An Atypical Case of Autochthonous Cutaneous Leishmaniasis Associated with Naturally Infected Phlebotomine Sand Flies in Texas, United States.

In the United States, phlebotomine sand flies carrying Leishmania (Leishmania) mexicana are endemic along the southern border. However, relatively little is known about the enzootic and zoonotic transmission of L. (L.) mexicana within the United States, and autochthonous cases of the consequent disease are rarely reported. We investigated an atypical case of cutaneous leishmaniasis (CL) caused by L. (L.) mexicana in a patient from central Texas which did not respond to a typical antileishmanial chemotherapy. We also investigated sand fly vectors around the patient's residence. PCR followed by DNA sequencing was used for determination of Leishmania spp., sand fly species, and host blood meal source. The L. (L.) mexicana genotype from the patient was identical to one found in a positive sand fly. Moreover, this genotype presented the same single-nucleotide polymorphisms as other historical CL cases acquired in Texas over the last 10 years, but distinct from those originating in Mexico and Central America. Three sand fly species were identified among the samples analyzed (n = 194), the majority of which were Lutzomyia (Dampfomyia) anthophora (n = 190), of which four specimens tested positive for Leishmania and two blood-fed specimens showed the presence of a human blood meal. This study highlights the complexity of clinical management of CL in a setting where the disease is infrequently encountered. The detection of human blood in Lu. (D.) anthophora is the first documentation of anthropophagy in this species. This is the first report of wild-caught, naturally infected sand flies found in association with an autochthonous case of human leishmaniasis and the specific strain of Leishmania (Leishmania) mexicana in the United States.

Characteristics of owned dogs in rabies endemic KwaZulu-Natal province, South Africa.

BACKGROUND: Canine rabies has been enzootic in the dog population of the KwaZulu-Natal province of South Africa since the mid-1970s and has been associated with high rates of human exposures and frequent transmissions to other domestic animal species. Several decades of control efforts, consisting primarily of mass vaccination programs, have previously failed to sufficiently curb rabies in the province. Despite this history of canine rabies, the target canine population has never been extensively studied or quantified. For efficient and effective vaccination campaign planning, the target population must be evaluated and understood. This study reports evaluated observations from survey records captured through a cross sectional observational study regarding canine populations and dog owners in rabies enzootic KwaZulu-Natal province, South Africa. The objective of this study was to aid government veterinary services in their current and ongoing efforts to eliminate canine rabies in the province by gaining information about the size and distribution of the owned dog population. RESULTS: Thirty-eight percent of the households owned one or more dogs, with rural areas surveyed containing a significantly higher number of owned dogs than urban areas. The mean dog/person ratio for this study was 1:7.7 (range 1:5.4-1:31). The provincial sex ratio was 1.5:1 male to female, with the percentages for male dogs across the communities ranging from 53 to 61.5%. The age structure of this dog population indicates a high turnover rate. Dogs were kept mostly for guarding homes or livestock. Eighty-four percent of dogs had received a rabies vaccine at some point in their lifetime, almost all during a rabies campaign. CONCLUSIONS: The study indicates the majority of owned dogs can be handled by at least one member of the household, thus can be made readily accessible for rabies vaccination during a campaign. Characteristics of owned dogs in the province were similar to those studied in other African countries; however, there were remarkable differences in age, sex and husbandry practices compared to dogs in eastern or northern Africa. These geographical differences lend credence to the theory that canine populations are heterogeneous; therefore, target populations should be evaluated prior to intervention planning.

Risk factors associated with nonvaccination rabies status of dogs in KwaZulu-Natal, South Africa.

Canine rabies has been enzootic in the dog population of the KwaZulu-Natal province of South Africa since the mid-1970s and has been associated with high rates of human exposures and frequent transmissions to other domestic animal species. Several decades of control efforts, consisting primarily of mass vaccination programs, failed to sufficiently curb rabies in this province. For meaningful progression toward better control and elimination, the factors contributing to the persistence of this disease need to be elucidated and addressed. This paper reports evaluated observations from survey records captured through a cross-sectional observational study regarding owned canine populations in this South African province. We used logistic regression modeling to predict variables associated with risk of nonvaccination of rabies in owned dogs. The study indicated that husbandry practices, rabies knowledge, geographical area/location, and the ages of dogs were important factors associated with the risk of nonvaccination. High population turnover, together with large free roaming dog populations, compromised the levels of vaccination achieved and contributed to the persistence of dog rabies in the province. Dog owners in this study also reported that they were more likely to present their dogs for vaccination when the vaccines were free of charge (52%) and less than a kilometer from their homes (91%). It has been suggested that effective dog rabies control requires 70% or more of the dog population to be vaccinated. Our data showed that this figure was not reached in the surveyed dog population.

Dog bite histories and response to incidents in canine rabies-enzootic KwaZulu-Natal, South Africa.

The objective of this paper is to report evaluated observations from survey records captured through a cross-sectional observational study regarding canine populations and dog owners in rabies enzootic KwaZulu-Natal province, South Africa. Our aim was to evaluate respondent knowledge of canine rabies and response to dog bite incidents towards improved rabies control. Six communities consisting of three land use types were randomly sampled from September 2009 to January 2011, using a cluster design. A total of 1992 household records were analyzed using descriptive statistics and regression modeling to evaluate source of rabies knowledge, experiences with dog bites, and factors affecting treatment received within respective households that occurred within the 365 day period prior to the surveys. 86% of the population surveyed had heard of rabies. Non-dog owners were 1.6 times more likely to have heard of rabies than dog owners; however, fear of rabies was not a reason for not owning a dog. Government veterinary services were reported most frequently as respondent source of rabies knowledge. Nearly 13% of households had a member bitten by a dog within the year prior to the surveys with 82% of the victims visiting a clinic as a response to the bite. 35% of these clinic visitors received at least one rabies vaccination. Regression modeling determined that the only response variable that significantly reflected the likelihood of a patient receiving rabies vaccination or not was the term for the area surveyed. Overall the survey showed that most respondents have heard of dog associated rabies and seek medical assistance at a clinic in response to a dog bite regardless of offending dog identification. An in-depth study involving factors associated within area clinics may highlight the area dependency for patients receiving rabies post exposure prophylaxis shown by this model.