Kala-azar in Portugal--IV. The wild reservoir: the isolation of a Leishmania from a fox.
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Biomedical subjects
Publications and source records attributed to P Abranches.
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A serological and parasitological survey of dogs was done in four slum areas on the outskirts of Lisbon and a rural area west of Setúbal. The serological test was the IFAT. The total number of dogs examined was 572 which 55 (9,6%) had titre greater than or equal to 1/128, 10 of these dogs were among 182 (5,5%) in the urban areas and 45 were in the sample of 390 dogs (11,5%) in the rural area. 23 dogs with titres of greater than or equal to 1/128 were examined parasitologically. The methods were the examination of tissue from popliteal lymph nodes (by direct examination and the inoculation of NNN cultures and hamsters), the direct examination of stained smears from sores and the direct examination of stained smears of healthy skin. Parasites were demonstrated in 15 (65,2%) of the 23 dogs. 14 dogs with high titres were followed up by a second IFAT. 5 had become higher, 5 had remained the same and, in 4, the titres had fallen. The results of the survey suggest that canine leishmaniasis is more common in the rural area than in the urban sites. The disease in man in the focus studied appears to be accidental and, paradoxically likely to be acquired rather in the town than in the villages. The reason is probably related to zoophilic preference of vector, and the fact that the population in rural areas is widely dispersed.
Kala-azar is now increasing in Portugal where it has been known since 1910. The natural region studied is made up of the western basins of the Tejo and Sado rivers with their important estuaries and the area south of Lisbon. The climate and vegetation are mainly of the mediterranean type. Kala-azar has always been endemic in the sub-region southwest of Lisbon (45 cases from 1961 to 1978). In the Setubal peninsula the disease has always had a low incidence (10 cases from 1961 to 1978). The Alcácer do Sal subregion was, in the past, the second most active endemic zones in the country although after 1950 there was a sudden fall in prevalence (only two cases reported from 1961 to 1978). In this natural region foxes (Vulpes vulpes silacea Miller, 1907) are abundant. One-hundred and ninety-eight foxes, mostly from the Alcácer do Sal region, were killed and studied using direct examination of spleen and liver, culture in NNN of spleen and bone-marrow, hamster inoculation of spleen and IFAT of serum. All the examinations were negative for Leishmania, while Hepatozoon was found in 40.6% of the foxes and filaria in 11.9%. In spite of some shortcomings of the study methods it is suggested that they may not be an autonomous sylvatic cycle of kala-azar. The negativity of the results, lack of any sporadic cases in rural people and absence of the characteristics of a natural reservoir in the foxes, all seem to point to such a conclusion.
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A direct agglutination test (DAT) and an immunofluorescence technique (IFAT) were compared for detection of Leishmania infantum infection in 43 dogs and five foxes from Alto-Douro and Arrábida, two known endemic areas in Portugal. In four dogs with proved canine leishmaniasis, both DAT and IFAT showed positive readings (titres > or = 1:320 and > or = 1:128). Of 34 samples collected from apparently healthy dogs, ten were positive by both serological tests and eight were serologically positive by one test or the other. Three foxes out of five captured in this area, scored titres indicative of leishmaniasis in both DAT and IFAT. The concordance between DAT and IFAT in all collected samples (48) was 81.25%. Considering these and previous studies in the adjacent Mediterranean areas, the seroprevalence of L. infantum infection in the canine and vulpine populations appear to be of high magnitude.
Five mixed breed dogs were inoculated intradermally (ID) with cultured virulent stationary phase promastigotes of Leishmania infantum Nicole, 1908 stocks recently isolated. Parasite transformations in the skin of ID infected dogs were monitored from the moment of inoculation and for 48 h, by skin biopsies. Anti-Leishmania antibody levels were measured by indirect immunofluorescence assay, counterimmunoelectrophoresis and direct agglutination test, and clinical conditions were examined. Thirty minutes after ID inoculation the first amastigotes were visualised and 3 to 4 h after inoculation the promastigotes were phagocytized by neutrophils and by a few macrophages. These cells parasitised by amastigotes progressively disappeared from the skin and 24 h after inoculation parasites were no longer observed. Local granulomes were not observed, however, serological conversion for antibodies anti-Leishmania was achieved in all dogs. Direct agglutination test was the only technique positive in all inoculated dogs. Amastigotes were found in the popliteal lymph node in one dog three months after inoculation. This work demonstrates that, with this inoculum, the promastigotes were transformed into amastigotes and were up taken by neutrophils and macrophages. The surviving parasites may have been disseminated in the canine organism, eliciting a humoral response in all cases.
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The different quality control methods which should be used in seroimmunological assays for detection of antibodies in infectious disease are analyzed. The concepts of reliability, sensitivity, specificity, cut off, efficacy and predictive value are described, explained how they can be calculated and exemplified. The statistics which can be used for comparing results in different situations it is also referred.
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