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Introduction: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. Methods: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. Results: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. Conclusions: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence.


Costa C.H.N.,Federal University of Piaui | Ribeiro J.C.C.B.,Institute Doencas Tropicais Natan Portella | Nunes-Filho L.P.,Clinica de Imagem Lucidio Portella
Revista da Sociedade Brasileira de Medicina Tropical | Year: 2013

Although cryptococcal infections begin in the lungs, meningoencephalitis is the most frequently encountered manifestation of cryptococcosis among individuals with advanced immunosuppression. As the infection progresses along the Virchow-Robin spaces, these structures may become dilated with mucoid material produced by the capsule of the organism. We report a case of a 24-year-old man with cryptococcal meningoencephalitis in which magnetic resonance imaging showed clusters of gelatinous pseudocysts in the periventricular white matter, basal ganglia, mammillary bodies, midbrain peduncles and nucleus dentatus with a soap bubble appearance.


Silva J.M.,Institute Doencas Tropicais Natan Portella | Zacarias D.A.,Federal University of Paraiba | De Figueiredo L.C.,Federal University of Piaui | Soares M.R.A.,Federal University of Para | And 3 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2014

Kala-azar or visceral leishmaniasis, found mostly throughout the Indian Subcontinent, East Africa, and Brazil, kills 20,000-40,000 persons annually. The agents, Leishmania donovani and Leishmania infantum, are obligatory intracellular protozoa of mononuclear phagocytes found principally in the spleen and bone marrow. Protracted fever, anemia, wasting, hepatosplenomegaly, hemorrhages, and bacterial co-infections are typical features. One hundred and twenty-two (122) in-hospital patients were studied to verify if higher bone marrow parasite load estimated by quantitative polymerase chain reaction is associated with severe disease. The estimated median parasite load was 5.0 parasites/106 human nucleated cells. It is much higher in deceased than among survivors (median 75.0 versus 4.2). Patients who lost more weight had a higher parasite burden, as well as patients with epistaxis, abdominal pain, edema, and jaundice. This study suggests that higher parasite load is influenced by wasting, which may lead to more severe disease. Copyright © 2014 by The American Society of Tropical Medicine and Hygiene.


Harhay M.O.,University of Pennsylvania | Olliaro P.L.,World Health Organization | Olliaro P.L.,University of Oxford | Costa D.L.,Federal University of Piaui | And 3 more authors.
Trends in Parasitology | Year: 2011

Since the early 1980s, visceral leishmaniasis (VL) which is, in general, a rural zoonotic disease, has spread to the urban centers of the north, and now the south and west of Brazil. The principal drivers differ between cities, though human migration, large urban canid populations (animal reservoir), and a decidedly peripatetic and adaptable sand fly vector are the primary forces. The exact number of urban cases remains unclear as a result of challenges with surveillance. However, the number of urban cases registered continues to increase annually. Most control initiatives (e.g. culling infected dogs and household spraying to kill the sand fly) could be effective, but have proven hard to maintain at large scales due to logistical, financial and other reasons. In this article, the urbanization of VL in Brazil is reviewed, touching on these and other topics related to controlling VL within and outside Brazil. © 2011 Elsevier Ltd.


Alonso D.P.,Sao Paulo State University | Costa D.L.,Institute Doencas Tropicais Natan Portella | De Mendonca I.L.,Federal University of Piaui | Costa C.H.N.,Institute Doencas Tropicais Natan Portella | Ribolla P.E.M.,Sao Paulo State University
American Journal of Tropical Medicine and Hygiene | Year: 2010

Leishmania infantum chagasi is the causative agent of visceral leishmaniasis in Brazil. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of kinetoplast DNA (kDNA) minicircles was used to evaluate genetic profiles of 48 Leishmania infantum chagasi strains from dog and human parasite cultures, fresh collected dog bone marrow aspirates, and from infected sand flies. Results revealed that heterogeneity in kDNA minicircles depends mostly on the source of the samples, with cultured parasites showing a high degree of homogeneity. Copyright © 2010 by The American Society of Tropical Medicine and Hygiene.

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