The epidemiology and control of leishmaniasis in Andean countries.

This paper reviews the current knowledge of leishmaniasis epidemiology in Venezuela, Colombia, Ecuador, Peru, and Bolivia. In all 5 countries leishmaniasis is endemic in both the Andean highlands and the Amazon basin. The sandfly vectors belong to subgenera Helcocyrtomyia, Nyssomiya, Lutzomyia, and Psychodopygus, and the Verrucarum group. Most human infections are caused by Leishmania in the Viannia subgenus. Human Leishmania infections cause cutaneous lesions, with a minority of L. (Viannia) infections leading to mucocutaneous leishmaniasis. Visceral leishmaniasis and diffuse cutaneous leishmaniasis are both rare. In each country a significant proportion of Leishmania transmission is in or around houses, often close to coffee or cacao plantations. Reservoir hosts for domestic transmission cycles are uncertain. The paper first addresses the burden of disease caused by leishmaniasis, focusing on both incidence rates and on the variability in symptoms. Such information should provide a rational basis for prioritizing control resources, and for selecting therapy regimes. Secondly, we describe the variation in transmission ecology, outlining those variables which might affect the prevention strategies. Finally, we look at the current control strategies and review the recent studies on control.

Density estimates of the domestic vector of Chagas disease, Rhodnius prolixus Stål (Hemiptera: Reduviidae), in rural houses in Venezuela.

We reported the use of the timed manual method, routinely employed as an indicator to the relative abundance of domestic triatomine bugs, to estimate their absolute density in houses. A team of six people collected Rhodnius prolixus Stål bugs from the walls and roofs of 14 typical palm-leaf rural houses located in Cojedes, Venezuela, spending 40 minutes searching in each house. One day after these manual collections, all the houses were demolished and the number of triatomine bugs were identified by instar and counted. Linear regression analyses of the number of R. prolixus collected over 4 man-hours and the census counts obtained by house demolition indicated that the fit of the data by instar (stage II--adult) and place of capture (roof versus palm walls versus mud walls) was satisfactory. The slopes of the regressions were interpreted as a measure of "catchability" (probability of capture). Catchability increased with developmental stage (ranging from 11.2% in stage II to 38.7% in adults), probably reflecting the increasing size and visibility of bugs as they evolved. The catchability on palm wall was higher than that for roofs or mud walls, increasing form 1.3% and 3.0% in stage II to 13.4% and 14.0% in adults, respectively. We reported, also, regression equations for converting field estimates of timed manual collections of R. prolixus into absolute density estimates.

Coexistence of two species of Leishmania in the digestive tract of the vector Lutzomyia ovallesi.

Leishmania isolated from the digestive tract of a naturally infected Lutzomyia ovallesi sand fly were cultured in blood agar for rapid growth, cloning, and subsequent identification through schizodeme analysis, dot-blot hybridization, use of monoclonal antibodies with various specificities and absorbed polyclonal antibodies. Twenty-three clones isolated from the primary culture were identified. The results showed that parasites belonging to some clones corresponded to the L. mexicana complex, while others belonged to the L. braziliensis complex. These results clearly establish the coexistence of two Leishmania species in the digestive tract of a single Lu. ovallesi sand fly.

Cutaneous leishmaniasis in Tachira State, Venezuela.

Cutaneous and mucocutaneous leishmaniases are widely spread in the mountainous Andean regions of South America. In Venezuela, these regions consist of the coffee-growing states of Trujillo, Merida and Tachira. Entomological and parasitological investigations in three geographically different climatic zones (Lomas Bajas, Delicias and La Grita) in Tachira state have shown a predominance of the sandfly species Lutzomyia spinicrassa (verrucarum group) and two Leishmania species, Leishmania mexicana and Leishmania braziliensis. Two transmission cycles appear to occur: a peridomestic cycle in Lomas Bajas and a sylvatic one in Delicias and La Grita.

Molecular approaches applied to the epidemiology of leishmaniasis in Venezuela.

Leishmaniasis is on the increase in Venezuela (ca 30,000 new cases per year) due to deterioration in health management, increased risk groups among inmunosuppressed individuals and increased human penetration into the ecological habitats of sandfly vectors. An STD2-funded project (1989-1992) focused on the Andean state of Táchira, which showed the highest annual index of new cases (ca 200-250). The project aimed at contributing to vector/parasite identification through a combination of molecular and well established field techniques: Newly developed molecular methods distinguished among Lu. spinicrassa, Lu. youngi and Lu. townsendi. These three species of the Verrucarum group are sympatric in the Northeast of the state and could be successfully identified by CHA, DNA probes and RAPD. A Le. braziliensis specific KDNA probe used with squash blots indicated that Lu. spinicrassa is the main vector and that Le. braziliensis is the main parasite species in Táchira state, Venezuela. PCR and the Le. brasiliensis specific DNA probe, schizodemes, isoenzymes and polyclonal antibodies agreed as taxonomic criteria for classification of Leishmania isolated from parasitologically confirmed cases in Tachira. Considerable degree of antigen heterogeneity in Venezuelan Le. braziliensis complex and Le. mexicana complex isolates from Tachira suggests multiple candidate antigens for improving the specificity of immunological diagnosis. The methods developed and tested in Táchira state should be valuable in order to help solving other outstanding epidemiological problems such as following of the epidemiological impact of intervention and vector control measures in highly endemic areas. Future work (STD3 funded, 1993-1996) aims to apply these molecular techniques to a vector control pilot study in Lara state, an area showing the highest incidence of new cases in the country.

Molecular approaches applied to the analysis of sympatric sandfly populations in endemic areas of western Venezuela.

To understand the epidemiology of cutaneous and mucocutaneous leishmaniasis in three distinct endemic foci of Tachira state, Western Venezuela, we aim to improve vector identification methods by developing species-specific sandfly DNA probes. These probes will be able to distinguish between sympatric sandfly populations thereby providing epidemiological data for determining the significance of individual sandfly groups related to their vectorial capacity.