied to the diagnosis of leishmaniosis in peripheral blood in dogs. Blood of 39 dogs of different breeds, all sampled in Catalonia (Spain), were tested for leishmaniosis by enzyme linked immunosorbent assay (ELISA), western blotting (WB) and peripheral blood mononuclear cell (PBMC) culture and nested PCR. Twenty negative controls (healthy dogs less than 1-year-old that had not been exposed to a sandfly season) were also studied. Nineteen of the 39 dogs studied were positive by ELISA and/or WB, and 18 of these had a positive PBMC nested PCR. PBMC nested PCR was negative in all the remaining animals that were negative by serological examination, including the 20 negative controls. Parasitological examination and nested PCR of bone marrow and lymph node aspirate from the 19 dogs positive by serological examination, were also positive. These results indicate that PBMC nested PCR is a sensitive and specific tool to diagnose leishmaniosis in dogs. The use of PBMC has the advantage over bone marrow and lymph node aspirates in that it is a less invasive sample.

Long term improvement in the treatment of canine leishmaniosis using an antimony liposomal formulation

Pharmacokinetic and clinical effectiveness of liposome-encapsulated N-methylglucamine antimoniate (LMA) was performed in dogs suffering from experimental leishmaniosis. LMA was compared with N-methylglucamine antimoniate (MGA), the same drug in its free form. Sb plasma concentrations for LMA were always higher than those for MGA. Mean residence time (MRT), half-life time (t(1/2)) and clearance (Cl) showed that Sb was eliminated slower after liposome administration. The high volume of distribution (Vd) obtained with LMA suggests that Sb could achieve therapeutic concentrations in parasite-infected tissues. Average plasma concentration at steady state (Css(ave)) shows that Sb body concentrations after LMA treatment (9.8 mg/kg Sb, each 24h) would be effective in Leishmania infantum canine infection. Comparing LMA with MGA in a 1-year follow-up we observed no relapses for LMA and total protein and gammaglobulin concentrations were within normal range, while for MGA both began to rise 3 months after treatment. Use of antimonial liposomal formulations may restore effectiveness to an existing drug and reduce toxicity.

Leishmania infantum: stage-specific activity of pentavalent antimony related with the assay conditions

The determination of the intrinsic sensitivity of Leishmania strains to pentavalent antimonials in clinical trials, before treatment is begun, is essential in order to avoid failures and to allow alternative drugs to be chosen. A comparative study of SbV activity on promastigotes, axenic amastigote-like cells, and intracellular amastigotes of Leishmania infantum, when administered in the form of meglumine antimoniate and free, in hydrochloric solution, was performed. Results indicate that the conditions under which the promastigotes were cultured affect the IC(50) obtained, although results were homogeneous when the products were assayed on axenic-like and intracellular amastigotes. The IC(50) obtained for SbV in the form of meglumine antimoniate or in hydrochloric solution on promastigotes cultured in Schneider's medium depends on the growth rate of the culture and therefore could be regulated by modifying the fetal calf serum concentration in the medium. The pH of the culture medium strongly affected the activity of meglumine antimoniate but not that of the SbV hydrochloric solution on promastigotes cultured in Schneider's medium. This influence of pH was observed to a much lesser extent when promastigotes were cultured on M199 or RPMI media. In homogeneous culture conditions, which included the regulation of the promastigote growth rate through the heat-inactivated fetal calf serum concentration in the medium and the dilution of the meglumine antimoniate with Schneider's medium at pH 6.5, the activity of SbV, free or in the form of meglumine antimoniate, was the same in promastigotes, intracellular amastigotes, and axenic amastigote-like cells.

Serological and parasitological follow-up in dogs experimentally infected with Leishmania infantum and treated with meglumine antimoniate

Six healthy beagle dogs were infected with Leishmania infantum (MCAN/ES/92/BCN-83/MON-1) by intravenous inoculation of 5 x 10(7) promastigotes and two others were used as controls. When animals showed clinical signs of disease at 29, 37, 41 and 45 weeks post-infection (p.i.), they were treated with meglumine antimoniate (20.4 mg Sb/kg/12 h) subcutaneously for two periods of 10 days each. Sera were tested periodically for Leishmania antibodies by Dot-ELISA, ELISA and Western blot (WB). Aspirates of popliteal lymph node (PLN), peripheral blood sample (PB) and healthy skin were cultured in NNN and Schneider's medium. PLNs were positive between 8 and 20 weeks p.i. and in one animal PB was positive 6 weeks p.i. Samples of healthy skin, obtained before treatment, were also positive. Dot-ELISA and ELISA detected specific antibodies at an early stage between 4 and 12 weeks p.i and surpassed the cut-off between 16-24 weeks p.i., while the WB was positive between 10-19 weeks p.i. The pattern of bands revealed during the first stages of infection was variable and only in two cases did the positivity start with bands of low molecular weight (12-14 kD); the number of bands increased until 15-24 weeks p.i., after which sera revealed a complete pattern of bands, from 12 to 85 kD, in the antigen of Leishmania. After treatment the clinical improvement of the animals was accompanied by a decrease in antibody titers (Dot-ELISA and ELISA) although the parasites remained in the PLN. This was reflected in the WB by a decrease in the intensity of bands, especially those in the region of 12-30 kD. A new increase in the antibody levels between 3 and 5 months after terminating the therapy was detected in the WB by a restoration of the initial complete pattern of bands.

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.

Study of haemostatic disorders in experimentally induced leishmaniasis in Beagle dogs

Haemostatic alterations in dogs experimentally infected with Leishmania infantum were studied before and after therapy with meglumine antimonate. Haemostatic function tests including platelet count, collagen-induced platelet aggregation, prothrombin time, activated partial thromboplastin time, thrombin time, plasma fibrinogen determination, and serum fibrinogen/fibrin degradation products concentration were performed. In the course of infection and before treatment, moderate thrombocytopenia (P<0.00001), decreased collagen induced platelet aggregation (P=0.0003), prolonged thrombin time (P=0.0117) and increased fibrinogen/fibrin degradation products were observed. Statistically significant differences of plasma fibrinogen concentration, prothrombin time, and activated partial thromboplastin time were not encountered. Haemostatic parameters returned to normal values after therapy. The results indicate that Leishmania infection may impair haemostasis suggesting induction of disseminated intravascular coagulation (DIC), and that treating dogs in an early stage of infection may potentially avoid the possibility of developing an uncompensated DIC.

Pharmacokinetics of meglumine antimoniate after administration of a multiple dose in dogs experimentally infected with Leishmania infantum

Pharmacokinetics of meglumine antimoniate in dogs with experimentally induced leishmaniosis has been investigated. After infection, dogs received a dose of 75 mg kg-1 of meglumine antimoniate twice daily by subcutaneous injection for 10 days. Blood samples were collected throughout the treatment. No statistical differences were found in the kinetic behaviour of the drug administered as a single dose to healthy dogs and that administered as a multiple dose to infected animals. However, peak plasma concentrations (Cmax) of 30.8 +/- 12.8 micrograms ml-1 found after this dosage regimen were higher than those observed after the single dose administration of 100 mg kg-1 24 h-1. Furthermore, sustained antimony concentrations of 1.14 +/- 0.52 micrograms Sb ml-1 were detected throughout the treatment. No signs of toxicity were found in the animals treated indicating that this regimen would be very appropriate to treat canine leishmaniosis.

[Cutaneous infections by Mycobacterium marinum. Description of 3 cases and review of the literature]

BACKGROUND

Human infection by Mycobacterium marinum is infrequent and is currently reported in association with the management of aquariums. The epidemiologic, clinical and microbiologic characteristics of three cases in our hospital are herein reported.

METHODS

Three cases of cutaneous infection by M. marinum attended in our hospital from February 1993 to October 1994 are described.

RESULTS

The three patients were related with the management of aquariums. In two cases the clinical presentation was of sporotricoid cutaneous dissemination, while the third patient presented a localized cutaneous form. The lesions were localized in the upper right extremity in the three cases. The delay in diagnosis was important in two of the cases. Cure, or improvement, were achieved in three cases with' treatment; one with cotrimoxazol, another with first line tuberculostatic drugs and another did not receive treatment.

CONCLUSIONS

Human infection by M. marinum is currently described is association with the management of aquariums. The infection is usually cutaneous, alone or well disseminated, with invasion of deep tissue occasionally observed. The lesions are generally found on the upper extremities. Diagnostic delay is frequent. The most adequate treatment appears to be the combination of rifampicin plus etambutol or cotrimoxazol alone, with cases of spontaneous remission also being observed.

Serologic diagnosis of canine leishmaniasis by dot-ELISA

A dot-enzyme-linked immunosorbent assay (ELISA) using protein A-peroxidase was evaluated as a diagnostic test for canine leishmaniasis. The test results were in agreement with parasitologic diagnosis and indirect immunofluorescence assay results. The sensitivity of the test calculated on 31 dogs with positive parasitologic examination was 90% when a titer of 1/800 was established as a cutoff and 100% when a titer of 1/400 was established. The specificity calculated on the canine population from nonendemic areas was 100% when both titers were established. Nevertheless, in endemic areas titers near the cutoff need careful interpretation. The results of this study demonstrate that dot-ELISA protein A using a bio-dot apparatus is highly suitable for seroepidemiologic field work.

Identification of blood meals of Phlebotomus perniciosus (Diptera: Psychodidae) in Spain by a competitive enzyme-linked immunosorbent assay biotin/avidin method

Blood meals from Phlebotomus perniciosus Newstead, collected in four different places in Spain, were identified to determine host-selection patterns. Blood meals were tested using a competitive enzyme-linked immunosorbent assay (ELISA) biotin-avidin method. Results indicate that this species is an opportunist that feeds on those animals to which it has easiest access. However, some preferences were indicated, because the insect never fed on chickens and frequently fed on sheep at sites where both sheep and goats were present. At some sites, the number of sand flies feeding on dogs was higher than expected, based on the proportion of dogs to man. Nevertheless, differences in host behavior, dispersal of engorged sand flies, and their exo- or endophilic habits make it difficult to assign specific host preferences.

First cases of gynandromorphism in Phlebotomus perniciosus Newstead 1911 (Diptera, Psychodidae, Phlebotominae)

Two gynandromorphic specimens of Phlebotomus perniciosus Newstead, 1911 are described and illustrated for the first time. The specimens were collected in the Northeast of the Iberian Peninsula (Spain).

Gynandromorphism in a population of Sergentomyia minuta (Rondani, 1843) in the northeast of Spain

A study carried out, from July 1990 until April 1991, in a small village situated in the northeast of Spain (Pradell de la Teixeta) has allowed the discovery of three sandflies species: Phlebotomus ariasi, P. perniciosus and Sergentomyia minuta. P. ariasi was present from the initial data of capture to the end of October, disappearing the two others at the first half of November. The population of S. minuta furnished gynandromorphic individuals (1.6%) being the female-like specimens most commonly found (37/45, 82.2%). The different degrees of development of the genital region are discussed.

Effect of treatment with an inhibitor of platelet aggregation on the evolution of background retinopathy: 2 years of follow-up

Ophthalmic evolution was studied for 2 years in 17 patients with insulin-dependent diabetes mellitus and background diabetic retinopathy. Nine patients were treated with triflusal, a new platelet antiaggregant drug, and the eight remaining patients, with similar clinical and biological characteristics, were considered the control group. At the end of the study the ophthalmic evolution was different in the two groups. In the control group the degree of fluorescein leakage and the number of microaneurysms increased, while in the triflusal-treated group both parameters were reduced. There were no differences in visual acuity and computerised perimetry between the groups. Our results suggest that platelet antiaggregant therapy can be useful in the treatment of background diabetic retinopathy.