Volume 81, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


We conducted a case-control study to evaluate risk factors for visceral leishmaniasis during an epidemic in a previously unaffected district of Ethiopia. We also collected blood and bone marrow specimens from dogs in the outbreak villages. In multivariable analyses of 171 matched case-control pairs, dog ownership, sleeping under an acacia tree during the day, and habitually sleeping outside at night were associated with significantly increased risk. Specimens from 7 (3.8%) dogs were positive by immunofluorescent antibody test (IFAT) and both enzyme-linked immunosorbent assays (ELISAs), whereas DNA was detected in 5 (2.8%) bone marrow aspirates (from 3 seropositive and 2 seronegative dogs). Insecticide-treated nets may only protect a portion of those at risk. Further research on the vectors, the role of the dog in the transmission cycle, and the effect of candidate interventions are needed to design the best strategy for control.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Jeronimo SMB, de Queiroz Sousa A, Pearson RD, 2006. Leishmaniasis. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens and Practice. Edinburgh, Scotland: Churchill Livingstone Elsevier, 1095–1113.
  2. Seaman J, Mercer AJ, Sondorp E, 1996. The epidemic of visceral leishmaniasis in western Upper Nile, southern Sudan: course and impact from 1984 to 1994. Int J Epidemiol 25 : 862–871. [Google Scholar]
  3. Alvar J, Bashaye S, Argaw D, Cruz I, Aparicio P, Kassa A, Orfanos G, Parreno F, Babaniyi O, Gudeta N, Canavate C, Bern C, 2007. Kala-azar outbreak in Libo Kemkem, Ethiopia: epidemiologic and parasitologic assessment. Am J Trop Med Hyg 77 : 275–282. [Google Scholar]
  4. Oskam L, Nieuwenhuijs JL, Hailu A, 1999. Evaluation of the direct agglutination test (DAT) using freeze-dried antigen for the detection of anti-Leishmania antibodies in stored sera from various patient groups in Ethiopia. Trans R Soc Trop Med Hyg 93 : 275–277. [Google Scholar]
  5. Boelaert M, El-Safi S, Hailu A, Mukhtar M, Rijal S, Sundar S, Wasunna M, Aseffa A, Mbui J, Menten J, Desjeux P, Peeling RW, 2008. Diagnostic tests for kala-azar: a multi-centre study of the freeze-dried DAT, rK39 strip test and KAtex in East Africa and the Indian subcontinent. Trans R Soc Trop Med Hyg 102 : 32–40. [Google Scholar]
  6. Bray RS, 1985. Immunodiagnosis of leishmaniasis. Chang KP, Bray RS, eds. Leishmaniasis. Amsterdam: Elsevier, 177–182.
  7. Fernandez-Perez FJ, Mendez S, de la Fuente C, Gomez-Munoz MT, Cuquerella M, Alunda JM, 1999. Short report: improved diagnosis and follow-up of canine leishmaniasis using amastigote-based indirect immunofluorescence. Am J Trop Med Hyg 61 : 652–653. [Google Scholar]
  8. Maia C, Campino L, 2008. Methods for diagnosis of canine leishmaniasis and immune response to infection. Vet Parasitol 158 : 274–287. [Google Scholar]
  9. Miro G, Montoya A, Mateo M, Alonso A, Garcia S, Garcia A, Caballero MJ, Molina R, 2007. A leishmaniosis surveillance system among stray dogs in the region of Madrid: ten years of serodiagnosis (1996–2006). Parasitol Res 101 : 253–257. [Google Scholar]
  10. Scott P, Pearce E, Natovitz P, Sher A, 1987. Vaccination against cutaneous leishmaniasis in a murine model. I. Induction of protective immunity with a soluble extract of promastigotes. J Immunol 139 : 221–227. [Google Scholar]
  11. Burns JM Jr, Shreffler WG, Benson DR, Ghalib HW, Badaro R, Reed SG, 1993. Molecular characterization of a kinesin-related antigen of Leishmania chagasi that detects specific antibody in African and American visceral leishmaniasis. Proc Natl Acad Sci USA 90 : 775–779. [Google Scholar]
  12. Cruz I, Canavate C, Rubio JM, Morales MA, Chicharro C, Laguna F, Jimenez-Mejias M, Sirera G, Videla S, Alvar J, 2002. A nested polymerase chain reaction (Ln-PCR) for diagnosing and monitoring Leishmania infantum infection in patients co-infected with human immunodeficiency virus. Trans R Soc Trop Med Hyg 96 (Suppl 1) : S185–S189. [Google Scholar]
  13. Elnaiem DA, Hassan HK, Ward RD, 1999. Associations of Phlebotomus orientalis and other sandflies with vegetation types in the eastern Sudan focus of kala-azar. Med Vet Entomol 13 : 198–203. [Google Scholar]
  14. Gebre-Michael T, Lane RP, 1996. The roles of Phlebotomus martini and P. celiae (Diptera: Phlebotominae) as vectors of visceral leishmaniasis in the Aba Roba focus, southern Ethiopia. Med Vet Entomol 10 : 53–62. [Google Scholar]
  15. Robert LL, Schaefer KU, Johnson RN, 1994. Phlebotomine sand-flies associated with households of human visceral leishmaniasis cases in Baringo District, Kenya. Ann Trop Med Parasitol 88 : 649–657. [Google Scholar]
  16. Bucheton B, Kheir MM, El-Safi SH, Hammad A, Mergani A, Mary C, Abel L, Dessein A, 2002. The interplay between environmental and host factors during an outbreak of visceral leishmaniasis in eastern Sudan. Microbes Infect 4 : 1449–1457. [Google Scholar]
  17. Dereure J, Boni M, Pratlong F, el Hadi Osman M, Bucheton B, el-Safi S, Feugier E, Musa MK, Davoust B, Dessein A, Dedet JP, 2000. Visceral leishmaniasis in Sudan: first identifications of Leishmania from dogs. Trans R Soc Trop Med Hyg 94 : 154–155. [Google Scholar]
  18. Dereure J, El-Safi SH, Bucheton B, Boni M, Kheir MM, Davoust B, Pratlong F, Feugier E, Lambert M, Dessein A, Dedet JP, 2003. Visceral leishmaniasis in eastern Sudan: parasite identification in humans and dogs; host-parasite relationships. Microbes Infect 5 : 1103–1108. [Google Scholar]
  19. Gebre-Michael T, Balkew M, Alamirew T, Gudeta N, Reta M, 2007. Preliminary entomological observations in a highland area of Amhara region, northern Ethiopia, with epidemic visceral leishmaniasis. Ann Trop Med Parasitol 101 : 367–370. [Google Scholar]
  20. Ashford DA, Bozza M, Freire M, Miranda JC, Sherlock I, Eulalio C, Lopes U, Fernandes O, Degrave W, Barker RH Jr, et al., 1995. Comparison of the polymerase chain reaction and serology for the detection of canine visceral leishmaniasis. Am J Trop Med Hyg 53 : 251–255. [Google Scholar]
  21. Quinnell RJ, Courtenay O, Davidson S, Garcez L, Lambson B, Ramos P, Shaw JJ, Shaw MA, Dye C, 2001. Detection of Leishmania infantum by PCR, serology and cellular immune response in a cohort study of Brazilian dogs. Parasitology 122 : 253–261. [Google Scholar]
  22. Courtenay O, Quinnell RJ, Garcez LM, Shaw JJ, Dye C, 2002. Infectiousness in a cohort of brazilian dogs: why culling fails to control visceral leishmaniasis in areas of high transmission. J Infect Dis 186 : 1314–1320. [Google Scholar]
  23. Dietze R, Barros GB, Teixeira L, Harris J, Michelson K, Falqueto A, Corey R, 1997. Effect of eliminating seropositive canines on the transmission of visceral leishmaniasis in Brazil. Clin Infect Dis 25 : 1240–1242. [Google Scholar]
  24. Solano-Gallego L, Morell P, Arboix M, Alberola J, Ferrer L, 2001. Prevalence of Leishmania infantum infection in dogs living in an area of canine leishmaniasis endemicity using PCR on several tissues and serology. J Clin Microbiol 39 : 560–563. [Google Scholar]
  25. Werneck GL, Costa CH, Walker AM, David JR, Wand M, Maguire JH, 2007. Multilevel modelling of the incidence of visceral leishmaniasis in Teresina, Brazil. Epidemiol Infect 135 : 195–201. [Google Scholar]
  26. Costa CH, Gomes RB, Silva MR, Garcez LM, Ramos PK, Santos RS, Shaw JJ, David JR, Maguire JH, 2000. Competence of the human host as a reservoir for Leishmania chagasi. J Infect Dis 182 : 997–1000. [Google Scholar]
  27. Agrela I, Sanchez E, Gomez B, Feliciangeli MD, 2002. Feeding behavior of Lutzomyia pseudolongipalpis (Diptera: Psychodidae), a putative vector of visceral leishmaniasis in Venezuela. J Med Entomol 39 : 440–445. [Google Scholar]
  28. Kolaczinski JH, Reithinger R, Worku DT, Ocheng A, Kasimiro J, Kabatereine N, Brooker S, 2008. Risk factors of visceral leishmaniasis in East Africa: a case-control study in Pokot territory of Kenya and Uganda. Int J Epidemiol 37 : 344–352. [Google Scholar]
  29. Ryan JR, Mbui J, Rashid JR, Wasunna MK, Kirigi G, Magiri C, Kinoti D, Ngumbi PM, Martin SK, Odera SO, Hochberg LP, Bautista CT, Chan AS, 2006. Spatial clustering and epidemiological aspects of visceral leishmaniasis in two endemic villages, Baringo District, Kenya. Am J Trop Med Hyg 74 : 308–317. [Google Scholar]
  30. Ali A, 1997. Visceral leishmaniasis in southern Ethiopia: I. Environmental and behavioral risk factors. Ethiop J Health Dev 11 : 131–137. [Google Scholar]
  31. Ali A, 1997. Visceral leishmaniasis in Southern Ethiopia: II. Nutritional risk factors. Ethiop J Health Dev 11 : 139–144. [Google Scholar]
  32. Reithinger R, Davies CR, 2002. Canine leishmaniasis: novel strategies for control. Trends Parasitol 18 : 289–290. [Google Scholar]

Data & Media loading...

  • Received : 22 Oct 2008
  • Accepted : 30 Jan 2009

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error