The eco-epidemiology of American Cutaneous Leishmaniasis (ACL) is drivenby animal reservoir species that are a source of infection for sand flies thatserve as vectors infecting humans with Leishmania spp parasites. The emergence and re-emergence of this disease across LatinAmerica calls for further studies to identify reservoir species associated withenzootic transmission. Here, we present results from a survey of 52 individualsfrom 13 wild mammal species at endemic sites in Costa Rica and Panama where ACLMammal hosts have not been previously studied. For Leishmania spp. diagnostics we employed a novel PCR technique usingblood samples collected on filter paper. We only found Leishmania spp parasites in one host, the two toed sloth, Choloepus hoffmanni. Our findings addfurther support to the major role of two toed sloths as an ACL reservoir inCentral America.

The eco-epidemiology of American cutaneous leishmaniasis (ACL) is driven by animal reservoir species that are a source of infection for sand flies that serve as vectors infecting humans with Leishmania spp parasites. The emergence and re-emergence of this disease across Latin America calls for further studies to identify reservoir species associated with enzootic transmission. Here, we present results from a survey of 52 individuals from 13 wild mammal species at endemic sites in Costa Rica and Panama where ACL mammal hosts have not been previously studied. For Leishmania spp. diagnostics we employed a novel PCR technique using blood samples collected on filter paper. We only found Leishmania spp parasites in one host, the two-toed sloth, Choloepus hoffmanni. Our findings add further support to the role of two-toed sloths as an important ACL reservoir in Central America.

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients. METHODS: The case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years). RESULTS: Of the 1,500 liver transplant patients, 94 (6.3%) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7% was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100%) patients, and biliary stones were removed in 21/24 (87.5%) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7%) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34). CONCLUSIONS: ERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.
Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing ; Cohort Studies ; Constriction, Pathologic ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Liver Transplantation ; Pancreatitis ; Stents ; Transplants