Leishmaniasis due to Leishmania infantum: Integration of human, animal and environmental data through a One Health approach.

The aim of this study was to explore Leishmania infantum epidemiology through a One Health approach that promotes a better estimation of leishmaniasis burden and a deeper understanding of the spatial distribution of the key actors of the parasite life cycle (vectors, reservoirs and humans). We conducted a 14-year mixed retrospective and prospective study of leishmaniasis cases in an endemic area in southern Spain (Granada province), to estimate the human incidence and its association with the vector presence, cryptic leishmaniasis rates and canine leishmaniasis prevalence. We found an annual linear increase in the incidence that cannot be fully explained by active case surveillance and the improvement of PCR diagnostic techniques. 49.4% of cases were not reported to the surveillance system. Approximately half of the human cases correspond to the visceral form that occurred more frequently in men; cutaneous, mucosal and cryptic forms were also detected. Leishmaniasis is no longer a disease of young children, accounting for a quarter of immunocompetent patients and most infected people remained asymptomatic. Human and canine leishmaniasis, cryptic or symptomatic, are present in the whole province, where there is a medium/high risk of the presence of Phlebotomus perniciosus, the main vector. We found association between the incidence of human leishmaniasis and the presence of the vector, but not with the prevalence of canine leishmaniasis and cryptic human leishmaniasis. A potential hot spot was also found, where high leishmaniasis incidence may be associated to the involvement of host species other than dogs.

Epidemiological implications of the use of various methods for the diagnosis of canine leishmaniasis in dogs with different characteristics and in differing prevalence scenarios.

Our aim was to establish the influence on the prevalence of canine leishmaniasis (CanL) of the following: (1) the use of different diagnostic techniques; (2) different positivity thresholds; (3) selection of animals either at random from a population or focused on symptomatic individuals, (4) the function which the dog performs; and (5) scenarios with differing epidemiological characteristic. Three groups of dogs were analysed (416 sampled at random from an endemic area, 71 with symptomatology compatible with CanL and 15 from a non-endemic area) using three serological techniques (indirect fluorescence antibody test (IFAT), Kalazar Detect(TM) and Q Letitest ELISA) and a PCR-ELISA. The diagnostic technique had a considerable influence on the CanL prevalence value obtained. Uncertain antibody titres were more representative in dogs sampled at random and with the IFAT technique. Although employing different capture antigens, correlation of results was higher between the two commercial techniques in the group of dogs with symptomatology compatible with CanL. The sensitivity and specificity values of the different diagnostic techniques were affected by the epidemiological characteristic of the area under study, the presence of clinical signs and the function which the dog performs. This must be taken into account when comparing endemicity in different geographical areas, such as in studies carried out for the construction of risk maps. Using more than one technique, and adopting the criterion of considering an animal to be positive only when it has been diagnosed as such by more than one technique, considerably raises the prevalence values but maintains the differences between areas with different characteristics.

Canine leishmaniasis in southeastern Spain.

To examine prevalence changes and risk factors for canine leishmaniasis, we conducted a cross-sectional seroprevalence study and a survey during April-June 2006. Seroprevalence had increased at the meso-Mediterranean bioclimatic level over 22 years. Risk was highest for dogs that were older, large, lived outside, and lived at the meso-Mediterranean level.