Dissemination of Leishmania (Viannia) braziliensis

Destructive human mucocutaneous leishmaniasis may appear many years after the primary cutaneous infection with Leishmania (Viannia) braziliensis. Hamsters (Mesocricetus auratus) were infected with metacyclic L. braziliensis promastigotes. It was found that secondary metastatic visceral lesions could arise from a primary cutaneous lesion, or secondary cutaneous lesions from a primary visceral lesion. Parasites in the viscera were shown to be viable, multiplying and capable of metastasis to either secondary visceral or cutaneous sites. The finding of an early metastasis in the wall of a small cutaneous vessel indicates that dissemination can occur by the haematogenous route. Slow growing organisms in viscera may thus be a source for late metastasis to mucocutaneous sites or for systemic relapse after immunosuppression.

Identification of the C-terminal region of 70 kDa heat shock protein from Leishmania (Viannia) braziliensis as a target for the humoral immune response

A Leishmania (Viannia) braziliensis (Lb) promastigote cDNA library in lambda gt11 was screened with patients' sera with the aim of identifying antigens specifically related to mucocutaneous leishmaniasis (MCL). One of the clones isolated, 133P, consistently reacted with MCL sera; it was sequenced and found to encode the C-terminal three-quarters of a protein belonging to the highly conserved Hsp70 family. Since Hsp70 proteins from different species tend to be less conserved through the C-terminal end, it was predicted that this region would be more antigenic and was likely to bear the discriminatory epitopes. In order to test this hypothesis, the N- and C-terminal halves of the polypeptide encoded by 133P, 133P-N and 133P-C, respectively, were expressed in Escherichia coli. Immunoblotting analysis demonstrated that 133P-C reacted more strongly with a pool of MCL sera than 133P-N, and both recombinant proteins reacted faintly with pools of cutaneous (CL) and visceral (VL) leishmaniasis sera. These results confirmed the predicted epitope location in the C-terminal region. The 133P-C fragment was also expressed as a fusion protein with glutathione-S-transferase (GST-133P-C), affinity-purified with glutathione-agarose and tested by ELISA with individual sera. From 46 Lb-infected patients, 41 sera (89%) were positive, no cross-reactivity was observed with healthy, Trypanosoma cruzior L. amazonensis-infected individuals. Despite a relatively high cross-reactivity with VL sera, the enhanced humoral response of MCL as compared with CL patients might be interesting for studies on disease aggravation.

Genetic exchange as a possible source of genomic diversity in sylvatic populations of Trypanosoma cruzi

Thirty six stocks of Trypanosoma cruzi isolated from sylvatic mammals (32 Didelphis marsupialis and one Philander opossum) and triatomine bugs (Rhodnius robustus and one unidentified bug) in the Amazonian forest by Carajas, Brazil were characterized by isoenzyme and random amplified polymorphic DNA (RAPD) analysis as belonging to principal zymodeme '1 (Z1). Two different homozygous phenotypes and the corresponding heterozygous phenotype were found for phosphoglucomutase with an observed frequency almost identical with that predicted by the theoretical Hardy-Weinberg distribution. Parental and hybrid profiles were also suggested by RAPD analysis, which allowed exclusion of mixed parental strains from the hybrids: isoenzyme and RAPD profiles of biological clones were also indistinguishable from those of uncloned stocks. Trypanosoma cruzi stocks from widely separated geographic origins in Central and South America gave similar RAPD profiles that allowed them to be recognized as being Z1. These results indicate that genetic exchange could contribute to the generation of genetic diversity during the sylvatic cycle of T. cruzi, and this may have epidemiologic and taxonomic implications.

Detection of parasites of the Leishmania donovani-complex by a polymerase chain reaction-solution hybridization enzyme-linked immunoassay (PCR-SHELA)

A polymerase chain reaction (PCR) based on the detection of the Lmet2 repeat sequence specific to members of the Leishmania donovani-complex is described. To improve PCR specificity, a post-PCR hybridization step is often performed but this usually involves an entirely new procedure with additional manipulations, expense and time. We have simplified this post-PCR hybridization by developing a strategy which includes the probe in the PCR and enables the hybridization to be performed automatically as part of the PCR programme. The hybrids are afterwards detected by capture in microtitre wells and colorimetric visualization. This method, which we have termed PCR-solution hybridization enzyme-linked immunoassay (PCR-SHELA), is rapid, able to detect less than 5 cultured parasites and is specific for parasites of the Leishmania donovani-complex. We also describe the application of PCR-SHELA to the detection of amastigotes in various tissues of infected laboratory animals.

Estimating increases in outpatient dialysis costs resulting from scientific and technological advancement

The Medicare program's base payment rate for outpatient dialysis services has never been adjusted for the effects of inflation, productivity changes, or scientific and technological advancement on the costs of treating patients with end-stage renal disease. In recognition of this, Congress asked the Prospective Payment Assessment Commission to annually recommend an adjustment to Medicare's base payment rate to dialysis facilities. One component of this adjustment addresses the cost-increasing effects of technological change--the scientific and technological advances (S&TA) component. The S&TA component is intended to encourage dialysis facilities to adopt technologies that, when applied appropriately, enhance the quality of patient care, even though they may also increase costs. We found the appropriate increase to the composite payment rate for Medicare outpatient dialysis services in fiscal year 1995 to vary from 0.18% to 2.18%. These estimates depend on whether one accounts for the lack of previous adjustments to the composite rate. Mathematically, the S&TA adjustment also depends on whether one considers the likelihood of missing some dialysis sessions because of illness or hospitalization. The S&TA estimates also allow for differences in the incremental costs of technological change that are based on the varying advice of experts in the dialysis industry. The major contributors to the cost of technological change in dialysis services are the use of twin-bag disconnect peritoneal dialysis systems, automated peritoneal dialysis cyclers, and the new generation of hemodialysis machines currently on the market. Factors beyond the control of dialysis facility personnel that influence the cost of patient care should be considered when payment rates are set, and those rates should be updated as market conditions change. The S&TA adjustment is one example of how the composite rate payment system for outpatient dialysis services can be modified to provide appropriate incentives for producing high-quality care efficiently.

A putative Leishmania panamensis/Leishmania braziliensis hybrid is a causative agent of human cutaneous leishmaniasis in Nicaragua

As part of a survey of human leishmaniasis in Nicaragua we examined phenotypic and genotypic characteristics of 40 Leishmania isolates. We identified 3 distinct parasites associated with cutaneous disease in this area; Leishmania panamensis (40% of cases), Leishmania braziliensis (33%), and a strain which exhibits the heterozygous isoenzyme and DNA fingerprinting patterns expected of a L. panamensis/L. braziliensis hybrid (27%). There was complete correlation between the isoenzyme and DNA data for each of the putative hybrids examined. All of the 'hybrids' were obtained from foci in the northern region of the country where L. panamensis and L. braziliensis occur sympatrically. These observations provide strong evidence for sexual reproduction in New World Leishmania populations and suggest that it is of taxonomic and epidemiological significance.

Precise location of sequential dengue virus subcomplex and complex B cell epitopes on the nonstructural-1 glycoprotein

The reactions of a panel of 34 mouse monoclonal antibodies (MAbs) specific for the dengue-2 virus nonstructural-1 glycoprotein (NS1), were analysed using 174 overlapping synthetic nonameric peptides covering the entire sequence. Using this methodology, four epitopes were identified. One pair of MAbs, which defined a dengue-2/4 virus subcomplex epitope (24C: amino acids 299-309) using native NS1 proteins, showed the same reaction pattern with synthetic peptides containing the corresponding NS1 sequences of each virus serotype. One amino acid substitution, present in the sequences from the dengue-1/3 virus subcomplex abrogated almost all reaction by these MAbs. A dengue complex epitope (LX1: amino acids 111-121) was also located and peptides containing the sequences of each serotype were shown to contain only antigenically silent amino-acid substitutions. In contrast, MAbs which defined a dengue type-specific epitope (LD2: amino acids 25-33) and another dengue subcomplex epitope (24A: amino acids 61-69) failed to show the same reaction profiles using peptides of each serotype, suggesting that these determinants were partially dependent upon conformation. The LX1 epitope is a good candidate for further trials aimed at generating cross-protective immune responses to these viruses without the risk of antibody-dependent enhancement.

The structure, organization, and expression of the Leishmania donovani gene encoding trypanothione reductase

Trypanothione reductase (TR) is an NADPH-dependent flavoprotein oxidoreductase central to thiol metabolism in the trypanosomatids. We report here the cloning by expression of the Leishmania donovani gene. It is single copy, expresses a 2.6-kb transcript and a 52-kDa protein and is located on a 1.1-Mbp chromosome. The 491 amino acid sequence has 76% similarity to Crithidia fasciculata and 67% similarity to Trypanosoma cruzi, Trypanosoma congolense and Trypanosoma brucei TR. Residues recognising the adenosine pyrophosphate moiety of NADPH and FAD, and residues in the catalytic site segment (A47-A67) involving electron transfer from TR to trypanothione disulphide (T(S)2) were completely conserved. Thus inhibitors of TR are likely to be active against the enzyme from all the parasitic trypanosomatids. Two peptide inserts (39-47, 131-140) seen in other TR genes and a C-terminal extension of 19 residues were also present. When the gene was introduced back into L. donovani at high copy number using the pTEX expression vector, we detected elevated expression of TR RNA and a 14-fold increase in TR activity. Transfection and overexpression of the TR gene will facilitate studies of gene function and of the dependence of trypanosomatids on TR for protection against oxidative stress.

Diagnosis of amebic dysentery by detection of Entamoeba histolytica fecal antigen by an invasive strain-specific, monoclonal antibody-based enzyme-linked immunosorbent assay

An invasive strain-specific monoclonal antibody against Entamoeba histolytica has been used in a capture enzyme-linked immunosorbent assay (ELISA) for the detection of invasive E. histolytica fecal antigen in clinical specimens and for the diagnosis of amebic dysentery in patients from Bangladesh. The fecal antigen capture ELISA (FAC-ELISA) did not cross-react with other parasite species in the clinical specimens or with noninvasive E. histolytica present in those specimens and in experimentally seeded stools. The limit of detection of the assay for invasive E. histolytica crude antigen diluted in phosphate-buffered saline or in stools was 0.58 and 3.9 micrograms/ml, respectively, which is the equivalent of approximately 72 and 487 E. histolytica trophozoites per well, respectively. The sensitivity, specificity, and efficiency of the FAC-ELISA were 87, 100, and 98%, respectively, for the detection of invasive E. histolytica antigens and 100, 100, and 100%, respectively, for the diagnosis of amebic dysentery. The FAC-ELISA is a potential alternative for the field diagnosis of amebic dysentery and for epidemiological studies to define the distribution of invasive E. histolytica.

Value of microscopy in the diagnosis of dysentery associated with invasive Entamoeba histolytica

AIMS

To assess the reliability of the detection of erythrophagocytic amoebic trophozoites in stool samples in the diagnosis of dysentery associated with invasive Entamoeba histolytica.

METHODS

Amoebic culture was carried out on single stool samples collected from patients from Mexico, Colombia, and Bangladesh. The stools had been examined by light microscopy. Amoebic dysentery was diagnosed when erythrophagocytic E histolytica trophozoites were observed in a case of bloody diarrhoea. E histolytica isolates were characterised by isoenzyme electrophoresis and results correlated with microscopical findings in stools. Statistical analysis was performed using the chi 2 test.

RESULTS

Where erythrophagocytic amoebae had been observed in dysenteric stool specimens the E histolytica phenotype was invariably invasive (p < 0.0001). Observation of erythrophagocytic amoebae in dysentery is 100% specific and predictive of infection with invasive E histolytica. When amoebic culture-positive cases only are considered it is 96% sensitive. In this study E histolytica of zymodeme XIV was more commonly associated with amoebic dysentery than zymodeme II. There was no significant difference between the carriage rate of invasive and non-invasive E histolytica in non-dysenteric diarrhoea. Asymptomatic subjects carried non-invasive E histolytica more frequently than invasive E histolytica. Patients with non-amoebic dysentery, when shown to be infected with E histolytica, carried non-invasive strains (12%).

CONCLUSIONS

Sensitivity and specificity of microscopical examination of a single stool specimen for diagnosing amoebic dysentery is very high; intestinal carriage of invasive E histolytica detected by culture is not necessarily an indication of active disease as patients with diarrhoea and asymptomatic subjects shed invasive and non-invasive E histolytica. There are possibly two subpopulations of invasive E histolytica with different pathogenic potential which can be differentiated by zymodeme analysis.

Feed intake affects metabolic clearance rate of progesterone in sheep

To study the inverse relationship between feed level and concentrations of peripheral plasma progesterone, 36 ovariectomised ewes were fed rations at levels calculated to maintain liveweight (M). On the seventh day, the ewes were given an intravenous infusion of progesterone and the metabolic clearance rate (MCR) was calculated. The ewes were then randomly allotted to receive either 1/2M, M or 2M rations for seven days at which time the infusion and blood sampling schedules were repeated. The mean (SE) MCR of infused progesterone in ovariectomised ewes fed either 1/2M, M or 2M rations for seven days was 7.1 (0.59), 9.9 (1.64 and 13.0 (1.19) litre h-1 kg-1 of liveweight, respectively. Differences in MCR of progesterone between ewes fed 1/2M and 2M rations were significant (P < 0.05). The inverse relationship between level of feed intake and plasma progesterone concentration was attributed to differences in clearance rate of progesterone rather than to changes in the entry rate of the hormone into the blood.

Liver blood flow and metabolic clearance rate of progesterone in sheep

To study the effects of feeding on concentrations of peripheral plasma progesterone, ovariectomised ewes, given exogenous progesterone, were fed 750 g of chopped lucerne hay at either 09.00 (group A, n = 5) or at 15.00 (group B, n = 5) or were fed ad libitum regularly through the experimental period (group C, n = 5). Peripheral blood samples were taken from each ewe at 09.00, 11.00, 15.00, 17.00 and 23.00. In ewes of groups A and B, mean plasma progesterone concentrations declined significantly (P < 0.05) after feeding. Mean progesterone concentrations of group C ewes remained low and were significantly different (P < 0.05) from the pre-feeding values of group A and B ewes. These results showed that the metabolic clearance rate of progesterone changed with the act of feeding. In a second experiment, portal, hepatic and mesenteric vein cannulae were placed in ovariectomised ewes (n = 17). They were then fed a ration calculated to maintain liveweight for seven days (M ration). The ewes were then infused with progesterone into a jugular vein and with p-amino hippuric acid into a mesenteric vein. Ewes were then allotted to receive either half M or twice M rations for seven days after which the infusions and blood sampling procedures were repeated. The mean rate of blood flow in the portal vein was directly related to the level of feed offered when ewes received either 1/2M, M or 2M rations. The liver and gut region removed a mean of 96 per cent of the progesterone entering these tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary observations on the diagnosis and transmissibility of canine visceral leishmaniasis in Teresina, n.e. Brazil

A pilot group of 49 dogs and control groups from non-endemic areas were examined serologically for the presence of visceral leishmaniasis (VL) by direct agglutination test (DAT), indirect immunofluorescence (IFAT) enzyme-linked immunosorbent assay (ELISA) and DOT-ELISA. Results indicated that DAT is less sensitive than the other assays and that serology with filter paper blood samples is less sensitive than with serum. Promastigote infections were common in fed Lutzomyia longipalpis taken from a dog kennel inhabited by a dog carrying Leishmania chagasi. Colony-bred Lu. longipalpis readily acquired L. chagasi infection when fed on skin lesions of dogs naturally infected with L. chagasi: a small proportion of flies also became infected when fed on apparently normal skin. Widespread distribution of amastigotes in normal skin of asymptomatic animals was shown both by intensive microscopy and by probing skin biopsy samples with the Lmet2 L. donovani-complex specific DNA probe. It was demonstrated that an immunologically naive dog could be infected by a single experimentally infected sand fly. Abundant amastigotes present within the resultant lesion 22 days later were transmissible to sand flies but serology remained negative at least 45 days after the infective bite. Experimental transmission of canine VL by sand fly bite is a valuable approach for determining which diagnostic procedures are most sensitive, specific and suitable for field application in suburban households.

Visceral leishmaniasis in Teresina, n. e. Brazil: towards a DNA probe kit and its adaptation to processing blood-contaminated samples

The Lmet2 chemiluminescent DNA probe is a valuable tool for identifying parasites of the Leishmania donovani -complex in sand flies, dogs and human samples. Recent blood meals in sand flies or blood contamination of tissue samples inhibited probe sensitivity, whether radiolabelled or chemiluminescent detection systems were used. Treatment of membranes with protease before hybridisation restored positive signal. Alternatively samples could be lysed with protease and applied to membranes with a vacuum blotting apparatus. The Lmet2 protocol provides the basis for a DNA probe kit that is adaptable for use with a wide range of other probes.

Diagnosis of Giardia duodenalis infection in Bangladeshi infants: faecal antigen capture ELISA

An enzyme-linked immunosorbent assay (ELISA) to detect antigens of Giardia duodenalis in faeces was evaluated as a diagnostic tool by testing faecal samples collected during a cohort study of 229 infants living in an urban slum in Dhaka, Bangladesh. Faecal samples had been collected at enrollment, on a routine monthly basis, and repeatedly during episodes of diarrhoea and infection with Giardia, and a portion of all samples was frozen in saline. A direct smear of all had been examined by microscopy and again after concentrating cysts by ether sedimentation. A total of 2121 of the 4936 samples stored during the 22 months study were tested by the ELISA. After excluding non-specific binding, the sensitivity of the assay was 94.2% and the specificity was 98%. The presence of other parasites, including flagellated protozoa, was not linked to false positive ELISA results. There was a correlation between the number of Giardia cysts present and the ELISA optical density. Assuming that the ELISA is 100% sensitive, microscopy detected 92.4% of the infections detected by the ELISA.

Demonstration of natural Leishmania infection in asymptomatic dogs in the absence of specific humoral immunity

Asymptomatic dogs from a Kala-Azar endemic region were screened for infection status by parasitological, immunological and molecular techniques. Bone marrow was examined for the presence of parasites by NNN culture and by using the Lmet 2 DNA probe. All the samples were negative in culture but 24 of 41 were positive as determined by the probe. Cellular and humoral immunity were detected by T cell proliferation assays and IFAT respectively. Specific cellular and humoral immunity were found in 20 and 26 dogs respectively out of a total of 41 dogs examined. The vast majority of dogs with Leishmania-specific antibodies were found to be parasitologically positive using the DNA probe while almost half those that had demonstrable cellular immunity were apparently parasite free. The observation that dogs can develop cellular immunity following natural infection clearly indicates that there is a spectrum of canine leishmaniasis similar to that observed in the human disease. The prevalence of dog leishmanial infection must also be higher than was presumed.

Metacyclogenesis of Leishmania (Viannia) braziliensis in vitro: evidence that lentil lectin is a marker of complement resistance and enhanced infectivity

Axenic culture in modified Grace's medium was used to induce metacyclogenesis of Leishmania (Viannia) braziliensis in vitro. Morphological characteristics, lectin agglutination profiles, susceptibility to complement lysis, and infectivity in vivo were compared between metacyclic promastigotes and promastigotes in mid-log phase growth. Short, arrow-like promastigotes and round, oval promastigotes were defined as putative metacyclic forms on the basis of being highly motile and free swimming, with a small cell body and long flagellum. These forms increased during metacyclogenesis to > 80% whereas long-bodied, slender promastigotes and intermediate slender promastigotes declined progressively. Lentil lectin selectively agglutinated L. braziliensis after the induction of metacyclogenesis, whereas concanavalin A, wheat germ agglutinin and peanut agglutinin similarly agglutinated metacyclic promastigotes and mid-log phase promastigotes. Metacyclic promastigotes survived in 7.5%-20% human serum whereas mid-log phase promastigotes did not. Five hundred metacyclic promastigotes were highly infective to hamsters whereas 500 mid-log phase promastigotes rarely caused any lesion. Specific agglutination by lentil lectin should allow purification of metacyclic organisms for standardization of immunoprotection and challenge experiments.

Chloroquine-resistant Plasmodium falciparum isolates from the Sudan lack two mutations in the pfmdr1 gene thought to be associated with chloroquine resistance

Isolates of Plasmodium falciparum from 3 areas of the Sudan were recovered from cryopreservation in London and their chloroquine sensitivity was determined in vitro. Chloroquine resistance was detected in 6/6 isolates from Khartoum, 1/4 from Sennar and 3/3 from Gadarif, indicating that resistance is spreading. All the isolates were sensitive to mefloquine. Studies using blood spots on glass fibre discs and the polymerase chain reaction did not detect two mutations in the pfmdr1 gene, thought to be correlated with chloroquine-resistance, in any of the isolates studied.

A shuttle vector which facilitates the expression of transfected genes in Trypanosoma cruzi and Leishmania

A Trypanosoma cruzi expression vector has been constructed using sequences derived from the flanking regions of the glyceraldehyde 3-phosphate dehydrogenase (gGAPDH) genes. The neomycin phosphotransferase (neor) gene was incorporated as a selectable marker. Using electroporation we have introduced this vector into both T. cruzi and Leishmania cells and conferred G418 resistance. Transformation is mediated by large extrachromosomal circular elements composed of head-to-tail tandem repeats of the vector. The transformed phenotype is stable for at least 6 months in the absence of G418 and can be maintained during passage through the T. cruzi life-cycle. Foreign genes inserted into an expression site within the vector (pTEX) can be expressed at high levels in transformed cells. To our knowledge this paper describes the first trypanosome shuttle vector and the first vector which functions in both trypanosomes and Leishmania.

Mapping of a visceral leishmaniasis-specific immunodominant B-cell epitope of Leishmania donovani Hsp70

We have shown that a member of the 70-kDa heat shock protein (Hsp70) family is a major target of the humoral immune response during Leishmania donovani infection. A recombinant fusion protein was recognized by sera from 92% (35 of 38) of patients with visceral leishmaniasis, including representatives from each of the major regions where it is endemic. Serological analysis of recombinant Hsp70, expressed by a series of deletion constructs, identified the carboxy-terminal region as the immunodominant site. This region, which is the most evolutionarily divergent part of the molecule, was recognized by all sera from patients with visceral leishmaniasis which exhibited an anti-Hsp70 response. Purified recombinant L. donovani Hsp70 was not recognized by sera from patients with cutaneous leishmaniasis, Chagas' disease, leprosy, malaria, or schistosomiasis. To determine the regions involved in antibody recognition, a series of overlapping peptides were synthesized on polyethylene pins by the Pepscan method, and a hexamer, EADDRA, was identified by the visceral leishmaniasis serum samples as an immunodominant B-cell epitope.

Adaptation of a radioactive L. donovani complex DNA probe to a chemiluminescent detection system gives enhanced sensitivity for diagnostic and epidemiological applications

The cDNA probe, Lmet2, was labelled with digoxigenin and used in a chemiluminescent system to detect fewer than 100 membrane-immobilized Leishmania parasites. The probe was found to hybridize primarily with members of the L. donovani complex but a slight cross-reaction was also observed with greater than 5 x 10(4) L. major. This cross-reaction was reduced by hybridizations in 50% formamide at 37 degrees C. Formamide also significantly reduced non-specific binding of the digoxigenin-labelled probe to the membrane support which, in hybridizations without formamide, masked the specific hybridization signal. This background was not observed with the corresponding radio-isotope labelled probe. With hybridizations in formamide the sensitivity achieved by the chemiluminescent system after exposure to film for 3 h was greater than that achieved by the isotopic system even after autoradiography for 24 h.