Pessoa-E-Silva Rômulo, Vaitkevicius-Antão Victor, de Andrade Thiago André Santos, de Oliveira Silva Anny Caroliny, de Oliveira Gilsan Aparecida, Trajano-Silva Lays Adrianne Mendonça, Nakasone Eiji Kevin Nakasone, de Paiva-Cavalcanti Milena
Aggeu Magalhães Institute, Av. Moraes Rego, Cidade Universitária, CEP 50670-420, Recife-PE, Brazil.
Federal Rural University of Pernambuco (UFRPE), R. Manuel de Medeiros, s/n - Dois Irmãos, CEP 52171-900, Recife-PE, Brazil.
Exp Parasitol. 2019 Apr;199:9-16. doi: 10.1016/j.exppara.2019.02.012. Epub 2019 Feb 20.
In Brazil, the main strategy adopted to contain Visceral Leishmaniasis (VL) is the controversial culling of dogs with reagent serology for Canine VL (CVL). Despite there are studies showing that significant reduction of human cases has not been observed, as well as there are works demonstrating the occurrence of false-positive results in the confirmatory test, the protocol has been maintained. Researches that can reinforce the existence and persistence of this problem, as well as bring concrete alternatives are pivotal. In this context, the aim of this work was to evaluate and compare the serological, molecular and parasitological methods employed for CVL detection in Brazil, in dogs with diverse clinical profiles, from two endemic areas of Pernambuco state. Comparisons among TR-DPP, EIE-LVC and qPCR (animals from Goiana-PE: 91) demonstrated that agreements varied from 'poor' to 'moderate' (kappa = 0.162-0.442), and a triple agreement occurred in 61.36% (54/88) of the samples. The highest percentage of agreement was obtained between TR-DPP and EIE-LVC within the polysymptomatic group (93.33%; 14/15). Of the 34 dogs with reagent serology from Caruaru-PE, 17 (50%) and 29 dogs (85.29%) were positive for qPCR and parasitological exam, respectively. By comparing serology, qPCR and parasitological exam, the lowest percentage of agreements were obtained within the asymptomatic group (40%-72.72%). It was possible to observe that the percentage of agreement tended to decrease according to the absence of clinical manifestations in the dogs. Thus, from the fact that all diagnostic tools evaluated have their limitations, it is very important to be careful before to propose an alternative set of diagnostic criteria. Besides, the answer for better results in the control of CVL may not be in the choose of the best set of diagnostic tools, but it may be in the strategy of culling itself. In this context, it is very important to invest in alternative control measures, such as mass vaccination and treatment of dogs, thus reducing the transmission to the vector and helping to avoid new canine and human cases.
在巴西，为控制内脏利什曼病（VL）而采取的主要策略是对犬内脏利什曼病（CVL）血清学检测呈反应性的犬进行扑杀，这一策略存在争议。尽管有研究表明未观察到人类病例显著减少，且有研究证明确诊试验中存在假阳性结果，但该方案仍被保留。能够强化这一问题的存在和持续性并提出具体替代方案的研究至关重要。在此背景下，本研究旨在评估和比较巴西用于检测CVL的血清学、分子学和寄生虫学方法，这些方法应用于来自伯南布哥州两个流行地区、具有不同临床特征的犬。对TR-DPP、EIE-LVC和qPCR（来自戈亚尼亚-伯南布哥州的动物：91只）的比较表明，一致性从“差”到“中等”不等（kappa = 0.162 - 0.442），61.36%（54/88）的样本出现了三者一致的情况。在多症状组中，TR-DPP和EIE-LVC之间的一致性百分比最高（93.33%；14/15）。来自卡鲁阿鲁-伯南布哥州的34只血清学检测呈反应性的犬中，分别有17只（50%）和29只（85.29%）qPCR检测和寄生虫学检查呈阳性。通过比较血清学、qPCR和寄生虫学检查，无症状组的一致性百分比最低（40% - 72.72%）。可以观察到，随着犬无临床表现，一致性百分比趋于下降。因此，鉴于所有评估的诊断工具都有其局限性，在提出一套替代诊断标准之前务必谨慎。此外，在CVL控制中取得更好效果的答案可能不在于选择最佳的诊断工具组合，而可能在于扑杀策略本身。在此背景下，投资于替代控制措施，如犬的大规模疫苗接种和治疗，从而减少向媒介的传播并有助于避免新的犬类和人类病例，非常重要。
