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Acta Tropica
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a r t i c l e
i n f o
Article history:
Received 30 April 2015
Received in revised form 4 September 2015
Accepted 27 September 2015
Available online 1 October 2015
Keywords:
Mansonelliasis
Epidemiology
Subtropical mountainous rainforest
Northwestern Argentina
a b s t r a c t
Human lariasis caused by Mansonella ozzardi is a parasitic infection of a controversial pathology and
poorly studied in Argentina. The aim of this study was not only to obtain data of the prevalence of
M. ozzardi in Northwestern Argentina through comparison of infection rates in relation to sex and age
group determining the range of distribution of mansonelliasis in the region but also to investigate the
prevalence of the cases over time. Through eld work carried between 1986 and 2010 by technicians of the
National Ministry of Health, aiming to detect active cases of malaria in the Northwestern Argentina, blood
samples were taken for smear and thick blood. 417 blood samples were examined, 381 of them (91.4%)
were positive for M. ozzardi. The highest prevalence was found in Salta province (92.3%) mainly affecting
the male sex (92.6%) and the age groups comprised between 4857 years (97.0%) and 68 (90.7%).
The paired t-test and Spearman coefcients showed signicant differences in prevalence according to
sex (t = 2.677; p = 0.015), and according infection rates in males and females/age (r = 0.994; p = 0.001;
r = 0.994, p = 0.001, respectively). The prevalence over time showed a general pattern with the highest
cases in 1986, decreasing later during the following years. Aguas Blancas, El Oculto and San Ramn de
la Nueva Orn, exhibited a pattern of prevalence according to the general trend but Salvador Mazza and
Tartagal, which are also localities close to the border with Bolivia, showed peaks of cases up to 2010.
These results provide relevant information about M. ozzardi in Argentina, demonstrating not only its
presence and endemicity after almost 100 years from its discovery in the country, but also its wide range
of distribution in the region.
2015 Elsevier B.V. All rights reserved.
1. Introduction
Mansonella ozzardi (Nematoda: Onchocercidae) is a larial parasite which inhabits serous cavities of human hosts and that
generally are found accidentally when patients with symptoms of
malaria visit the physician and thick and thin blood smears reveal
the presence of larval forms of the nematodes called microlariae
(Formica and Botto,1990; Nathan and Stroom, 1991). At present,
this parasite is distributed in America, represented in Argentina,
Bolivia, Brazil, Colombia, the Caribbean, Mexico, Panama, Peru and
Venezuela (Tavares and Fraiha Neto, 1997; Shelley and Coscaron,
2001; Arrspide et al., 2012).
Corresponding author. Tel.: +54 381 4232965; fax: +54 381 4232965.
E-mail address: ceciliaveggianiaybar@yahoo.com.ar (C.A. Veggiani Aybar).
http://dx.doi.org/10.1016/j.actatropica.2015.09.018
0001-706X/ 2015 Elsevier B.V. All rights reserved.
The presence of microlariae infection in Argentina was recognized by malaria surveys in the Northwestern region of the
country, with the species Microlaria tucumana described by Aroz
and Biglieri (1915) in Tucumn province, a homonym of Mansonella ozzardi (Davis, 1928). This nding marked the beginning of a
series of epidemiological investigation in Northwestern Argentina
(Padilla, 1915; Rosenbsch, 1915; Mhlens et al., 1925; Davis,
and Wygodzinsky, 1950; Taranto and Castelli, 1988;
1928; Romana
Minoprio et al., 1988; Remondegui et al., 1988; Jrg, 1993; Zrate,
1996; Zaidenberg, 1997; Guzmn et al., 1998; Socolsky, 2010;
Degese et al., 2012). Since its discovery in the country, almost 100
years later, its existence is still reported, although sporadically, and
the epidemiology of this disease is still poorly understood, partly
because it occurs almost exclusively in areas with specic microclimate but also by their scarce attention in public health.
For the reasons exposed above, the aim of this investigation was
to obtain data of human infection by M. ozzardi in Northwestern
Argentina through comparison of infection rates in relation to sex
and age group, in order to determine the prevalence and the range
of distribution of mansonelliasis in the region. Also, the prevalence
over time was considered important to investigate and lastly, were
sought to identify the potential vectors involved in the transmission
of M. ozzardi.
2. Methods
2.1. Study area
This study was performed in two patches, central and northern,
of the subtropical mountainous rainforest of Argentina, also known
as Yungas. Yungas cover an area of 56,000 km2 , from the Bolivian
border (23 S) to the north of the Catamarca province (29 S), passing
through Salta, Jujuy and Tucumn provinces.
The climate of this forested region is subtropical with a dry
season, with the average of annual temperature of 1820 C
and marked seasonality of rainfall. The rainfall has a monsoon
regime resulting in rainy summers and dry winters, and with
90% of the rainfall events occurring during 4 moths in the year
(December, January, February and March). Along its altitudinal gradient (4002300 m.a.s.l), the tree species turnover promotes the
occurrence of three altitudinal belts, pre-montane forest, (400900
m.a.s.l), lower montane forest (900-1600 m.a.s.l) and upper montane forest (16002300 m.a.s.l).
Fig. 1. Geographical distribution of the localities in Salta and Jujuy provinces, Northwestern Argentina (1Acambuco, 2Aguas Blancas, 3El Oculto, 4San Ramn de
la Nueva Orn, 5Algarrobal, 6Pichanal, 7Embarcacin, 8General Ballivian, 9General Mosconi, 10Tartagal, 11Aguaray, 12Campo Durn, 13Salvador Mazza,
14Palma Sola, 15Isla Chica, 16San Borja, 17San Pedro de Jujuy and 18Libertador General San Martn).
Table 1
Number of individuals examined/positive for Mansonella ozzardi by sex in localities situated throughout the Yungas.
Localities
Positive/Examined (Prevalence %)
Salta Province
Acambuco
Aguas Blancas
El Oculto
San Ramn de la Nueva Orn
Algarrobal
Pichanal
Embarcacin
General Ballivian
General Mosconi
Tartagal
Aguaray
Campo Durn
Salvador Mazza
Total
Males
8/10 (80.0)
7/9 (77.7)
9/10 (90.0)
75/79 (94.9)
4/5 (80.0)
6/6 (100.0)
4/4 (100.0)
2/2 (100.0)
3/3 (100.0)
91/97 (93.8)
3/3 (100.0)
3/3 (100.0)
7/9 (77.8)
222/240 (92.5)
Females
3/4 (75.0)
2/2 (100.0)
3/3 (100.0)
23/25 (92.0)
1/2 (50.0)
1/1 (100.0)
2/2 (100.0)
1/1 (100.0)
1/1 (100.0)
62/64 (96.9)
2/3 (66.7)
1/1 (100.0)
2/4 (50.0)
104/113 (92.0)
Total
11/14 (78.6)
9/11 (81.8)
12/13 (92.3)
98/104 (94.2)
5/7 (71.4)
7/7 (100.0)
6/6 (100.0)
3/3 (100.0)
4/4 (100.0)
153/161 (95.0)
5/6 (83.3)
4/4 (100.0)
9/13 (69.2)
326/353 (92.3)
Jujuy Province
Palma Sola
Isla Chica
San Borja
San Pedro de Jujuy
Libertador General San Martn
Total
3/3 (100.0)
4/4 (100.0)
3/4 (75.0)
9/11 (81.8)
22/22 (100.0)
41/44 (93.2)
1/3 (33.3)
1/1 (100.0)
1/2 (50.0)
2/4 (50.0)
9/10 (90.0)
14/20 (70.0)
4/6 (66.7)
5/5 (100.0)
4/6 (66.7)
11/15 (73.3)
31/32 (96.9)
55/64 (85.9)
Fig. 3. Prevalence of M. ozzardi infections according to the age group, from 1986 to 2010, in Northwestern Argentina.
Fig. 5. Temporal uctuation of positive cases to M. ozzardi in localities grouped by their proximity.
general trend, with the highest cases at 19861989, meanwhile Salvador Mazza and Tartagal have shown peaks of cases up to 2010.
In Jujuy localities, San Pedro de Jujuy and Libertador General San
Martn, it was observed the prevalence over time with cases since
1988 up to 2010.
Taking into consideration previous studies to compare with,
Mhlens et al. (1925) and Remondegui et al. (1988) has reported
in Jujuy province a prevalence between 39.1% and 41.1%, respectively. Later, Zrate (1996) and Zaidenberg (1997) has cited in Salta
province, a prevalence of 50%. Considering our results, it can be
said that the values observed in this study agree with the high
prevalence of this parasitism for the region. Furthermore, in other
countries as Bolivia, Brazil and Peru have also been reported similar prevalence values (Medrano et al., 1992; Bartoloni et al., 1999;
Medeiros et al., 2009; Arrspide et al., 2012), which also conrming
the high endemicity observed in the present investigation.
Also, the migration of infected individuals in job search may
be responsible of the establishing of new active M. ozzardi transmission foci, because the vector species have a wide geographic
distribution in Argentina; the latter may also explain the observed
in the present study. Lastly, it is probable that the prevalence in this
region is due to social and environmental factors, considering the
lack of a continuous and wide-ranging treatment program.
Another result has been the detection in 11 blood samples of
microlariae that differ of M. ozzardi by the length and arrangement
of nuclei in the cephalic space.
Finally, experimental studies in specimens of Culicoides revealed
the presence of M. ozzardi in endemics areas of Northwestern
Argentina. However, is necessary to continue with these studies
and to determine the Parasitic Infection Rates (PIR) in the specimens collected in the region.
5. Conclusions
This study determined high rates of M. ozzardi infection in
Argentina during period 19862010, highlighting not only its
presence after almost 100 years of its discovery, but also its range of
distribution current in the region. However, due to the few data and
follow-up of this parasitic in Yungas populations, are necessary new
epidemiological studies that include complementary methodology
(molecular techniques, geographical information systems, entomological sampling, among others), and drug administration schemes
to understand this forgotten parasitosis in Northwestern Argentina.
Conict of interest
The authors declare that there is no conict of interest.
Acknowledgements
We want to thank the technicians of Coordinacin Nacional de
Control de Vectores, Ministerio de Salud de la Nacin for their
invaluable help in the collections of the hematic samples. We also
thank laboratory technician N. Garca (Ministerio de Salud de la
Nacin, Delegacin Salta) for her assistance in the conrmation of
parasite identication. This work was partially funded by Ministerio de Salud de la Nacin.
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