Visceral Leishmaniosis and Canine Leishmaniosis in Greece and other mediterranean countries


S. CHARALABIDIS (Σ. Θ. ΧΑΡΑΛΑΜΠΙΔΗΣ)
A. DIAKOU (Α. Ν. ΔΙΑΚΟΥ)
Résumé

The prevalence of canine leishmaniosis in mediterranean countries varies from 0.2% to 67% and annually, 1.4-300 cases of human infection are reported in each country. In Greece, 0.7-48.7% of dogs, 3.9% of cats, 1.2% of rodents (Citellus citellus) and 3.9-9.2% of inhabitants are seropositive, whereas 25 cases (mean annual rate) of visceral leishmaniosis are reported each year. As vector of the visceral leishmaniosis in Greece is considered the sand fly P. neglectus (0.12% infected by L. infantum) and additionally, as possible vectors the species P. sergenti, P.balcanicus and P.simici. No proven vector for the transmission of canine leishmaniosis has been found in Greece. As possible vectors are suspected P. perfìliewi and P. tobbi. No direct relation has been found between the incidence of canine leishmaniosis and the cases of the human infection in Greece. The sand flies and its preferable hosts in Greece are: P. neglectus (catde, horse, swine, rat, rarely human and never the dog), P. perfìliewi (dog, fox, catde, sheep, horse, swine, hare, rabbit, rodents), P. tobbi (sheep, dog, rabbit), P. balcanicus (bat, human), P. simici (rabbit, bat, human), P. papatasi (human), P. sergenti (human, rabbit, bat), P. similis (bat, rarely the human), P. alexandri (human, rodents), P. mascittii (dog, fox, human), Sergentomyia minuta (lizard, probably the fowls) and S. dentata (lizard, probably the fowls). The outcome of the disease is determined by a Th2 pattern (while Thl pattern results an effective cellular response and the self limitation of the disease) and the rupture of monocytes/ macrophages (multiplication of parasite), which is resulting in the lessions and the disfunction of spleen, bone marrow, liver, skin, lymphnodes, intestine, eye, membrane e.t.c, through the chronically high concentrations of immunocomplexes and the activation of complement (classic way) e.t.c. Mostly, diagnosis is established by the detection of the parasite and the detection of anti-leishmanial antibodies. The commonly used drugs to treat canine leishmaniosis are leishmanicids (meglumine antimoniate, aminosidine sulphate), leishmaniostatics (allopurinol, ketoconazole), immunostimmulants e.t.c. Repellents and insecticids (collars, shampoos, sprays) should be used to protect the dogs from May to November, while the infected dogs should be early diagnosed and treated.

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Références
Abranches Ρ, Campino L, Santos-Gomes GM (1998). Canine leishmaniasis. New concepts of epidemiology and immunopathology: their impact in the control of human visceral leishmaniasis. Acta Med.Port, 11: 871-875.
Αθανασίου Λ (2004). Συμβολή στην επιζωοτιολογία, τη διάγνωση και τη φαρμακευτική αντιμετώπιση της λεϊσμανίωσης του σκύλου. Διδακτορική διατριβή. Τμήμα Κτηνιατρικής του Α.Π.Θ. Θεσσαλονίκη.
Alberala J, Rodriguez A, Francino Ο, Roura X, Rivas L, Andreu D (2004). Safety and efficacy of antimicrobial peptides against naturally acquired leishmaniasis. Antimicrob Agents Chemother., 48: 641-643.
Alvar J (1999). Leishmania and HIV co-infection in the Mediterranean countries. Proceedings of the International Canine Leishmaniasis Forum, Barcelona.
Avar J, Molina R, San Andres M, Tesouro M, Nieto J, Vitutia M, Gonzalez F, San Antres MD, Boggio J, Rodriguez F, Sainz A, Escacena C (1994). Canine leishmaniasis: clinical, parasitological and entomological follow-up after chemotherapy. Ann.Trop.Med. Parasitol., 88: 371-378.
Αργυριάδης Δ, Λίτκε Ο (1991). Επιζωοτιολογική έρευνα της λεϊσμανίασης του σκύλου στην κεντρική και ανατολική Μακεδονία και στη Θεσσαλία. Δελτίον Ελλ.Κτην.Εταιρείας, 42: 30-34.
Attar ZJ, Chance ML, el-Safi S, Carney J, Azazy A, El-Hadi M, Dourado C, Hommel M (2001). Latex agglutination test for the detection of urinary antigens in visceral leishmaniasis. Acta Trop., 78: 11-16.
Baneth G (2002). A review of the treatment of canine leishmaniasis. Proceedings of the Second International Canine Leishmaniasis Forum, Sevilla.
Baneth G, Jaffe CL (1999). Canine visceral leishmaniasis in Israel: an overview of an emerging disease wit reference to wild canids and human infection. Canine Leishmaniasis: an update. Proceedings of the International Canine Leishmaniasis Forum, Barcelona.
Belloli C, Crescenzo G, Carli S, Zaghini A, Mengozzi G, Bertini S, Ormas Ρ (1999). Disposition of antimony and aminosidine combination after multiple subcutaneous injections in dogs. Vet.J., 157: 315-321.
Bier OG, da Silva DW, Goetze D, Mota I (1986). Funtamentals of Immunology. 6nd Ed., Springer-Verlag, Berlin.
Biocca E, Constantini R (1986). I pozzi come possibili focolai larval di flebotomi neh isola di Zante. Annali dell' Istituto Superiore di Sanità, 22: 59-60.
Boch J, Supperer R (1992). Veterinärmedizinische Parasitologie. Verlag Paul Parey, Berlin.
Brondonisio O, Panunzio M, Faliero SM, Ceci L, Fasanella A, Puccini V (1996). Evaluation of polymorphonuclear cell and monocyte functions in Leishmania infantum -infected dogs. Vet.Immunol.Immunopathol., 53: 95-103.
Cavaliero T, Arnold P, Mathis A, Glaus T, Hofmann-Lehmann R, Deplazes Ρ (1999). Clinical, serologic, and parasitologic followup after long-term allopurinol therapy of dogs naturally infected
with Leishmania infantum. J.Vet.Intern.Med., 13: 330-334.
Chaniotis B, Tselentis Y (1994). Leishmaniasis, sandfly fever and phlebotomine sandflies in Greece: an annotated bibliography. WHO/Leish/94.34.
Cortadellas Ο (2003). Initial and long-term efficacy of a lipid emulsion of amphotericin Β desoxycholate in the management of canine leishmaniasis. J Vet Intern Med, 17: 808-812.
Dangendorf F (1997). Zur geographischen Verbreitung der Leishmaniasen und der Phlebotomen als ihre Überträger in Griechenland seit 1958. Diplomarbeit. Geographische Institute der Rheinischen Friedrich-Wilhelms-Universität Bonn.
Davidson RN (1999). Leishmaniasis in humans, with particular reference to leishmaniasis with a canine reservoir. Proceedings of the International Canine Leishmaniasis Forum, Barcelona.
Davies CR, Kaye P, Croft SI, Sundar S (2003). Leishmaniasis: new approaches to disease control. BMJ, 326: 377-382.
De Luna R, Vuotto ML, Ielpo MT, Ambrosio R, Piantedosi D, Moscatello V, Ciaramella Ρ, Scalone A, Gradoni L, Mascino D (1999). Early suppression of lymphoproliferative response in dogs with natural infection by Leishmania infantum. Vet. Immunol. Immunopathol., 70: 95-103.
Denerolle P, Bourdoiseau G (1999). Combination allopurinol and antimony treatment versus antimony alone and allopurinol alone in the treatment of canine leishmaniasis (96 cases). J.Vet.Intern. Med., 13: 413-415.
Dereure J, Pratlong F, Debet JP (1999). Geographical distribution and the identification of parasites causing canine leishmaniasis in the Mediterranean Basin. Canine Leishmaniasis: an update. Proceedings of the International Canine Leishmaniasis Forum, Barcelona.
Διάκου A (2000). Βελτιστοποίηση της τεχνικής RAPD-PCR (random amplified polymorphic DNA-PCR) και εφαρμογή της στη μελέτη απομονώσεων Leishmania του σκύλου στην Ελλάδα. Διδακτορική διατριβή. Τμήμα Κτηνιατρικής του Α.Π.Θ. Θεσσαλονίκη.
Diakou A, Dovas CI (2001). Optimization of Random-Amplified Polymorphic DNA Producing Amplicons up to 8500 bp and Revealing Intraspecies Polymorphism in Leishmania infantum Isolates. Anal.Biochem., 288: 195-200.
Διάκου Α, Παπαδόπουλος Η, Λαζαρίδης Κ (2002). Ανίχνευση ειδικών IgG κατά των Leishmania spp. σε γάτες. 9ο Παν.Κτηνιατρ.Συν., Θεσσαλονίκη.
Eckert J (1986). Protozoologie. In: Wiesmann E, Kayser FH, Bienz KA, Eckert J, Lindenmann J. Medizinische Mikrobiologie, Immunologie, Bactériologie, Mykologie, Virologie, Parasitologie. Georg Thieme Verlag, Stuttgart.
ΕΔΛΝΕ-Επιδημιολογικό Δελτίο Λοιμωδών Νοσημάτων Ελλάδος (2000). Ε.Κ.Ε.ΠΑ.Π. και Κ.Ε.Ε.Λ. Υπουργείο Υγείας και Πρόνοιας, Αθήνα (1998-2000).
El Sawaf ΒΜ, el Sattar SA, Shehata MG, Lane RP, Morsy TA (1994). Reduced longevity and fecundity in Leishmania –infected sandflies. Am.J.Trop.Med.Hyg., 51: 767-770.
Ephros M, Paz A, Jaffe CL (1994). Asymptomatic visceral leishmaniasis in Israel. Trans.R.Soc.Trop. Med.Hyg., 88: 651-652.
Fayet G (1999). Canine leishmaniasis. Merial Ltd., Lyon.
Ferrer LM (1999). Clinical aspects of canine leishmaniasis. Proceedings of the International Canine Leishmaniasis Forum, Barcelona.
Fitch FW, McKisic MD, Lancki DW, Gajewski TF (1992). Differential regulation of murine Τ lymphocytes subsets. Proceedings of the 8th International Congress of Immunology. Budapest.
Frank C (1991). Serologische Klassifizierung und biochemische Identifizierung von in Griechenland isolierten Leishmania-Stämmen (Kinetoplastida: Trypanosomatidae). Inaugular-Dissertation. Fakultät für Biologie der Eberhard-Karle-
Universität Tübingen.
Frank C, Hadziandoniou M, Pratlong F, Garifallou A, Rioux JA (1993). Leishmania tropica and Leishmania infantum responsible for cutaneous leishmaniasis in Greece: sixteen autochthonous cases. Trans. R. Soc. Trop. Med. & Hyg., 87: 184-185.
Frydas S, Theodoridis Y, Rallis TS, Hatzistilianou M, Adamama- Moraitou KK, Reale M, Barbacane RC, Conti Ρ (2001).
Leishmania antibodies in children's serum samples in correlation with the disease in dogs. International Journal of Immunopathology and Pharmacology, 14: 173-178.
Garifallou A, Hadjiantoniou M, Schnur LF, Yuval B, Warburg A, Jacobson RL, Pateraki E, Patrikoussis M, Schiein Y, Serie C (1989) Epidemiology of human and canine leishmaniasis of the
island of Zakinthos. In: Leishmaniasis. Hart DT, ed., Plenum Press, New York,: 1011-1015.
Gonzalez JL, Fermin ML, Garcia P, Rollan E, Castano M (1990). Erosive colitis in experimental canine Leishmaniasis. ZentralbLVeterinarmed. B, 37: 377-382.
Gradoni L (1999). Epizootiology of canine leishmaniasis in Southern Europe. Canine Leishmaniasis: an update. Proceedings of the International Canine Leishmaniasis Forum, Barcelona.
Gradoni L (2002). The diagnosis of canine leishmaniasis. Proceedings of the Second International Canine Leishmaniasis Forum, Sevilla.
Gradoni L, Gramiccia M, Mancianti F, Pieri S (1988). Studies on canine leishmaniasis control. 2. Effectiveness of control measures against canine leishmaniasis in the Isle of Elba, Italy. Trans.R.Soc.Trop.Med. & Hyg., 82: 568-571.
Guarga JL, Moreno J, Lucientes J, Gracia MJ, Peribanez MA, Alvar J, Castillo JA (2000). Canine leishmaniasis transmission: higher infectivity amongst naturally infected dogs to sand flies is associated with lower proportions of Τ helper cells. Res.Vet.Sci., 69: 249-253.
Χαραλαμπίδης ΣΘ (1997). Λεισμανίωση, τοξοπλάσμωση, υδατίδωση-εχινοκόκκωση. Προκατάληψη και πραγματικότητα. Ι. Σπλαχνική λεισμανίωση. ANIMA, 5: 24-31.
Χαραλαμπίδης ΣΘ (2003). Παρασιτικά νοσήματα των ζώων και του ανθρώπου. Πρωτοζωώσεις. Ελμινθώσεις. Αρθροποδώσεις. University Studio Press, Θεσσαλονίκη.
Χαραλαμπίδης Σ, Φρυδάς Σ (1993). Ανίχνευση IgG-, IgM-, IgELeishmania infantum στους κατοίκους της Μακεδονίας. Δελτίο Ελλ.Μικροβιολ.Εταιρ., 38:40-46.
Χαραλαμπίδης ΣΘ, Διάκου ΑΝ (1998). Τοξοπλάσμωση, λεισμανίωση, τοξοκάρωση και φιλαρίωση του σκύλου, στη Μακεδονία και τη Θράκη. 5ο Παν.Συν.Κτηνιατρ.Μικρών Ζώων, Αθήνα.
Jha ΤΚ, Sundar S, Thakur CP, Bachmann Ρ, Karbwang J, Fischer C, Voss A, Berman J (1999). Miltefosine, an oral agent, for the treatment of Indian visceral leishmaniasis. N.Engl.J.Med., 341:
-1800.
Karanis P, Frank C, Schmale H, Naucke TJ, Jörden U, Metallinou C, Haralabidis S, Maier WA, Seitz SM, Himonas C (2000). Studies on sandfly distribution in Northern Greece. Entomol.Hellenica, 3: 13-16.
ΚΕΕΛ-Κέντρο Ελεγχου Ειδικών Λοιμώξεων (2004). Υπουργείο Υγείας και Κοινωνικής Αλληλεγγύης, τεύχος 1, σελ. 13, Αθήνα.
Killick-Kendrick R (2002). The life-cycles of Leishmania in the sand fly and transmission of leishmaniasis by bite. Proceedings of the Second International Canine Leishmaniasis Forum, Sevilla.
Killick-Kendrick R, Killick-Kendrick M (1999). Biology of sand fly vectors of Mediterranean canine leishmaniasis. Proceedings of the International Canine Leishmaniasis Forum, Barcelona.
Killick-Kendrick R, Killick-Kendrick M, Focheux C, Dereure J, Puch M-P, Cadiergues MC (1997). Protection of dogs from bites of phlebotomine sandflies by deltamethrin collars for control of canine leishmaniasis. Med.Vet.Entomol., 11: 105-111.
Κοντός Β (1986). Συμβολή στη μελέτη της λεϊσμανίωσης του σκύλου. Κλινική, ορολογική και πειραματική διερεύνηση. Διδακτορική διατριβή. Επιστ.Επετ.Τμημ.Κτηνιατρ., Α.Π.Θ., 22: 9-155.
Kontos VI, Spais AG (1989). The incidence of canine leishmaniasis on Northern Greece. A epizootiological study of the decade 1977-1987. In: The current status and new strategies for control. Ed.: Hart DT., NATO ASI series, Springer Verlag, pp. 77-82.
Kontos VI, Koutinas AF (1993). Old World Canine Leishmaniasis. Compendium, 15: 949-960.
Kostic D (1951). Source determination of blood meal in sandflies (Phlebotominae) in Yugoslavia (Dobrcky Country). 2760 haemoprecipitin tests. Acta Trop., 8: 131-135.
Koutinas AF, Polizopoulou ZS, Saridomichelakis MN, Argyriadis D, Fytianou A, Plevraki KG (1999). Clinical considerations on canine visceral leishmaniasis in Greece: a retrospective study of
cases (1989-1996). J.Am.Anim.Hosp.Assoc, 35: 376-383.
Koutinas AF, Saridomichelakis MN, Mylonakis ME, Leontides L, Polizopoulou Z, Billinis C, Argyriadis D, Diakou N, Papadopoulos Ο (2001). A randomised, blinded, placebocontrolled clinical trial with allopurinol in canine leishmaniosis. Vet. Parasitol., 98: 247-261.
Lane RP, Boorman J, Wilkinson Ρ (1984). Phlebotomus tobbi on the Greek island of Lesbos. Trans. R. Soc. Trop. Med. Hyg., 78: 413.
Lachaud L, Marchergui-Hammami S, Chabbert E, Dereure J, Dedet JP, Bastien Ρ (2002). Comparison of Six PCR Methods Using Peripheral Blood for Detection of Canine Visceral Leishmaniasis. J. Clin. Microbiol. 40: 210-215.
Leger Ν, Saratsiotis A, Pesson B, Leger Ρ (1977). La leishmaniose en Grèce. Résultats d'une enquête entomologique effectuée en juin 1977. Ann.Parasitol.Hum.Comp., 54: 11-29.
Leger Ν, Pesson Β, Madulo-Leblond G (1986). Les phlébotomes de Grèce. Biol.Gallo-Hellenica, 11: 165-192.
Leger Ν, Gramiccia M, Gradoni L, Madulo-Leblond G, Pesson B, Ferté H, Boulanger N, Killick-Kendrick R, Killick-Kendrick M (1988). Isolation and typing of Leishmania infantum from Phlebotomus neglectus on the island of Corfu, Greece. Trans. R. Soc. Trop. Med. Hyg., 82: 419-420.
Le Fichoux Y, Quaranta JF, Aufeuvre JP, Lelievre A, Marty P, Suffia I, Rousseau D, Kubar J (1999). Occurrence of Leishmania infantum parasitemia in asymptomatic blood donors living in an area of endemicity in southern France. J.Clin.Microbiol., 37:1953-1957.
Leontides LS, Saridomichelakis MN, Billinis C, Kontos V, Koutinas AF, Galatos AD, Mylonakis ME (2002). A cross-sectional study of Leishmania spp. infection in clinically healthy dogs with polymerase chain reaction and serology in Greece. Vet.Parasitol., 109: 19-27.
Loukaki K, Kirkilessi G, Haralabidis S, Diakou A (1999). Idiosyncratic homeopathy and canine leishmaniosis. Mondial Vet. Congress, Lyon.
Maltezou HC, Siafas C, Mavrikou M, Spyridis P, Stavrinadis C, Karpathios T, Kafetzis DA (2000). Visceral Leishmaniasis during Childhood in Southern Greece. Clin.Infect.Dis., 31: 1139-1143.
Manson-Bahr PEC, Bell DR (1987). Visceral leishmaniasis. In: Manson's Tropical Diseases. 19th Ed., Bailliere Tindal, London.
Martinez-Moreno A, Moreno T, Martinez-Moreno FJ, Acosta I, Hernandez S (1995). Humoral and cell-mediated immunity in natural and experimental canine leishmaniasis. Vet.Immunol. Immunopathol., 48: 209-220.
Minodier P, Piarroux R, Gamier JM, Unal D (1999). Mediterranean visceral leishmaniasis: physiopathology. Presse Med., 28: 33-39.
Miscevic Z, Milutinovic M (1986). The dynamics of the sandfly populations density (Diptera: Phlebotomidae) in human dwellings and animal quarters in the region of Dobric, South-east Serbia, Yugoslavia. Acta Veterinaria, 36: 229-234.
Murray HW, Delph-Etienne S (2000). Visceral leishmanicidal activity of hexadecylphosphocholine (miltefosine) in mice deficient in Τ cells and activated macrophage microbicidal mechanisms. J.Infect.Dis., 181: 795-799.
Naucke TJ (1997). Περίπτωση λεισμανίωσης σε σκΰλο. Τέσσερα χρόνια μετά τη φαρμακευτική αγωγή. ANIMA, 5: 47-50.
Naucke TJ (1998). Untersuchungen zur Vektorkontrplle von Sandmücken (Diptera: Psychodidae) in Nordostgriechenland. Inaugular-Dissertation. Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn.
Παπαδογιαννάκης E (2003). Συμβολή στη μελέτη της ανοσοπαθογένειας της αποφολιδωτικής δερματίτιδας της λεϊσμανίωσης του σκύλου (Leishmania infantum). Διδακτορική διατριβή, Τμήμα Κτηνιατρικής, Α.Π.Θ., Θεσσαλονίκη.
Papadopoulos Β, Tselentis Υ (1994). Sandflies in the greater Athens region, Greece. Parasite, 1: 131-140.
Papadopoulos B, Tselentis Y (1998). Sandflies on the island of Corfu, Greece. Parasite, 5: 387-391.
Papadopoulos B, Gozalo G, Aransay AM, Tselentis I (1994). The sandfly population in the greater Athens region, Greece. Bios (Macedonia, Greece), 2: 245-249.
Παπαδοπούλου Χ, Δημητρίου Δ, Πανάγιου Α, Μάνης Η, Αντωνιάδης Γ (1995). Μελέτη του επιπολασμοΰ της Leishmania infantum σε σκύλους της βορειοδυτικής Ελλάδας. Δελτίο Ελλ,Μικροβιολ,Εταιρ., 40: 54-57.
Pesson Β, Leger Ν, Madulo-Leblond G (1984). La leishmaniose en Grèce: Les Phlébotomes des Iles Ioniennes et de la mer Egée. Ann.Parasitol.Hum.Comp., 59: 277-296.
Pesson B, Leger Ν, Madulo-Leblond G, Ferte H, Tselentis I, Papadopoulos B, Perieres J (1994). Speciation et variance chez les Phlébotomes des Iles Grecques (référence à Phlebotomus neglectus et au sous-genre Larroussius). Bios (Macedonia, Greece), 2: 233-243.
Reale S, Maxia L, Vitale F, Glorioso NS, Caracappa S, Vesco G (1999). Detection of Leishmania infantum in dogs by PCR with lymph node aspirates and blood. J.Clin.Microbiol., 37: 2931-2935.
Ruitenberg EJ, Solano-Gallego L, Monen J, Pinelli E, Rutten VPMG (2001). Immune responses in canine leishmaniasis. International Canine Leishmaniasis Forum, Crete, Greece.
Sacks DL, Brodin TN, Turco S J (1990). Development modification of the lipophosphoglycan from Leishmania major promastigotes during metacyclogenesis. Mol.Biochem.Parasitol., 42: 225-234.
Santos-Gomes GM, Campino L, Abranches Ρ (2000). Canine experimental infection: intradermal inoculation of Leishmania infantum promastigotes. Mem.Inst.Oswaldo Cruz, 95: 193-198.
Schettini DA, Costa Val AP, Souza LF, Demicheli C, Rocha OGF, Melo MN, Michalick MSM, Frézard F (2003). Distribution of liposome-encapsulated antimony in dogs. Braz.J.Med.Biol.Res.,
: 269-272.
Schmale H, Karanis Ρ, Maier WA, Haralabidis S, Seitz HM (1993). Untersuchungen zur Verbreitung von Phlebotomus-Arten in Neos Marmaras, Nord-Griechenland. Entomologen-Tagung, Deutsche Gesellschaft fur allgemeine und angewandte Entomologie e.V.(DGaaE), Jena.
Sideris V, Papadopoulou G, Dotsika E, Karagouni E (1999). Asymptomatic canine leishmaniasis in greater Athens area, Greece. Eur.J.Epidemiol., 15: 271-276.
Sideris V, Karagouni E, Papadopoulou G, Garifallou A, Dotsika E (1996). Canine visceral leishmaniasis in the great Athens area, Greece. Parasite, 3: 125-130.
Slappendel RJ, Teske E (1999). A review of canine leishmaniasis presenting outside endemic areas. Proceedings of the International Canine Leishmaniasis Forum, Barcelona.
Solano-Gallego L, Morell P, Arboix M, Alberala 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. Clin.Microbiol., 39: 560-563.
Solbach W, Rollinghoff M, Kern Ρ (1992). Differentialdiagnose: Leishmaniase. Dt.Arztebl., 89(C): 1602-1607.
Sotira Β (2000). Zoonotic diseases of major cornern in Albania. Epidemiological overview. WHO Mediterranean Zoonoses Control Centre, No.49: 6-9.
Tselentis Y, Gordossis Th, Stefanou Th, Melissinos Κ (1980). Biogeographic distribution of visceral leishmaniasis in Greece.10h International Congress of Tropical Medicine and Malariology, Manila.
Valladares JE, Alberala J, Esteban M, Arboix M (1996). Dispositionof antimony after the administration of N-methylglucamine antimoniate to dogs. Vet.Rec, 138: 181-183.
WHO (2000). Leishmania/HIV co-infection in south-western Europe1990-1998: Retrospective analysis of 965 cases. WHO/LEISH/2000.42. Division of Control of Tropical Diseases. Geneva.