Dogs L. infantum infection from an endemic region of the north of Tunisia: a prospective study.

A follow-up study of 917 dogs was undertaken between 1994 and 1995 in the focus of visceral leishmaniasis in northern Tunisia. It permitted to assess the demography of the dog population, the importance of canine leishmaniasis (CL) and the determinants of seropositivity and mortality of dogs. Canine population was stable through time with an input of 231 dogs and an output of 218 dogs per year. The prevalence of seropositivity was 18% and 22.3% in 1994 and 1995 respectively and 90% of dogs were asymptomatic. Among 525 negative dogs in 1994 and reassessed in 1995, 78 seroconverted revealing an annual cumulative incidence of 14.74%. On the other hand, 23.47% (27/115) of seropositive dogs became negative in 1995. Age, presence of symptoms and density of dogs were independently associated with CL seropositivity. These results demonstrate the difficulty of control strategies of visceral leishmaniasis targeting the dog population.

[Efficacy of intra-lesional glucantime in the treatment of zoonotic cutaneous leishmaniasis in basic health care conditions]. / Efficacité du traitement de la leishmaniose cutanée zoonotique par le glucantime en intra-lésionnel, dans les conditions des soins de santé de base.

A randomized placebo-controlled trial treating cutaneous lesions due to Leishmania major with intralesionnel glucantime, was conducted in El Guettar between december 1994 and June 1995, in order to assess efficacy of this therapy under field conditions. It included 109 patients: 52 were administrated glucantime and 57 received local treatment (eosin 5% and alcohol 95%). Prognostic factors were similar in both groups. Results did not reveal a significant difference between glucantime and eosin regarding the rapidity of the healing of lesions. However, scars seem to be of better quality among the glucantime group. Bacterial super infection was noticed among 57.6% of humid lesions sampled among 33 patients. Isolated strains included group A streptococcus (22%), staphylococcus aureus (16.7%) or an association of both agents (61.1%). Resistance profile indicated that streptococcus and staphylococcus respond well to macrolids compared to other antibiotic groups.

A randomized, placebo-controlled trial in Tunisia treating cutaneous leishmaniasis with paromomycin ointment.

A randomized, placebo-controlled, double-blind trial was carried out in 1992 in central Tunisia to assess the tolerability and efficacy of paromomycin ointment against zoonotic cutaneous leishmaniasis caused by Leishmania major. One hundred fifteen patients, 2--60 years of age, with a single lesion of parasitologically confirmed cutaneous leishmaniasis, were included in the trial. The ointment was applied twice a day from day 1 through day 14. Clinical and parasitologic evaluations of lesions were done at days 0, 15, 45, and 105. Fifty-seven patients were allocated the treatment and 58 the placebo. Based on local toxicity and laboratory evaluation, there was no difference in tolerability between the two groups. Parasitologic evaluation at day 15 showed that 74.5% of the treated group had negative smears compared with 56.4% among controls (P = 0.06). This difference was no longer apparent at days 45 and 105. Clinical evaluation at days 15, 45, and 105 did not indicate any difference between the two groups. The clinical evaluation at day 15 was a good predictor of the final prognosis of the lesion in the two groups when analyzed separately, suggesting no clinical relapse in either group. These findings suggest that paromomycin ointment should not be used in the present formulation as a treatment for zoonotic cutaneous leishmaniasis in Tunisia.

[Spontaneous course of lesions of Leishmania major cutaneous leishmaniasis in Tunisia]. / Evolution spontanée des lésions de leishmaniose cutanée a Leishmania major en Tunisie.

INTRODUCTION: The evolution of zoonotic cutaneous leishmaniasis (ZCL) caused by L. major, was usually described with crosssectional studies of patients under anti-leishmanial drugs. This work aimed to describe the clinical and parasitological status by a follow-up study of patients with ZCL and treated with a placebo. MATERIAL AND METHODS: In 1992, 58 patients with unique lesion of ZCL confirmed parasitologically and treated with vaseline twice a day for 15 days were followed in days 0, 15, 45 and 105. During every visit we have performed a clinical description of the lesion, a direct smear and a culture on NNN medium. RESULTS: 81 p. 100 of the lesions were ulcerated in day 0. A rapid clinical healing was noticed in 6.9 p. 100 of patients and the lesion remained active in 25.9 p. 100 of cases until day 105. Direct smears became negative among 56.4 p. 71 p. 100 and 92.3 p. 100 in days 15, 45 and 105 respectively. DISCUSSION: The ulcer was the most frequent sign during the diagnosis. The rapid conversion of positive parasitological tests suggest that the diagnosis of ZCL in endemic zones should be based mainly on clinical criteria.

The squash blot technique and the detection of Leishmania major in Phlebotomus papatasi in Tunisia.

This study describes the preliminary applications of the squash blot technique in Tunisia, to detect Leishmania major in naturally infected Phlebotomus papatasi. 309 P. papatasi among 364 female sandflies squashed on to nylon Gene Screen DNA transfer membranes, were identified using the 3.2 kb ribosomal P. papatasi specific DNA probe described by Ready et al. A second hybridization using the Taq1 DNA probe described by Smith et al. (1989) allowed the detection and identification of the parasite in 15 (4.9%) of these P. papatasi specimens. The dissection of P. papatasi females during the same period and from the same biotopes showed an infection rate of 7.9% (9 positives among 113 dissected). The t proportion comparison test indicated that there is no significant statistical difference between the dissection and the squash blot technique for the estimation of infection rates of P. papatasi.