Possibility of Leishmaniasis Transmission in Jura, France

LETTERS

Possibility of Rhine axis and mild microclimatic Etymologia: Prion niches. Entomologic and serologic Leishmaniasis surveys will be carried out in summer To the Editor: The January 2012 Transmission in 2012 in Jura to look for evidence of Etymologia section might confuse Jura, France possible indigenous transmission readers because it incorrectly reports of leishmaniasis. These data should that “prion” describes a noninfectious To the Editor: The report of a supplement the current model of agent (1). In fact, prion—pronounced human cutaneous leishmaniasis case northern spread of leishmaniasis- pree’-on—is a term coined in 1982 acquired in Clairvaux-les-lacs (1) endemic areas. by Nobel laureate Stanley Prusiner led us to carry out an investigation to describe the novel infectious agent with the veterinary clinics in Jura Mohamed Kasbari, responsible for scrapie, a transmissble Department, France. Clairvaux-les- Christophe Ravel, Noel Harold, neurodegenerative disorder of sheep lacs is a lakeside resort located in Bernard Pesson, and goats. He proposed his new Jura, one of the areas in France with Francis Schaffner, term to underscore that the agents the coldest average temperatures, and and Jerome Depaquit are “small proteinaceous infectious is clearly located outside the usual Author affi liations: French Agency for particles” resistant to procedures that leishmaniasis-endemic area. At least Health and Safety, Maisons-Alfort, France attack nucleic acids (2). In his seminal 31 cases of canine leishmaniasis were (M. Kasbari); University of Montpellier, article, he summarized experimental diagnosed by veterinary clinics in Jura Montpellier, France (M. Kasbari, C. Ravel); data indicating that the molecular during 2007–2011. Because these University of Reims Champagne-Ardenne, properties of this infectious agent dogs were native of or traveled in the Reims, France (M. Kasbari, B. Pesson, differed from those of other infectious leishmaniasis-endemic area along the J. Depaquit); French Institute for Public agents, including viruses, viroids, Mediterranean Sea, all veterinarians Health Surveillance, Saint-Maurice, France and plasmids; he proposed the word considered the infections as acquired (N. Harold); University of Strasbourg, prion to replace other terms then in outside Jura. Illkirch, France (B. Pesson); and University circulation, such as “unconventional Although phlebotomine sand fl ies of Zurich, Zurich, Switzerland (F. Schaffner) virus” or “unusual slow virus–like have not been reported in Jura to date, DOI: http://dx.doi.org/10.3201/eid1806.120158 agent.” Phlebotomus perniciosus sand fl ies, Although Dr. Prusiner acknow- proven vectors of leishmaniasis, have References ledged that he could not exclude the been found in 2 areas neighboring 1. Faber WR, Hoekzema R, Bart A, Zeege- possibility of a small nucleic acid Jura: Côte-d’Or and Saône-et-Loire laar JE, de Vries HJC. Cutaneous leish- contained within the interior of the (2,3). We have also recently caught maniasis acquired in Jura, France [letter]. prion particle, now 3 decades later, Emerg Infect Dis. 2012;18:183–4. http:// P. mascittii sand fl ies, a species with dx.doi.org/10.3201/eid1801.110408 no nucleic acid in the agent has yet an unknown vectorial competence, 2. Larousse F. Phlébotomes observés dans de been identifi ed. Increasingly accepted in the Swiss region of Jura, Alsace, nouvelles localités françaises. Ann Parasi- in the scientifi c community, prions Champagne-Ardennes, and Belgium. tol Hum Comp. 1925;3:103. are now considered to be a class of 3. Rossi P. Sur la présence de Phlebotomus Therefore, the presence of sand fl ies perniciosus à Mâcon. Bull Soc Pathol misfolded proteinaceous, infectious in Jura, particularly in wet and milder Exot. 1935;28:282–4. agents responsible for several types microclimatic areas (as Clairvaux-les- 4. Chamaillé L, Tran A, Meunier A, Bour- of human and animal transmissible lacs), is likely, and canine infections doiseau G, Ready P, Dedet JP. Environ- spongiform encephalopathies. Their mental risk mapping of canine leishmani- could have been acquired locally. asis in France. Parasit Vectors. 2010;3:31. evolving defi ning characteristics A recent model predicted that http://dx.doi.org/10.1186/1756-3305-3-31 classically include at least partial new at-risk areas are mostly located in 5. Naucke TJ, Menn B, Massberg D, Lorentz protease resistance, insolubility, and western France along the Atlantic coast S. Sand fl ies and leishmaniasis in Germa- transmissibility. The term, prions, ny. Parasitol Res. 2008;103:S65–8. http:// (4). In accordance with this model, dx.doi.org/10.1007/s00436-008-1052-y usually refers to the complete we report new foci of autochthonous transmissible proteinaceous particles canine leishmaniasis in Deux Sèvres, Address for correspondence: Mohamed Kasbari, in nature or to their classically present, Loire-Atlantique, and Loiret. Canine ANSES–French Agency for Health and Safety, transmissible, protease-resistant leishmaniasis cases contracted in the Animal Health Laboratory, Leishmaniasis oligomer cores, composed of protein Rhine Valley in Germany (5) and and Sandfl ies Team, 23, Ave Général De fragments with molecular masses of the canine cases in Jura argue for a Gaulle, 94706 Maisons-Alfort, France; email: ≈27–30 kDa. northeastern spread of the disease- [email protected] Adding confusion to the endemic area along the Rhone- terminology, it has become customary

1030 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 6, June 2012 LETTERS for prion researchers to refer to the Hepatitis E Virus value of serologic testing is probably normal nonpathogenic conformation low because of the artifi cially low of prions as “cellular prion proteins” Infection in HEV prevalence reported for this (3). When these normal cellular prion Sheltered Homeless population. Despite these limitations, precursors convert to pathogenic Persons, France our study suggests that the high prion proteins, the transmissible prevalence of HEV infection among conformations are characterized by To the Editor: Kaba et al. (1) homeless persons in southern France β-pleated sheets rather than the normal reported a seroprevalence of 11.6% was not infl uenced by IDU, but α-helix structure, and they do not elicit for hepatitis E virus (HEV) among refl ected the general epidemiology of an immune response (4). homeless persons in the city of HEV in this region. Marseille, located in southern France, Lawrence B. Schonberger and a multivariate analysis suggested Sylvie Larrat, and Robert B. Schonberger that injection drug use (IDU) was Stéphanie Gaillard, Author affi liations: Centers for Disease an independent risk factor for HEV Monique Baccard, Lionel Piroth, Control and Prevention, Atlanta, Georgia, transmission. We disagree with this Patrice Cacoub, Stanislas Pol, USA (L.B. Schonberger); and Yale reported fi nding. Christian Perronne, University School of Medicine, New Haven, We conducted a retrospective Fabrice Carrat and Connecticut, USA (R.B. Schonberger) subanalysis of results from a multicenter Patrice Morand for the French National Agency for Research DOI: http://dx.doi.org/10.3201/eid1806.120271 therapeutic trial assessing HEV seroprevalence among HIV/hepatitis on AIDS and viral hepatitis References C co-infected patients in France (2). HC02 Ribavic Study Team Serum samples from 84 IDU patients, Author affi liation: University Hospital of 1. Etymologia: prion. Emerg Infect Dis. enrolled during 2000–2002 were stored Michallon, Isère, Grenoble, France 2012;18:157. http://dx.doi.org/10.3201/ at −80°C. The mean ± SD age of the eid1801.ET1801 DOI: http://dx.doi.org/10.3201/eid1806.110632 2. Prusiner SB. Novel proteinaceous infec- patients was 39 ± 4 years; 53 (63%) tious particles cause scrapie. Science. were men, 19 (23%) were born outside References 1982;216:136–44. http://dx.doi.org/10. France, and 38 (45%) were living 1126/science.6801762 in southern France. HEV antibodies 1. Kaba M, Brouqui P, Richet H, Badiaga S, 3. Brown P, Cervenakova L. A lexicon were tested with the same assay as Gallian P, Raoult D, et al. Hepatitis E vi- (out of control). Lancet. 2005;365:122. rus infection in sheltered homeless persons, http://dx.doi.org/10.1016/S0140-6736 that used by Kaba et al. (1), and HEV France. Emerg Infect Dis. 2010;16:1761–3. (05)17700-9 RNA was detected by using a real-time 2. Carrat F, Bani-Sadr F, Pol S, Rosenthal 4. Dorland’s illustrated medical dictionary reverse transcription PCR amplifying E, Lunel-Fabiani F, Benzekri A, et al. 2012, 32nd ed. Philadelphia: Elsevier open reading frame 3 (3). None of the Pegylated interferon alfa-2b vs stan- Saunders; 2012. p. 1515. dard interferon alfa-2b, plus ribavirin, patients had detectable IgM against for chronic hepatitis C in HIV-infected Address for correspondence: Lawrence B. HEV or HEV RNA. Test results for 3 patients: a randomized controlled trial. Schonberger, Centers for Disease Control and (3.6%) patients were positive for HEV JAMA. 2004;292:2839–48. http://dx.doi. org/10.1001/jama.292.23.2839 Prevention, 1600 Clifton Rd NE, Mailstop A30, IgG. Two of them lived in southern 3. Jothikumar N, Cromeans TL, Robertson Atlanta, GA 30333, USA; email: [email protected] France, resulting in a 5.3% (2/38) HEV BH, Meng XJ, Hill VR. A broadly reac- prevalence for IDU patients living in tive one-step real-time RT-PCR assay for this region, where HEV IgG prevalence rapid and sensitive detection of hepatitis for healthy blood donors has reportedly E virus. J Virol Methods. 2006;131:65– 71. http://dx.doi.org/10.1016/j.jviromet. ranged from 9% to 16.6% (4). 2005.07.004 The difference between our study, 4. Mansuy JM, Legrand-Abravanel F, Calot which demonstrated low HEV IgG JP, Peron JM, Alric L, Agudo S, et al. High prevalence in IDU patients, even in prevalence of anti-hepatitis E virus anti- bodies in blood donors from south west southern France, and the results from France. J Med Virol. 2008;80:289–93. Kaba et al. (1) must be interpreted with http://dx.doi.org/10.1002/jmv.21056 caution because there were several epidemiologic differences between Address for correspondence: Sylvie Larrat, the 2 populations. Moreover, there Laboratoire de Virologie, Département des is a risk for false-negative serologic Agents Infectieux, CHU de Grenoble BP results for HIV patients because of 2170 Grenoble Cedex 9 38043, France; email: impaired immunity, and the predictive [email protected]

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