Role of Food Insecurity in Outbreak of Anthrax Infections Among Humans and Hippopotamuses Living in a Game Reserve Area, Rural Zambia

Role of Food Insecurity in Outbreak of Anthrax Infections Among Humans and Hippopotamuses Living... The Pediatric Infectious Disease Journal • Volume 37, Number 3, March 2018 DCL Treated With Liposomal Amphotericin B 7. Vega-López F. Diagnosis of cutaneous leishmaniasis. Curr Opin Infect Dis. with properties similar to sodium stibogluconate, another pentava- 2003;16:97–101. lent antimony compound. These medications are considered first-line 8. Organization WH. World Health Report 2004: Changing History. Geneva: agents in the treatment of leishmaniasis. Their efficacy and toxicity World Health Organization; 2004. are thought to be related to their content of pentavalent antimony. 9. Postigo JAR. Leishmaniasis in the world health organization Eastern Amphotericin B has been shown to be effective in the treatment of Mediterranean region. Int J Antimicrob Agents. 2010;36:S62–S65. 16,17 CL. Also, there have been obvious favorable results of miltefosine 10. Kar S, Soong L, Colmenares M, et al. The immunologically protective P-4 treatment for CL and VL. Meglumine antimoniate, amphotericin B antigen of Leishmania amastigotes. A developmentally regulated single and miltefosine were used for the treatment of our case. strand-specific nuclease associated with the endoplasmic reticulum. J Biol Chem. 2000;275:37789–37797. 11. Ferreira MS, Borges AS. Some aspects of protozoan infections in immu- ACKNOWLEDGMENTS nocompromised patients—a review. Mem Inst Oswaldo Cruz. 2002;97: The authors thank the patient and the parents for their 443–457. patience and for giving them the opportunity to publish her case. 12. Kumar P, Roozitalab M, Lak P, et al. Ocular leishmaniasis; a cause of blind- ness. Irn J Med Sci. 1993;18:106–111. REFERENCES 13. ModarresZadeh M, Manshai K, Shaddel M, et al. Ocular leishmaniasis. 1. Desjeux P. The increase in risk factors for leishmaniasis worldwide. Trans R Iranian J Ophthalmol. 2007;19:1–5. Soc Trop Med Hyg. 2001;95:239–243. 14. Peters W, Killick-Kendrick R. The leishmaniases in biology and medicine. 2. Alvar J, Vélez ID, Bern C, et al; WHO Leishmaniasis Control Team. Volume II. Clinical aspects and control. London: Academic Press Inc. Ltd; Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7:e35671. 15. World Health Organization. Control of the leishmaniasis. WHO Tech Rep 3. Aghaei S, Salmanpour R, Handjani F, et al. Ulcerated disseminated cutaneous Ser. 1990;793:40–55. leishmaniasis associated with vitiligo, hypothyroidism, and diabetes mellitus in a patient with Down syndrome. Dermatology online journal. 2004;10:21. 16. Balasegaram M, Ritmeijer K, Lima MA, et al. Liposomal amphotericin B as a treatment for human leishmaniasis. Expert Opin Emerg Drugs. 4. World Health Organization. Neglected tropical diseases: innovative and 2012;17:493–510. intensified disease management. Geneva: World Health Organization. 2007. 17. Singh N, Kumar M, Singh RK. Leishmaniasis: current status of avail- 5. Asadi-Kani Z, Qeisari M, Azizaddini S, et al. Unusual presentations of cutane- able drugs and new potential drug targets. Asian Pac J Trop Med. ous leishmaniasis in two Iranian patients. Iranian J Dermatol. 2010;13:99–102. 2012;5:485–497. 6. Hajjaran H, Mohebali M, Akhavan A, et al. Unusual presentation of dis- 18. Sundar S, Jha TK, Thakur CP, et al. Oral miltefosine for Indian visceral seminated cutaneous leishmaniasis due to Leishmania major: case reports of four Iranian patients. Asian Pac J Trop Med. 2013;6:333–336. leishmaniasis. N Engl J Med. 2002;347:1739–1746. Current Actsbstra Edited by: Robert J. Leggiadro, MD To clarify transmission, the authors conducted a cross-sectional, Role of Food Insecurity in Outbreak of Anthrax Infections interviewer-administered household survey in villages where human Among Humans and Hippopotamuses Living in a Game anthrax cases and hippopotamus deaths were reported. Among 284 respond- Reserve Area, Rural Zambia ents, 84% ate hippopotamus meat before the outbreak. Eating, carrying and preparing meat were associated with anthrax infection. Most people Lehman MW, Craig AS, Malama C, et al. Emerg Infect Dis. 2017; 23: surveyed [216 (76%)] reported that they would not eat meat from a dead 1471–1477. hippopotamus knowing now that it can cause anthrax infection. Despite the During August–September 2011, a total of 85 hippopotamuses (Hippopota- risk, 23% of respondents reported that they would eat meat from hippo- mus amphibious) died of suspected anthrax (Bacillus anthracis) infection in potamuses found dead again because of food shortage (73%), lack of meat a game management area along the South Luangwa River near the district (12%), hunger (7%) and protein shortage (5%). of Chama in northeastern Zambia. At least 521 suspected human anthrax cases and 5 deaths were reported near this area during this period. Residents Comment: Anthrax outbreaks associated with animals are common of the area near the river had reportedly found dead hippopotamuses and and reported worldwide. Herbivores are thought to have onset of disease subsequently butchered, cooked and consumed meat from the dead animals, after ingesting spores in soil, water or on vegetation. Reports of anthrax out- which was thought to be the cause of the human outbreak. Most human breaks occurring in wild and domestic animals in Africa have usually been cases of anthrax infection were cutaneous infections, with most patients associated with the dry season and have stopped with the onset of the rainy initially having papular lesions (95%) and the rest having lymphadenopa- season. Outbreaks can begin with wildlife, expand into domestic livestock thy and gastrointestinal symptoms. Most cases resolved after the patient and ultimately affect humans. Multiple challenges make it impractical to received a course of oral ciprofloxacin. vaccinate free-ranging wildlife populations; sometimes vaccine programs Because of Chama’s status as a game management area, residents are initiated but usually only to protect endangered species or populations are not permitted to protect crops from foragers or hunt on area grounds, at high risk. which are overseen by the Zambia Wildlife Authority. Food and water are To inform planning, wildlife authorities should identify high-risk scarce for animals and humans during Zambia’s dry season, generally May– periods and locations for naturally occurring animal outbreaks through eco- November. A delay in the annual rainy season, usually December–March, logic studies that identify conditions favoring anthrax infection among animal can put farmers at risk for low crop production, as was the case in 2011. populations. Community-based interventions should involve residents in ad- During this period, animals forage deep into riverbeds in search of water and food, digging up and activating dormant anthrax spores. Residents, for dressing communitywide food insecurity and in educating neighbors on the whom food can also be scarce under these conditions, have been known to hazards of consuming meat from animals that die of unknown causes. These consume animals they find dead in their area. interventions should begin before the dry season in outbreak-prone areas. © 2017 Wolters Kluwer Health, Inc. All rights reserved. www.pidj.com | 277 Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pediatric Infectious Disease Journal Wolters Kluwer Health

Role of Food Insecurity in Outbreak of Anthrax Infections Among Humans and Hippopotamuses Living in a Game Reserve Area, Rural Zambia

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Wolters Kluwer Health
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Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
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0891-3668
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Abstract

The Pediatric Infectious Disease Journal • Volume 37, Number 3, March 2018 DCL Treated With Liposomal Amphotericin B 7. Vega-López F. Diagnosis of cutaneous leishmaniasis. Curr Opin Infect Dis. with properties similar to sodium stibogluconate, another pentava- 2003;16:97–101. lent antimony compound. These medications are considered first-line 8. Organization WH. World Health Report 2004: Changing History. Geneva: agents in the treatment of leishmaniasis. Their efficacy and toxicity World Health Organization; 2004. are thought to be related to their content of pentavalent antimony. 9. Postigo JAR. Leishmaniasis in the world health organization Eastern Amphotericin B has been shown to be effective in the treatment of Mediterranean region. Int J Antimicrob Agents. 2010;36:S62–S65. 16,17 CL. Also, there have been obvious favorable results of miltefosine 10. Kar S, Soong L, Colmenares M, et al. The immunologically protective P-4 treatment for CL and VL. Meglumine antimoniate, amphotericin B antigen of Leishmania amastigotes. A developmentally regulated single and miltefosine were used for the treatment of our case. strand-specific nuclease associated with the endoplasmic reticulum. J Biol Chem. 2000;275:37789–37797. 11. Ferreira MS, Borges AS. Some aspects of protozoan infections in immu- ACKNOWLEDGMENTS nocompromised patients—a review. Mem Inst Oswaldo Cruz. 2002;97: The authors thank the patient and the parents for their 443–457. patience and for giving them the opportunity to publish her case. 12. Kumar P, Roozitalab M, Lak P, et al. Ocular leishmaniasis; a cause of blind- ness. Irn J Med Sci. 1993;18:106–111. REFERENCES 13. ModarresZadeh M, Manshai K, Shaddel M, et al. Ocular leishmaniasis. 1. Desjeux P. The increase in risk factors for leishmaniasis worldwide. Trans R Iranian J Ophthalmol. 2007;19:1–5. Soc Trop Med Hyg. 2001;95:239–243. 14. Peters W, Killick-Kendrick R. The leishmaniases in biology and medicine. 2. Alvar J, Vélez ID, Bern C, et al; WHO Leishmaniasis Control Team. Volume II. Clinical aspects and control. London: Academic Press Inc. Ltd; Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7:e35671. 15. World Health Organization. Control of the leishmaniasis. WHO Tech Rep 3. Aghaei S, Salmanpour R, Handjani F, et al. Ulcerated disseminated cutaneous Ser. 1990;793:40–55. leishmaniasis associated with vitiligo, hypothyroidism, and diabetes mellitus in a patient with Down syndrome. Dermatology online journal. 2004;10:21. 16. Balasegaram M, Ritmeijer K, Lima MA, et al. Liposomal amphotericin B as a treatment for human leishmaniasis. Expert Opin Emerg Drugs. 4. World Health Organization. Neglected tropical diseases: innovative and 2012;17:493–510. intensified disease management. Geneva: World Health Organization. 2007. 17. Singh N, Kumar M, Singh RK. Leishmaniasis: current status of avail- 5. Asadi-Kani Z, Qeisari M, Azizaddini S, et al. Unusual presentations of cutane- able drugs and new potential drug targets. Asian Pac J Trop Med. ous leishmaniasis in two Iranian patients. Iranian J Dermatol. 2010;13:99–102. 2012;5:485–497. 6. Hajjaran H, Mohebali M, Akhavan A, et al. Unusual presentation of dis- 18. Sundar S, Jha TK, Thakur CP, et al. Oral miltefosine for Indian visceral seminated cutaneous leishmaniasis due to Leishmania major: case reports of four Iranian patients. Asian Pac J Trop Med. 2013;6:333–336. leishmaniasis. N Engl J Med. 2002;347:1739–1746. Current Actsbstra Edited by: Robert J. Leggiadro, MD To clarify transmission, the authors conducted a cross-sectional, Role of Food Insecurity in Outbreak of Anthrax Infections interviewer-administered household survey in villages where human Among Humans and Hippopotamuses Living in a Game anthrax cases and hippopotamus deaths were reported. Among 284 respond- Reserve Area, Rural Zambia ents, 84% ate hippopotamus meat before the outbreak. Eating, carrying and preparing meat were associated with anthrax infection. Most people Lehman MW, Craig AS, Malama C, et al. Emerg Infect Dis. 2017; 23: surveyed [216 (76%)] reported that they would not eat meat from a dead 1471–1477. hippopotamus knowing now that it can cause anthrax infection. Despite the During August–September 2011, a total of 85 hippopotamuses (Hippopota- risk, 23% of respondents reported that they would eat meat from hippo- mus amphibious) died of suspected anthrax (Bacillus anthracis) infection in potamuses found dead again because of food shortage (73%), lack of meat a game management area along the South Luangwa River near the district (12%), hunger (7%) and protein shortage (5%). of Chama in northeastern Zambia. At least 521 suspected human anthrax cases and 5 deaths were reported near this area during this period. Residents Comment: Anthrax outbreaks associated with animals are common of the area near the river had reportedly found dead hippopotamuses and and reported worldwide. Herbivores are thought to have onset of disease subsequently butchered, cooked and consumed meat from the dead animals, after ingesting spores in soil, water or on vegetation. Reports of anthrax out- which was thought to be the cause of the human outbreak. Most human breaks occurring in wild and domestic animals in Africa have usually been cases of anthrax infection were cutaneous infections, with most patients associated with the dry season and have stopped with the onset of the rainy initially having papular lesions (95%) and the rest having lymphadenopa- season. Outbreaks can begin with wildlife, expand into domestic livestock thy and gastrointestinal symptoms. Most cases resolved after the patient and ultimately affect humans. Multiple challenges make it impractical to received a course of oral ciprofloxacin. vaccinate free-ranging wildlife populations; sometimes vaccine programs Because of Chama’s status as a game management area, residents are initiated but usually only to protect endangered species or populations are not permitted to protect crops from foragers or hunt on area grounds, at high risk. which are overseen by the Zambia Wildlife Authority. Food and water are To inform planning, wildlife authorities should identify high-risk scarce for animals and humans during Zambia’s dry season, generally May– periods and locations for naturally occurring animal outbreaks through eco- November. A delay in the annual rainy season, usually December–March, logic studies that identify conditions favoring anthrax infection among animal can put farmers at risk for low crop production, as was the case in 2011. populations. Community-based interventions should involve residents in ad- During this period, animals forage deep into riverbeds in search of water and food, digging up and activating dormant anthrax spores. Residents, for dressing communitywide food insecurity and in educating neighbors on the whom food can also be scarce under these conditions, have been known to hazards of consuming meat from animals that die of unknown causes. These consume animals they find dead in their area. interventions should begin before the dry season in outbreak-prone areas. © 2017 Wolters Kluwer Health, Inc. All rights reserved. www.pidj.com | 277 Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

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Pediatric Infectious Disease JournalWolters Kluwer Health

Published: Mar 1, 2018

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