1
|
Ruiz P, Durán Á, Gil M, Sevidane I, Cristóbal JI, Nicolás P, Duque FJ, Zaragoza C, García AB, Macías-García B, Barrera R. Urinary neutrophil gelatinase-associated lipocalin as early biomarker for renal disease in dogs with leishmaniosis. Vet Parasitol 2024; 331:110251. [PMID: 39002284 DOI: 10.1016/j.vetpar.2024.110251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/08/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
Canine leishmaniosis (CanL), caused by Leishmania sp., presents a wide array of symptoms; renal dysfunction is frequently observed in these dogs and is associated with a poor prognosis and increased mortality. The traditional biomarkers namely urea and creatinine can detect renal damage but only in advanced stages of the disease. However, it has been shown that the symmetric dimethylarginine assay (SDMA) or the protein/creatinine ratio (UPC) and are early biomarkers of renal dysfunction. Their elevation occurs earlier than that of creatinine, but other novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) are currently under investigation. Our objective was to determine whether the urine NGAL-creatinine ratio (uNGAL/c) can provide very early diagnosis of kidney disease in CanL. In total, 68 dogs were included in the study: 15 healthy dogs and 53 dogs with CanL who were classified according to International Renal Interest Society (IRIS) classification: IRIS 1 (N= 34), IRIS 2 (N= 9) and IRIS 3/4 (N= 10). IRIS 1 was subdivided according to proteinuria in IRIS 1NP (13 dogs with UPC < 0.2), IRIS 1BL (8 dogs with UPC = 0.2-0.5) and IRIS 1 P (13 dogs with UPC > 0.5). Blood samples were collected for complete hematological and biochemistry analysis including plasma NGAL. Urinalysis included specific gravity, UPC, CysC and NGAL expressed as a ratio with creatinine. The mean concentrations of pCysC and SDMA in CanL, show a statistically significant increase from IRIS 1NP, not being statistically significant for pCysC in the IRIS 1BL group. The UPC show a statistically significant increase from IRIS 1NP. In all groups with CanL for uCysC/c and uNGAL/c was observed a statistically significant increase. The uNGAL/c in the group proteinuric animals, presents a positive correlation with all renal biomarkers studied. In the group of non-proteinuric animals, the uNGAL/c presents a positive correlation with SDMA and UPC. The uNGAL/c can be considered a reliable indicator of renal disease in dogs diagnosed with CanL who are non-azotemic and non-proteinuric.
Collapse
Affiliation(s)
- Patricia Ruiz
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - Ángela Durán
- Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - María Gil
- Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - Inmaculada Sevidane
- Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - Jose Ignacio Cristóbal
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - Paloma Nicolás
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - Francisco Javier Duque
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - Concepción Zaragoza
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - Ana Belén García
- Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| | - Beatriz Macías-García
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain.
| | - Rafael Barrera
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, Cáceres 10003, Spain
| |
Collapse
|
2
|
Ulasi II, Burdmann EA, Ijoma CK, Chou LF, Yang CW. Neglected and Emerging Infections of The Kidney. Semin Nephrol 2023; 43:151472. [PMID: 38216373 DOI: 10.1016/j.semnephrol.2023.151472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Individuals, societies, and the environment are affected by neglected and emerging diseases. These diseases result in a variety of severe outcomes, including permanent disabilities, chronic diseases such as chronic kidney disease, and even mortality. Consequences include high health care expenditures, loss of means of support, social stigma, and social exclusion. The burden of these diseases is exacerbated in low- and middle-income countries owing to poverty, inadequate fundamental infrastructure, and the absence of health and social protection systems. The World Health Organization is committed to promoting the following public health strategies to prevent and control neglected tropical diseases: preventive chemotherapy; intensive case management; vector control; provision of safe drinkable water, sanitation, and hygiene; and veterinary public health. In addition, it promotes a One Health strategy, which is a collaborative, multisectoral, and interdisciplinary approach to achieving the greatest health outcomes by recognizing the interdependence of human beings, animals, plants, and their shared environment. This article provides knowledge and strategies for the prevention and treatment of neglected and emerging diseases, with a particular concentration on kidney diseases, as part of a comprehensive approach to One Health.
Collapse
Affiliation(s)
- Ifeoma I Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria-University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; Renal Unit, Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Emmanuel A Burdmann
- Laboratório de Investigação Médica (LIM 12), Faculdade de Medicina da Universidade de So Paulo, So Paulo, Brazil
| | - Chinwuba K Ijoma
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria-University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Li-Fang Chou
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
3
|
Asfaw KG, Gizaw ST, Gnanasekaran N. Evaluation of Renal Function Profile in Human Visceral Leishmaniasis (Kala-Azar) Patients: A Case of Western Tigray, Ethiopia. Res Rep Trop Med 2023; 14:21-33. [PMID: 37404482 PMCID: PMC10315324 DOI: 10.2147/rrtm.s410137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/16/2023] [Indexed: 07/06/2023] Open
Abstract
Background Leishmaniasis is a vector-borne protozoan infection that has a wide clinical spectrum in the tropics and subtropics. Kidney damage is frequently associated with increased morbidity and mortality in visceral leishmaniasis (VL) patients. However, up to date, there is a very limited report on the effect of visceral leishmaniasis on kidney function profiling in Ethiopia. Objective To evaluate the renal function profile in human visceral leishmaniasis (kala-azar) patients. Materials and Methods Human blood was taken from VL patients (n = 100) and healthy controls (n = 100) attending Kahsay Abera and Mearg Hospitals, Western Tigray of Ethiopia. Serum was separated according to the conventional protocol and kidney function profiling (creatinine, urea, and uric acid) was analyzed by Mindray 200E automated chemistry analyzer. The estimated glomerular filtration rate (eGFR) was also assessed in this study. The obtained data were processed using SPSS Version 23.0. Descriptive statistics, independent-test, and bivariate correlations were used for data analysis. P values <0.05 were considered statistically significant at a 95% confidence level. Results The mean serum creatinine level was found significantly higher, while respective serum urea and eGFR were significantly lower in VL patients compared to healthy controls. Specifically, from 100 VL cases, an increased level of serum creatinine, urea, and uric acid was found in 10%, 9% and 15% VL cases, respectively; meanwhile, a decreased serum urea and eGFR have been reported from 33% to 44% VL cases, respectively. Conclusion The finding of this study asserted that visceral leishmaniasis causes derangement in kidney activities characterized by alteration of renal function profile. This may indicate that VL is the determinant factor for developing kidney dysfunction. This study encourages researchers to engage in visceral leishmaniasis and its effect on other organ function profiles in humans and identify potential markers for both prevention and intervention.
Collapse
Affiliation(s)
- Kibrom Gerezgiher Asfaw
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Tebeje Gizaw
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Natesan Gnanasekaran
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Regan Institute of Metabolic Therapy, Rasipuram Tk, Namakkal Dt, Tamilnadu, India
| |
Collapse
|
4
|
Ruiz P, Durán Á, Duque FJ, González MA, Cristóbal JI, Nicolás P, Pérez-Merino EM, Macías-García B, Barrera R. Urinary cystatin C and N-acetyl-beta-D-glucosaminidase (NAG) as early biomarkers for renal disease in dogs with leishmaniosis. Vet Parasitol 2023; 318:109930. [PMID: 37030024 DOI: 10.1016/j.vetpar.2023.109930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/10/2023]
Abstract
Canine leishmaniasis (CanL) is a disease caused by Leishmania infantum that can vary from a subclinical infection to a severe disease. Dogs affected with CanL present varying degrees of renal dysfunction. Unfortunately, traditional biomarkers such as urea and creatinine detect renal damage in advanced stages of the disease, so more accurate biomarkers are needed. Hence, we aimed to study how urinary cystatin C (CysC) and N-acetyl-beta-D-glucosaminidase (NAG), behave in dogs with CanL at different stages of the disease. Eighty-six CanL infected dogs were classified according to LeishVet stages: LI (16 dogs), LIIa (12 dogs), LIIb (12 dogs), LIII (16 dogs) and LIV (30 dogs); as a control, 17 healthy dogs were studied. Blood samples were collected for complete haematological and biochemistry analysis including plasma cystatin C. Urine analysis included urine specific gravity (USG), urine protein to creatinine ratio (UPC), CysC and NAG expressed as a ratio with creatinine uCysCc (μg/g) and uNAGc (IU/g). The haematological, biochemical and urinary analysis coincided with the LeishVet guidelines. The statistical study of the uCysCc ratio and the uNAGc, showed significant increase when compared against control starting from group LI (p < 0.05). Interestingly, when the cut-off values were calculated using the ROC curve, uCysCc (258.85 µg/g) and uNAGc (2.25 IU/g) 75 % of the dogs included in LI groups surpassed the threshold. Hence our study indicates that uCysCc and uNAGc, could help to detect early renal damage in CanL affected dogs.
Collapse
Affiliation(s)
- Patricia Ruiz
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Ángela Durán
- Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Francisco Javier Duque
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Mario Alberto González
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain
| | - José Ignacio Cristóbal
- Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Paloma Nicolás
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Eva María Pérez-Merino
- Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Beatriz Macías-García
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain.
| | - Rafael Barrera
- MINVET Research Group. Departamento de Medicina Animal, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain
| |
Collapse
|
5
|
Assessment of Risk of Exposure to Leishmania Parasites among Renal Disease Patients from a Renal Unit in a Sri Lankan Endemic Leishmaniasis Focus. Pathogens 2022; 11:pathogens11121553. [PMID: 36558887 PMCID: PMC9786158 DOI: 10.3390/pathogens11121553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Leishmania donovani causes both cutaneous and visceral leishmaniasis (CL and VL) in Sri Lanka, where chronic kidney disease (CKD) and kidney transplant recipients' (KTR) geographical areas overlap. This study aimed to determine the risk of exposure to Leishmania infection among renal patients. This cross-sectional study in a renal unit assessed clinical symptoms and signs of CL and VL in recipients of blood/kidney or immunosuppressives. Sera were tested with Leishmania-specific DAT and rK-39 ELISA. There were 170 participants. A total of 84.1% (n = 143) were males (CKD: 101, KTR; 42, mean age 45) and 27 were females (females: CKD: 23, KTR: 4, mean age 39 years). Recipients of blood transfusion/s within last 2 years: 75.9% (CKD: 115, KTR: 14), on immunosuppressive therapy: 34.1% (CKD: 13, KTR: 45). Two CKD patients repeatedly showed clear positive titres (1: 12,800 and 1: 3200) with Leishmania-DAT and another two (CKD) became marginally positive with rK39-ELISA. Prevalence of anti-Leishmania antibodies: 2.4% (4/170). All four patients were clinically asymptomatic and were recipients of recent blood transfusions. Attributable risk of exposure to Leishmania infection through blood transfusions was 0.032, OR 2.99 (95% CI = 0.16 to 56.45, p = 0.47). Therefore, routine screening of kidney/blood donors and CKD and KTR patients in Sri Lanka may not be necessary.
Collapse
|
6
|
Busutti M, Deni A, De Pascali AM, Ortalli M, Attard L, Granozzi B, Fabbrizio B, La Manna G, Comai G, Varani S. Updated diagnosis and graft involvement for visceral leishmaniasis in kidney transplant recipients: a case report and literature review. Infection 2022; 51:507-518. [PMID: 36329343 PMCID: PMC10042904 DOI: 10.1007/s15010-022-01943-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
Visceral leishmaniasis (VL) has become a rising concern to transplantation teams, being associated with graft dysfunction and reduced survival of renal transplant recipients. Here, we describe a case of VL occurring in a kidney transplant (KT) recipient in Italy, a country in which Leishmania infantum is endemic and we reviewed the literature on the clinical course and diagnosis of VL in KT recipients residing or travelling to southern Europe.
Results
The VL case was diagnosed 18 months after transplant and 28 days after the onset of symptoms by quantitative PCR (qPCR) on peripheral blood. A graft biopsy showed renal involvement, and PCR performed on graft tissue displayed the presence of Leishmania DNA. The retrospective confirmation of Leishmania-positive serology in a serum sample collected before transplantation, as well as the absence of anti-Leishmania IgG in the graft donor strongly suggest that reactivation of a latent parasitic infection caused VL in the current case.
Conclusion
VL is often underdiagnosed in transplant recipients, despite the presence of latent Leishmania infection being reported in endemic countries. This case report, as well as the literature review on leishmaniasis in KT recipients, underline the importance of rapid VL diagnosis to promptly undergo treatment. Serology is scarcely sensitive in immunocompromised patients, thus molecular tests in peripheral blood should be implemented and standardized for both VL identification and follow-up.
Collapse
|
7
|
Abstract
Parasitic agents have been known to cause human disease since ancient times and are endemic in tropical and subtropical regions. Complications of parasitic diseases, including kidney involvement, are associated with worse outcomes. Chagas disease, filariasis, leishmaniasis, malaria and schistosomiasis are important parasitic diseases that can damage the kidney. These diseases affect millions of people worldwide, primarily in Africa, Asia and Latin America, and kidney involvement is associated with increased mortality. The most common kidney complications of parasitic diseases are acute kidney injury, glomerulonephritis and tubular dysfunction. The mechanisms that underlie parasitic disease-associated kidney injury include direct parasite damage; immunological phenomena, including immune complex deposition and inflammation; and systemic manifestations such as haemolysis, haemorrhage and rhabdomyolysis. In addition, use of nephrotoxic drugs to treat parasitic infections is associated with acute kidney injury. Early diagnosis of kidney involvement and adequate management is crucial to prevent progression of kidney disease and optimize patient recovery.
Collapse
|
8
|
Gebel B, Rupp J, Kramme E. [Pancytopenia and B-symptoms - an unexpected souvenir?]. Dtsch Med Wochenschr 2022; 147:108-111. [PMID: 35100643 DOI: 10.1055/a-1685-5173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HISTORY The 79-year-old patient was admitted with recurring fever, weight loss, night sweat, a decrease in physical capacity and hematomas of the extremities. FINDINGS The patient presented with pancytopenia, elevated CRP and impaired renal function. A splenomegaly was evident in abdominal sonography. A bone marrow aspiration was performed. DIAGNOSIS Histopathologic examination revealed a visceral Leishmaniasis. The diagnosis was confirmed by PCR from peripheral blood. THERAPY AND COURSE After initiation of liposomal amphotericin B haematopoiesis recovered and CRP decreased. Initially the renal function deteriorated with prolongated improvement in the course of therapy. CONCLUSIONS Pancytopenia and corresponding symptoms are suspect for visceral Leishmaniasis also in patients supposed to be immunocompetent with travel history of endemic regions.
Collapse
Affiliation(s)
- Benjamin Gebel
- Klinik für Infektiologie und Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Jan Rupp
- Klinik für Infektiologie und Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Evelyn Kramme
- Klinik für Infektiologie und Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| |
Collapse
|
9
|
Rahim S, Sharif MM, Amin MR, Rahman MT, Karim MM. Real Time PCR-based diagnosis of human visceral leishmaniasis using urine samples. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000834. [PMID: 36962767 PMCID: PMC10022223 DOI: 10.1371/journal.pgph.0000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022]
Abstract
Diagnosis of visceral leishmaniasis (VL) through the detection of its causative agents namely Leishmania donovani and L. infantum is traditionally based on immunochromatographic tests, microscopy of bone marrow, spleen aspirates, liver or lymph node and differential diagnosis. While the first process has low specificity, the later one carries the risk of fatal hemorrhage. Over the last decade, multiple Polymerase Chain Reaction (PCR) based diagnosis has been developed using blood and urine sample with a varying degree of sensitivity and specificity, an issue worth improving for precision diagnosis. Earlier, we reported a PCR-based diagnosis of L. donovani in peripheral blood using a novel set of PCR primers with absolute specificity. Using the same set of primers and PCR conditions, here we describe diagnosis of L. donovani from urine, for a non-invasive, rapid and safe diagnosis. Diagnosis of VL was carried out using urine samples collected from clinically diagnosed VL patients (n = 23) of Bangladesh in Real Time PCR. Test results were validated by comparing blood samples from the same set of patients. Sensitivity and specificity of this diagnosis was analyzed using retrospective bone marrow samples, collected earlier from confirmed VL patients (n = 19). The method showed 100% sensitivity in detecting L. donovani in urine and corresponding blood and retrospective bone marrow samples, as well as 100% specificity in control groups. A Real Time PCR-based molecular detection system using urine sample is hereafter presented what could be a, non-invasive approach for VL detection with precision and perfection.
Collapse
Affiliation(s)
- Samiur Rahim
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
| | | | - Md Robed Amin
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | | | | |
Collapse
|
10
|
Hailu W, Mohamed R, Fikre H, Atnafu S, Tadesse A, Diro E, van Grienvsen J. Acute kidney injury in patients with Visceral Leishmaniasis in Northwest Ethiopia. PLoS One 2021; 16:e0252419. [PMID: 34101727 PMCID: PMC8186802 DOI: 10.1371/journal.pone.0252419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and associated with increased mortality. There is however limited data on acute kidney injury (AKI) in VL patients in East-Africa, particularly in areas with high rates of HIV co-infection. This study aims to determine the prevalence, characteristics and associated factors of AKI in VL patients in Northwest Ethiopia. METHODS A hospital based retrospective patient record analysis was conducted including patients treated for VL from January 2019 to December 2019 at the Leishmaniasis Research and Treatment Center (LRTC), Gondar, Ethiopia. Patients that were enrolled in ongoing clinical trials at the study site and those with significant incomplete data were excluded. Data was analyzed using SPSS version 20. P values were considered significant if < 0.05. RESULTS Among 352 VL patients treated at LRTC during the study period, 298 were included in the study. All were male patients except two; the median age was 23 years (IQR: 20-27). The overall prevalence of AKI among VL patients was 17.4% (confidence interval (CI): 13.6%-22.2%). Pre-renal azotemia (57%) and drug-induced AKI (50%) were the main etiologies of AKI at admission and post-admission respectively. Proteinuria and hematuria occurred in 85% and 42% of AKI patients respectively. Multivariate logistic regression revealed HIV co-infection (adjusted odds ratio (AOR): 6.01 95% CI: 1.99-18.27, p = 0.001) and other concomitant infections (AOR: 3.44 95% CI: 1.37-8.65, p = 0.009) to be independently associated with AKI. CONCLUSION AKI is a frequent complication in Ethiopian VL patients. Other renal manifestations included proteinuria, hematuria, and pyuria. HIV co-infection and other concomitant infections were significantly associated with AKI. Further studies are needed to quantify proteinuria and evaluate the influence of AKI on the treatment course, morbidity and mortality in VL patients.
Collapse
Affiliation(s)
- Workagegnehu Hailu
- Department of Internal Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Rezika Mohamed
- Department of Internal Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Saba Atnafu
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Azeb Tadesse
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Ermias Diro
- Department of Internal Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Johan van Grienvsen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
11
|
Kot K, Łanocha-Arendarczyk N, Ptak M, Łanocha A, Kalisińska E, Kosik-Bogacka D. Pathomechanisms in the Kidneys in Selected Protozoan Parasitic Infections. Int J Mol Sci 2021; 22:4209. [PMID: 33921746 PMCID: PMC8073708 DOI: 10.3390/ijms22084209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 11/17/2022] Open
Abstract
Leishmaniasis, malaria, toxoplasmosis, and acanthamoebiasis are protozoan parasitic infections. They remain important contributors to the development of kidney disease, which is associated with increased patients' morbidity and mortality. Kidney injury mechanisms are not fully understood in protozoan parasitic diseases, bringing major difficulties to specific therapeutic interventions. The aim of this review is to present the biochemical and molecular mechanisms in kidneys infected with Leishmania spp., Plasmodium spp., Toxoplasma gondii, and Acanthamoeba spp. We present available mechanisms of an immune response, oxidative stress, apoptosis process, hypoxia, biomarkers of renal injury in the serum or urine, and the histopathological changes of kidneys infected with the selected parasites. Pathomechanisms of Leishmania spp. and Plasmodium spp. infections have been deeply investigated, while Toxoplasma gondii and Acanthamoeba spp. infections in the kidneys are not well known yet. Deeper knowledge of kidney involvement in leishmaniasis and malaria by presenting their mechanisms provides insight into how to create novel and effective treatments. Additionally, the presented work shows gaps in the pathophysiology of renal toxoplasmosis and acanthamoebiasis, which need further research.
Collapse
Affiliation(s)
- Karolina Kot
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.K.); (N.Ł.-A.); (E.K.)
| | - Natalia Łanocha-Arendarczyk
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.K.); (N.Ł.-A.); (E.K.)
| | - Michał Ptak
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Aleksandra Łanocha
- Department of Haematology and Transplantology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Elżbieta Kalisińska
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.K.); (N.Ł.-A.); (E.K.)
| | - Danuta Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| |
Collapse
|
12
|
Aksoy OY, Koksoy AY, Kiremitci S, Cakar N, Cayci FS. A rare cause of postinfectious glomerulonephritis: Answers. Pediatr Nephrol 2021; 36:557-559. [PMID: 32588222 DOI: 10.1007/s00467-020-04674-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ozlem Yuksel Aksoy
- Department of Pediatric Nephrology, Kayseri City Hospital, Kayseri, Turkey
| | - Adem Yasin Koksoy
- Department of Pediatric Nephrology, Van Training and Research Hospital, Van, Turkey
| | - Saba Kiremitci
- Department of Pathology, Ankara University, Ankara, Turkey
| | - Nilgun Cakar
- Department of Pediatric Nephrology, Ankara University, Ankara, Turkey
| | - Fatma Semsa Cayci
- Department of Pediatric Nephrology, University of Health Sciences, Ankara City Hospital, Ankara Şehir Hastanesi, Bilkent Bulvarı, No: 1, Ankara, Turkey.
| |
Collapse
|
13
|
The balance between IL-12/IL4 in renal tissue switches the inflammatory response arm and shows relationship with the clinical signs in Leishmania-infected dogs. Vet Immunol Immunopathol 2021; 234:110196. [PMID: 33582406 DOI: 10.1016/j.vetimm.2021.110196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/21/2020] [Accepted: 01/23/2021] [Indexed: 11/24/2022]
Abstract
The pathogenesis of Canine leishmaniosis (CanL) is associated with altered cytokine expression and parasitic tissue shows a lot of inflammation. The aim of this study was to assess the renal inflammation and cytokine expression in eight symptomatic and eight asymptomatic Leishmania- infected dogs, and seven uninfected control dogs. Kidney fragments were stained with hematoxylin and eosin for morphometric evaluation. mRNA expression levels of interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, IL-4, IL-10, and IL-12 were assessed in the kidney fragments using quantitative real time-polymerase chain reaction. Inflammation, quantified by the average area of the infiltrated immune cells, was greater in symptomatic dogs than in those asymptomatic, whereas asymptomatic dogs exhibited higher inflammation than the control dogs (p > 0.05, Tukey's test). Expression levels of IFN-γ, TNF-α, IL-4, IL-10, and IL-12 were upregulated in symptomatic dogs and downregulated in asymptomatic dogs compared with those of the uninfected group. Furthermore, IL-4 showed higher expression in symptomatic dogs than in asymptomatic ones (p < 0.05, Mann-Whitney test), which was directly associated with clinical manifestations (p < 0.05, Chi-square test). However, IL-12 was predominantly expressed in symptomatic dogs, shifting the balance from IL-12/IL-4 to IL-12, which elicits a change in the inflammatory response. Leishmania was not found in the renal tissues in any one of the studied groups. Our data suggests that the balance between IL-12 and IL-4 plays an important role in the regulation of inflammation in renal tissue and clinical presentations in CanL.
Collapse
|
14
|
Viana Nunes AM, das Chagas Pereira de Andrade F, Filgueiras LA, de Carvalho Maia OA, Cunha RLOR, Rodezno SVA, Maia Filho ALM, de Amorim Carvalho FA, Braz DC, Mendes AN. preADMET analysis and clinical aspects of dogs treated with the Organotellurium compound RF07: A possible control for canine visceral leishmaniasis? ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 80:103470. [PMID: 32814174 DOI: 10.1016/j.etap.2020.103470] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
Tellurium compounds have been described as potential leishmanicides, bearing promising leishmanicidal and antimalarial effects. Therefore, the present study investigated the pharmacological potential of the organotellurane compound RF07 through preADMET parameters, such as absorption, distribution, metabolism and excretion. After studying the pharmacokinetic properties of RF07, studies were carried out on dogs naturally infected with visceral leishmaniasis after the administration of RF07, in order to assess pathophysiological parameters. Thus, dogs were divided into 4 groups with administration of daily intraperitoneal injections for 3 weeks (containing RF07 or placebo). During the trial, hematological parameters, renal and hepatic toxicity were evaluated. Serum urea, creatinine, alkaline phosphatase, transaminases (GOT and GPT), as well as hemogram results, were evaluated before the first administration and during the second and third weeks after the start of the treatment. In dogs with VL, RF07 improved liver damage, regulated GPT levels and significantly decreased leukocyte count, promoting its regularization. These phenomena occurred at the end of the third week of treatment. The administration of RF07 promoted a significant decrease in the average levels of GOT and GPT after the third week of treatment and did not significantly alter the hematological parameters. The application of RF07 in the treatment of visceral leishmaniasis suggests that it is an alternative to the disease, since the reversal of clinical signs in dogs with VL requires the use of 0.6 mg/kg.
Collapse
Affiliation(s)
| | | | - Lívia Alves Filgueiras
- Departament of Biophysics and Physiology, Federal University of Piauí, Teresina, Piauí, Brazil
| | | | - Rodrigo L O R Cunha
- Laboratory of Chemical Biology, Center for Natural Sciences and Humanities, Federal University of ABC (UFABC), Santo André, São Paulo, Brazil
| | - Sindy V A Rodezno
- Laboratory of Chemical Biology, Center for Natural Sciences and Humanities, Federal University of ABC (UFABC), Santo André, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
15
|
Tesfanchal B, Gebremichail G, Belay G, Gebremariam G, Teklehaimanot G, Haileslasie H, Kahsu G, Gebrewahd A, Mardu F, Adhanom G, Berhe B, Teame H, Tsegaye A, Wolde M. Alteration of Clinical Chemistry Parameters Among Visceral Leishmaniasis Patients in Western Tigrai, Ethiopia, 2018/2019: A Comparative Cross-Sectional Study. Infect Drug Resist 2020; 13:3055-3062. [PMID: 32943889 PMCID: PMC7467734 DOI: 10.2147/idr.s261698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/04/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis causes alterations of lipid metabolism and it is associated with hypocholesterolemia and severe hypertriglyceridemia. Hepatic dysfunction and life-threatening hepatitis are associated with visceral leishmaniasis. Kidney damage is frequently associated with increased morbidity and mortality in visceral leishmaniasis patients. METHODS A cross-sectional study was carried out to assess the alterations of clinical chemistry parameters among visceral leishmaniasis patients attending Kahsay Abera and Mearg hospitals, Northwest Ethiopia. A total of 100 visceral leishmaniasis patients and 100 healthy controls without visceral leishmaniasis were selected by using convenient sampling techniques. Data were entered and analyzed using statistical package for social sciences (SPSS) version 23. RESULTS Results were showed that the mean value of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, and triglyceride was significantly higher in visceral leishmaniasis patients than in apparently healthy controls, but the mean value of serum urea and total cholesterol was significantly lower in visceral leishmaniasis patients than healthy controls. CONCLUSION The finding of this study concluded that visceral leishmaniasis causes significant alterations of clinical chemistry tests like liver and lipid profile tests compared to healthy controls.
Collapse
Affiliation(s)
- Brhane Tesfanchal
- Unit of Clinical Chemistry, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Gebremedhin Gebremichail
- Unit of Hematology and Immuno-Hematology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Getachew Belay
- Unit of Clinical Chemistry, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Gebreslassie Gebremariam
- Unit of Clinical Chemistry, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebreyohannes Teklehaimanot
- Unit of Hematology and Immuno-Hematology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hagos Haileslasie
- Unit of Hematology and Immuno-Hematology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Getachew Kahsu
- Unit of Clinical Chemistry, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Aderajew Gebrewahd
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Fitsum Mardu
- Unit of Medical Parasitology and Entomology, Department of Medical Laboratory Science, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
| | - Gebre Adhanom
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Brhane Berhe
- Unit of Medical Parasitology and Entomology, Department of Medical Laboratory Science, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
| | - Hirut Teame
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Aster Tsegaye
- Unit of Hematology and Immuno-Hematology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mistire Wolde
- Unit of Clinical Chemistry, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
16
|
Dias AFDLR, Ayres EDCBS, Maruyama FH, Monteiro BRG, de Freitas MS, de Almeida ADBPF, Mendonça AJ, Sousa VRF. Monitoring of serum and urinary biomarkers during treatment of canine visceral leishmaniasis. Vet World 2020; 13:1620-1626. [PMID: 33061236 PMCID: PMC7522955 DOI: 10.14202/vetworld.2020.1620-1626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/25/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND AIM Canine visceral leishmaniasis (CanL) has a broad spectrum of changes, with kidney disease being considered the main cause of mortality. Thus, this study aimed to monitor serum and urinary biomarkers in response to two short-term treatments for CanL. MATERIALS AND METHODS Thirty dogs with CanL were equally divided into two treatment groups and treated with either miltefosine (Group M) or miltefosine plus allopurinol (Group MA); the groups were evaluated before treatment and after 28 days of treatment. Physical exams were performed and hematimetric, biochemical, and urinary parameters, including urinary biomarkers cystatin C (CisC), lipocalin-2 (NGAL), and microalbuminuria, were measured. RESULTS Both treatments significantly reduced clinical scores (p<0.05), but only the MA group saw a reduction in the clinical-pathological score. The serum albumin and calcium levels increased significantly in the MA and M groups (p<0.05). Proteinuria and urinary density did not decrease significantly after the treatments. With regard to the biomarkers, CisC and microalbuminuria did not have any significant changes; however, NGAL was significantly reduced in the MA group (p<0.05). CONCLUSION Both pharmacotherapeutic protocols promoted clinical and clinical-pathological improvements. In addition, miltefosine plus allopurinol proved to be a safe treatment due to the lack of changes detected in the monitored renal biomarkers. The treatment with miltefosine plus allopurinol proved to be the most effective, with more pronounced beneficial effects for canines with visceral leishmaniasis.
Collapse
Affiliation(s)
- Alvaro Felipe de Lima Ruy Dias
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| | - Eveline da Cruz Boa Sorte Ayres
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| | - Fernanda Harumi Maruyama
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| | - Bruna Ribeiro Gomes Monteiro
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| | - Maria Sabrina de Freitas
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| | | | - Adriane Jorge Mendonça
- Veterinary Clinical Pathology Laboratory, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| | - Valéria Régia Franco Sousa
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| |
Collapse
|
17
|
Leishmaniasis immunopathology-impact on design and use of vaccines, diagnostics and drugs. Semin Immunopathol 2020; 42:247-264. [PMID: 32152715 DOI: 10.1007/s00281-020-00788-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
Leishmaniasis is a disease complex caused by 20 species of protozoan parasites belonging to the genus Leishmania. In humans, it has two main clinical forms, visceral leishmaniasis (VL) and cutaneous or tegumentary leishmaniasis (CL), as well as several other cutaneous manifestations in a minority of cases. In the mammalian host Leishmania parasites infect different populations of macrophages where they multiply and survive in the phagolysosomal compartment. The progression of both VL and CL depends on the maintenance of a parasite-specific immunosuppressive state based around this host macrophage infection. The complexity and variation of immune responses and immunopathology in humans and the different host interactions of the different Leishmania species has an impact upon the effectiveness of vaccines, diagnostics and drugs.
Collapse
|
18
|
Meneses GC, da Silva GB, Tôrres PPBF, de Castro VQ, Lopes RL, Martins AMC, Daher EDF. Novel kidney injury biomarkers in tropical infections: a review of the literature. Rev Inst Med Trop Sao Paulo 2020; 62:e14. [PMID: 32074217 PMCID: PMC7032010 DOI: 10.1590/s1678-9946202062014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 12/29/2022] Open
Abstract
Tropical diseases are mainly found in the tropical regions of Asia, Africa and Latin America. They are a major Public Health problem in these regions, most of them are considered neglected diseases and remain as important contributors to the development of AKI (Acute Kidney Injury), which is associated with increased patients' morbidity and mortality. In most countries, kidney disease associated to tropical diseases is attended at health services with poor infrastructure and inadequate preventive measures. The long-term impacts of these infections on kidney tissue may be a main cause of future kidney disease in these patients. Therefore, the investigation of novel kidney injury biomarkers in these tropical diseases is of utmost importance to explain the mechanisms of kidney injury, to improve their diagnosis and prognosis, as well as the assessment to health systems by these patients. Since 2011, our group has been studying renal biomarkers in visceral and cutaneous leishmaniasis, schistosomiasis, leptospirosis and leprosy. This study has increased the knowledge on the pathophysiology of kidney disease in the presence of these infections and has contributed to the early diagnosis of kidney injury, pointing to glomerular, endothelial and inflammatory involvement as the main causes of the mechanisms leading to nephropathy and clinical complications. Future perspectives comprise establishing long-term cohort groups to assess the development of kidney disease and the patients' survival, as well as the use of new biomarkers such as urinary exosomes to detect risk groups and to understand the progression of kidney injuries.
Collapse
Affiliation(s)
- Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
| | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Paulo Pacelli Bezerra Filizola Tôrres
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Valeska Queiroz de Castro
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Renata Lima Lopes
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
| |
Collapse
|
19
|
Bezerra GSN, Barbosa WL, Silva EDD, Leal NC, Medeiros ZMD. Urine as a promising sample for Leishmania DNA extraction in the diagnosis of visceral leishmaniasis - a review. Braz J Infect Dis 2019; 23:111-120. [PMID: 31054271 PMCID: PMC9425670 DOI: 10.1016/j.bjid.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 02/04/2023] Open
Abstract
Visceral leishmaniasis is a serious and debilitating infection with high fatality rate in tropical and subtropical countries. As clinical symptoms of visceral leishmaniasis are not so specific, confirmatory diagnostic methods with high sensitivity and specificity are needed. Noninvasive methods have been developed using urine as a clinical sample for visceral leishmaniasis diagnosis. In fact, there is a clear correlation between kidney impairment and Leishmania DNA in urine. However, it has been proved that Leishmania nucleic acid may also be isolated from patients without any sign of renal involvement. Even though urine has become a promissing biological sample, it is still not widely used due to several issues, such as (i) incomprehension of the whole renal pathophysiology process in visceral leishmaniasis, (ii) presence of many amplification inhibitors in urine, and (iii) lack of an efficient urinary DNA extraction method. In this article, we performed a literature review to bring a new perspective for Leishmania DNA isolation in urine.
Collapse
Affiliation(s)
- Gilberto Silva Nunes Bezerra
- Universidade de Pernambuco (UPE), Programa de Pós-Graduação em Ciências da Saúde, Recife, PE, Brazil; Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Parasitologia, Recife, PE, Brazil.
| | - Walter Lins Barbosa
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Parasitologia, Recife, PE, Brazil
| | - Elis Dionísio da Silva
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Parasitologia, Recife, PE, Brazil
| | - Nilma Cintra Leal
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Microbiologia, Recife, PE, Brazil
| | - Zulma Maria de Medeiros
- Universidade de Pernambuco (UPE), Programa de Pós-Graduação em Ciências da Saúde, Recife, PE, Brazil; Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Parasitologia, Recife, PE, Brazil
| |
Collapse
|
20
|
Alwazzeh MJ, Alhashimalsayed ZH. Visceral Leishmaniasis and Glomerulonephritis: A Case Report. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:40-43. [PMID: 30787856 PMCID: PMC6381853 DOI: 10.4103/sjmms.sjmms_166_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Visceral leishmaniasis is an endemic in the southwestern region of Saudi Arabia, with a low incidence rate. Clinical presentations of visceral leishmaniasis include recurrent fever, substantial weight loss, hepatosplenomegaly and anemia. However, the clinical features may not be easily evident owing to the involvement of multiple organs. This, in turn, can cause difficulties in establishing the correct diagnosis, and subsequently, in managing the patient. Here, the authors report a case of a 42-year-old male from Jizan, southwestern Saudi Arabia, who presented with impaired renal function. After kidney biopsy, the patient was diagnosed with glomerulonephritis of unknown etiology and treated with mycophenolate and prednisone. After 3 months, the patient developed high fever with hepatomegaly and pancytopenia. Based on the investigations, a possible diagnosis of visceral leishmaniasis was considered. Accordingly, he was treated with liposomal amphotericin B, following which his condition improved significantly. This case report discusses the relationship between glomerulonephritis and visceral leishmaniasis and focuses on the potential consequences of glomerulonephritis management without investigating the etiology of the underlying diseases, especially in patients from tropical and subtropical areas.
Collapse
Affiliation(s)
- Marwan Jabr Alwazzeh
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Zaki Hajji Alhashimalsayed
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| |
Collapse
|
21
|
Cuestas D, Forero Y, Galvis I, Peñaranda E, Cortes C, Motta A, Mora S, Pérez C, Velasquez O, Puentes J. Drug reaction with eosinophilia and systemic symptoms (DRESS) and multiple organ dysfunction syndrome (MODS): one more reason for a new effective treatment against leishmaniasis. Int J Dermatol 2018; 57:1304-1313. [PMID: 30156263 DOI: 10.1111/ijd.14126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 05/15/2018] [Accepted: 06/08/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced reaction associated with eosinophilia and systemic manifestations. Anticonvulsants, sulfonamides, and antivirals are the most related and described drugs in DRESS syndrome. METHODS AND CASE We present a case of severe multiple organ dysfunction syndrome (MODS) with the risk of death associated with DRESS syndrome due to antileishmanial pentavalent antimonial drug and its simultaneous toxicity. Consequently, a comprehensive review of the main clinical problems and comparative discussion of both clinical conditions was made. DISCUSSION The overlap of DRESS syndrome and antileishmanial pentavalent antimonial drug toxicity can be life-threatening. Both conditions represent a true clinical, diagnostic, and therapeutic challenge. We exposed specific clinical and laboratory results with rare occurrence. CONCLUSION Any physician and dermatologists should keep in mind the broad spectrum of clinical manifestations and laboratory findings associated with the use of pentavalent antimonial drugs. The clinical suspicion, an early diagnosis, and aggressive treatment are essential to prevent complications and death.
Collapse
Affiliation(s)
- Daniel Cuestas
- Dermatology Program, El Bosque University, Bogotá, Colombia
| | - Yency Forero
- Internal Medicine Department, University Hospital of the Samaritan ESE, Bogotá, Colombia.,Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia
| | - Ingrid Galvis
- Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia.,Rheumatology Department, University Hospital of the Samaritan ESE, Bogotá, Colombia
| | - Elkin Peñaranda
- Dermatology Department, University Hospital of the Samaritana ESE, Bogotá, Colombia
| | - Carolina Cortes
- Dermatology Department, University Hospital of the Samaritana ESE, Bogotá, Colombia
| | - Adriana Motta
- Dermatology Program, El Bosque University, Bogotá, Colombia
| | - Sergio Mora
- Head of the Rheumatology Department, University Hospital of the Samaritan ESE, Bogotá, Colombia
| | - Carlos Pérez
- Infectious Diseases Department, Hospital of the Samaritana, Bogotá, Colombia
| | - Oscar Velasquez
- Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia
| | - José Puentes
- Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia
| |
Collapse
|
22
|
Infections and the kidney: a tale from the tropics. Pediatr Nephrol 2018; 33:1317-1326. [PMID: 28879600 DOI: 10.1007/s00467-017-3785-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/01/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023]
Abstract
Tropical infections are caused by a variety of bacteria, viruses and parasitic organisms across varying geographical regions and are more often reported in adults than in children. Most of the infections are acute, presenting as a febrile illness with involvement of multiple organ systems, including the kidney. The gamut of renal manifestations extends from asymptomatic urinary abnormalities to acute kidney injury and-albeit rarely-chronic kidney disease. Tropical infections can involve the glomerular, tubulointerstitial and vascular compartments of the kidney. Leptospirosis, malaria, dengue, rickettsial fever and schistosomiasis are the most prevalent tropical infections which affect the kidneys of children living in the tropics. In this review we discuss renal involvement in these most prevalent tropical infections.
Collapse
|
23
|
Meneses GC, De Francesco Daher E, da Silva Junior GB, Bezerra GF, da Rocha TP, de Azevedo IEP, Libório AB, Martins AMC. Visceral leishmaniasis-associated nephropathy in hospitalised Brazilian patients: new insights based on kidney injury biomarkers. Trop Med Int Health 2018; 23:1046-1057. [PMID: 29987885 DOI: 10.1111/tmi.13127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the usefulness of early acute kidney injury (AKI) biomarkers in clinical management of visceral leishmaniasis. METHODS Prospective study with 50 hospitalised VL patients. AKI biomarkers, that is, serum and urinary neutrophil gelatinase-associated lipocalin (sNGAL, uNGAL, respectively), urinary kidney injury molecule-1 (uKIM-1) and urinary monocyte chemotactic protein-1 (uMCP-1), were quantified by immunoassay (ELISA). Also, interferon-gamma (INF-y) and C-reactive protein (CRP) were evaluated as inflammatory biomarkers possibly related to VL severity. RESULTS VL patients had hyponatremia, hypoalbuminemia, hypergammaglobulinemia, haematologic and hepatic disorders. AKI was found in 46%, and one death (2%) occurred. The AKI group had significant longer hospital stay, lower levels of IFN-y and higher levels of CRP, more clinical renal abnormalities and higher levels of sNGAL, uNGAL, uKIM-1 and uMCP-1. Overall, sNGAL, uKIM-1 and uMCP-1 showed correlations with important clinical renal abnormalities, such as proteinuria, albuminuria, serum creatinine and glomerular filtration rate using adjusted correlations with CRP and IFN-y. Only sNGAL showed an early association with AKI development (OR = 2.78, 95% CI = 1.429-5.428, per each increase of 50 ng/ml), even after adjusting for clinical signals of VL severity and for immune biomarkers. Moreover, sNGAL showed a better performance in predicting AKI development (AUC-ROC = 0.81, 95% CI = 0.69-0.93; cut-off = 154 ng/ml, sensitivity = 82.6%, specificity = 74.1%, P < 0.001). CONCLUSIONS Visceral leishmaniasis-associated nephropathy showed important proximal tubular injury and glomerular inflammation. Serum NGAL showed an early association with VL-associated nephropathy and may be used to improve clinical management strategies and decrease morbimortality in VL patients.
Collapse
Affiliation(s)
- Gdayllon C Meneses
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.,Medical Sciences Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Geraldo B da Silva Junior
- Collective Health Graduate Program, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Brazil
| | - Gabriela F Bezerra
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Thaiany P da Rocha
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Isabella E P de Azevedo
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre B Libório
- Medical Sciences Post-Graduate Program, University of Fortaleza, Fortaleza, Brazil
| | - Alice M C Martins
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.,Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| |
Collapse
|
24
|
Daher EDF, Soares DDS, Filho SLAP, Meneses GC, Freitas TVDS, Leite TT, da Silva Junior GB. Hyponatremia and risk factors for death in human visceral leishmaniasis: new insights from a cross-sectional study in Brazil. BMC Infect Dis 2017; 17:168. [PMID: 28231825 PMCID: PMC5322621 DOI: 10.1186/s12879-017-2257-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
Background Visceral leishmaniasis (VL) is an important and potentially fatal neglected tropical disease. The aim of this study was to investigate hyponatremia and risk factors for death among VL patients. Methods This is a cross-sectional study with VL patients admitted to a tertiary hospital in Northeast Brazil, from 2002 to 2009. Patients were divided into two groups: non-survivors and survivors. Hyponatremia was defined as serum sodium < 135 mEq/L. A logistic regression model was done to investigate risk factors for death. Results A total of 285 VL patients were included, with mean age 37 ± 15 years, and 74% were males. Thirty-four patients died (11.9%). Non-survivors had a significantly higher prevalence of dyspnea (38.2 vs. 16.7%, p = 0.003), pulmonary crackles (11.8 vs. 4.0%, p = 0.049), dehydration (23.5 vs. 10.8%, p = 0.033), oliguria (8.8 vs. 0.8%, p = 0.001) and jaundice (47.1 vs. 14.3%, p < 0.001). They also presented higher prevalence of hyponatremia (41.9 vs. 24.1%, p = 0.035), thrombocytopenia (91.2 vs. 65.3%, p = 0.002) and severe hypoalbuminemia (78.3 vs. 35.3%, p < 0.001). In multivariate analysis, moderate/severe hyponatremia (OR = 2.278, 95% CI = 1.046–4.962), thrombocytopenia (OR = 5.482, 95% CI = 1.629–18.443), jaundice (OR = 5.133, 95% CI = 1.793–14.696) and severe hypoalbuminemia (OR = 6.479, 95% CI = 2.124–19.766) were predictors of death. Conclusion Higher prevalence of dehydration, oliguria, pulmonary symptoms and liver involvement was found in non-survivors VL patients. Hypoalbuminemia and hyponatremia were frequent and significantly associated with mortality.
Collapse
Affiliation(s)
- Elizabeth De Francesco Daher
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil. .,Medical Sciences Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil.
| | - Douglas de Sousa Soares
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil
| | - Sérgio Luiz Arruda Parente Filho
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil
| | - Gdayllon Cavalcante Meneses
- Pharmacology Graduate Program, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Tainá Veras de Sandes Freitas
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil
| | - Tacyano Tavares Leite
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil
| | - Geraldo Bezerra da Silva Junior
- School of Medicine, Public Health Graduate Program, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| |
Collapse
|
25
|
Pessoa-E-Silva R, Mendonça Trajano-Silva LA, Lopes da Silva MA, da Cunha Gonçalves-de-Albuquerque S, de Goes TC, Silva de Morais RC, Lopes de Melo F, de Paiva-Cavalcanti M. Evaluation of urine for Leishmania infantum DNA detection by real-time quantitative PCR. J Microbiol Methods 2016; 131:34-41. [PMID: 27713020 DOI: 10.1016/j.mimet.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/05/2016] [Accepted: 10/01/2016] [Indexed: 11/17/2022]
Abstract
The availability of some sorts of biological samples which require noninvasive collection methods has led to an even greater interest in applying molecular biology on visceral leishmaniasis (VL) diagnosis, since these samples increase the safety and comfort of both patients and health professionals. In this context, this work aimed to evaluate the suitability of the urine as a specimen for Leishmania infantum kinetoplast DNA detection by real-time quantitative PCR (qPCR). Subsequent to the reproducibility analysis, the detection limit of the qPCR assay was set at 5fg (~0.025 parasites) per μL of urine. From the comparative analysis performed with a set of diagnostic criteria (serological and molecular reference tests), concordance value of 96.08% was obtained (VL-suspected and HIV/AIDS patients, n=51) (P>0.05). Kappa coefficient (95% CI) indicated a good agreement between the test and the set of diagnostic criteria (k=0.778±0.151). The detection of Leishmania DNA in urine by qPCR was possible in untreated individuals, and in those with or without suggestive renal impairment. Fast depletion of the parasite's DNA in urine after treatment (from one dose of meglumine antimoniate) was suggested by negative qPCR results, thus indicating it as a potential alternative specimen to follow up the efficacy of therapeutic approaches. Even when evaluated in a clinically heterogeneous set of patients, the urine showed good prospect as sample for VL diagnosis by qPCR, also indicating a good negative predictive value for untreated suspected patients.
Collapse
Affiliation(s)
- Rômulo Pessoa-E-Silva
- Aggeu Magalhães Research Center, Av. Moraes Rego, Cidade Universitária, CEP 50670-420 Recife, PE, Brazil; Public Health's Central Laboratory Dr. Milton Bezerra Sobral (LACEN-PE), Praça Oswaldo Cruz, S/N, Soledade, CEP 50050-215 Recife, PE, Brazil.
| | | | | | - Suênia da Cunha Gonçalves-de-Albuquerque
- Aggeu Magalhães Research Center, Av. Moraes Rego, Cidade Universitária, CEP 50670-420 Recife, PE, Brazil; Public Health's Central Laboratory Dr. Milton Bezerra Sobral (LACEN-PE), Praça Oswaldo Cruz, S/N, Soledade, CEP 50050-215 Recife, PE, Brazil.
| | - Tayná Correia de Goes
- Aggeu Magalhães Research Center, Av. Moraes Rego, Cidade Universitária, CEP 50670-420 Recife, PE, Brazil.
| | | | - Fábio Lopes de Melo
- Aggeu Magalhães Research Center, Av. Moraes Rego, Cidade Universitária, CEP 50670-420 Recife, PE, Brazil.
| | - Milena de Paiva-Cavalcanti
- Aggeu Magalhães Research Center, Av. Moraes Rego, Cidade Universitária, CEP 50670-420 Recife, PE, Brazil.
| |
Collapse
|
26
|
Baltazar PI, Da Silva Moura L, Pessoa GT, De Sá Rodrigues RP, Sanches MP, Das Neves Diniz A, Das Chagas Araújo Sousa F, Guerra PC, Neves WC, Giglio RF, De Jesus Rosa Pereira Alves J, De Assis Leite Souza F, Braga JFV, Alves FR. Comparative B-mode and Doppler renal ultrasonography with histopathological findings in dogs positive for canine visceral leishmaniasis. Microsc Res Tech 2016; 79:637-45. [PMID: 27194210 DOI: 10.1002/jemt.22677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/23/2016] [Accepted: 04/18/2016] [Indexed: 01/09/2023]
Abstract
Morphological parameters and renal flow were assessed and measured in six clinically healthy dogs with negative serological and parasitological examinations for canine visceral leishmaniasis (CVL) and six dogs with CVL-positive serological and parasitological tests and asymptomatic condition of the disease. Kidney length and diameter were measured and compared with the aorta/kidney ratio. Alterations in flow were measured using the flow velocity (cm/s) and resistance index (RI). Renal function was assessed by serum biochemical examination (urea, creatine, total proteins, albumin, and globulin) and urinalysis. CVL-positive animals presented heterogeneous kidney echotexture, reduced vascular flow, hypoperfusion, lesser visualization of the arcuate arteries, high RI values (1.06 ± 0.28 for the right kidney and 1.10 ± 0.30 for the left kidney), reduced diastolic flow, and high systolic peak. They also presented positive creatine/RI correlation and between the renal artery vascular flow and kidney diameter. Histopathological analysis of CVL-positive animals was compatible and confirmed hemodynamic changes observed by Doppler ultrasound. The findings in the present study showed that Doppler ultrasonography is a valid method to assess and detect alterations in flow in renal pathological processes with kidney vascular damage, as in the case of leishmaniasis, and can help in the diagnosis of animals with this infection. Microsc. Res. Tech. 79:637-645, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Pollyana Irene Baltazar
- Animal Science Post-Graduate Program, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| | - Laecio Da Silva Moura
- Animal Science Post-Graduate Program, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| | - Gerson Tavares Pessoa
- Animal Science Post-Graduate Program, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| | - Renan Paraguassu De Sá Rodrigues
- Graduate of Veterinary Medicine, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| | - Marina Pinto Sanches
- Graduate of Veterinary Medicine, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| | - Anaemilia Das Neves Diniz
- Animal Science Post-Graduate Program, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| | - Francisco Das Chagas Araújo Sousa
- Animal Science Post-Graduate Program, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| | - Porfírio Candanedo Guerra
- Health Department Clinics, State University of Maranhão, Campus Paulo VI, São Luís, Maranhão, 65055-310, Brazil
| | - Willams Costa Neves
- Department of Morphophysiology, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| | - Robson Fortes Giglio
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, 32610
| | | | | | - Juliana Fortes Vilarinho Braga
- Department of Clinical and Veterinary Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 30161-970, Brazil
| | - Flávio Ribeiro Alves
- Department of Morphophysiology, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil
| |
Collapse
|
27
|
Martín-Martín I, Jiménez M, González E, Eguiluz C, Molina R. Natural transmission of Leishmania infantum through experimentally infected Phlebotomus perniciosus highlights the virulence of Leishmania parasites circulating in the human visceral leishmaniasis outbreak in Madrid, Spain. Vet Res 2015; 46:138. [PMID: 26645907 PMCID: PMC4673772 DOI: 10.1186/s13567-015-0281-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022] Open
Abstract
A human leishmaniasis outbreak is occurring in the Madrid region, Spain, with the parasite and vector involved being Leishmania infantum and Phlebotomus perniciosus respectively. The aim of this study was to investigate the virulence of L. infantum isolates from the focus using a natural transmission model. Hamsters were infected by intraperitoneal inoculation (IP) or by bites of sand flies experimentally infected with L. infantum isolates obtained from P. perniciosus collected in the outbreak area (IPER/ES/2012/BOS1FL1 and IPER/ES/2012/POL2FL6) and a well characterized L. infantum strain JPCM5 (MCAN/ES/98/LLM-877). Hamster infections were monitored by clinical examination, serology, culture, parasite burden, Giemsa-stained imprints, PCR, histopathology and xenodiagnostic studies. Establishment of infection of L. infantum was achieved with the JPCM5 strain and outbreak isolates by both P. perniciosus infective bites or IP route. However, high virulence of BOS1FL1 and POL2FL6 isolates was highlighted by the clinical outcome of disease, high parasite detection in spleen and liver, high parasitic loads and positivity of Leishmania serology. Transmission by bite of POL2FL6 infected flies generated a slower progression of clinical disease than IP infection, but both groups were infective to P. perniciosus by xenodiagnosis at 2 months post-infection. Conversely, hamsters inoculated with JPCM5 were not infective to sand flies. Histopathology studies confirmed the wide spread of POL2FL6 parasites to several organs. A visceral leishmaniasis model that mimics the natural transmission in nature allowed us to highlight the high virulence of isolates that are circulating in the focus. These findings contribute to a better understanding of the outbreak epidemiology.
Collapse
Affiliation(s)
- Inés Martín-Martín
- Unidad de Entomología Médica, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo s/n, Majadahonda, 28220, Madrid, Spain.
| | - Maribel Jiménez
- Unidad de Entomología Médica, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo s/n, Majadahonda, 28220, Madrid, Spain.
| | - Estela González
- Unidad de Entomología Médica, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo s/n, Majadahonda, 28220, Madrid, Spain.
| | - César Eguiluz
- Unidad de Veterinaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo s/n, Majadahonda, 28220, Madrid, Spain.
| | - Ricardo Molina
- Unidad de Entomología Médica, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo s/n, Majadahonda, 28220, Madrid, Spain.
| |
Collapse
|
28
|
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a serious complication of visceral leishmaniasis (VL). The aim of this study is to describe demographical, clinical and laboratory features of HLH in children with VL. METHODS This is a retrospective cohort of children with HLH and VL admitted to a tertiary hospital in Northeast, Brazil, from January 2012 to April 2014. Clinical and laboratory data at admission and during hospital stay were reviewed. Acute kidney injury (AKI) was defined according to the pediatric Risk, Injury, Failure, Loss, End-stage kidney disease criteria. RESULTS A total 127 VL children were admitted, and 35 children had diagnosis of HLH. Mean age was 4.2 ± 4.3 years, with 62.9% males. Mean hospital stay was 29 ± 12 days. Main signs and symptoms were fever (100%), splenomegaly (94.2%) and hepatomegaly (60%). Laboratory findings showed pancytopenia, albumin 3.03 ± 0.77 g/dL, fibrinogen 236.1 ± 117.2 mg/dL, total calcium 8.2 ± 1.2 mEq/L, lactate dehydrogenase 1804 ± 1019 mg/dL, alkaline phosphatase 1275.4 ± 2160.5 IU/L, total bilirubin 1.9 ± 2.4 mg/dL, direct bilirubin 0.67 ± 1.02 mg/dL, indirect bilirubin 1.2 ± 2.2 mg/dL, aspartate aminotransferase 140.0 ± 145.3 IU/L, alanine aminotransferase 71.4 ± 81.1 IU/L, ferritin 4296.5 ± 8028.8 ng/dL and triglycerides 333 ± 141 mg/dL. AKI was observed in 16 children (45.7%), predominantly mild forms (93.75% "risk"). AKI group presented lower levels of platelets (69,131 ± 40,247 vs. 138,678 ± 127,494/mm, P = 0.035) than non-AKI. No patient required dialysis and there was no death. CONCLUSIONS HLH was not a rare complication of VL. Main symptoms were compatible with both VL and HLH. Main laboratory findings reflected HLH pathophysiology. Mild forms of AKI were a common complication of HLH. Despite the disease severity and complications, mortality was low.
Collapse
|
29
|
Santana IU, Dias B, Nunes EAS, Rocha FACD, Silva FS, Santiago MB. Visceral leishmaniasis mimicking systemic lupus erythematosus: Case series and a systematic literature review. Semin Arthritis Rheum 2014; 44:658-65. [PMID: 25704907 DOI: 10.1016/j.semarthrit.2014.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/10/2014] [Accepted: 12/19/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease that may present manifestations that resemble other diseases. Visceral leishmaniasis (VL) is a parasitic infection whose hallmarks may mimic SLE symptoms. Here, we report a case series and evaluate the published, scientific evidence of the relationship between SLE and VL infection. METHODS To assess original studies reporting cases of VL-infected patients presenting manifestations that are capable of leading to inappropriate suspicions of SLE or mimicking an SLE flare, we performed an extensive search in several scientific databases (MEDLINE, LILACS, SciELO, and Scopus). Two authors independently screened all citations and abstracts identified by the search strategy to identify eligible studies. Secondary references were additionally obtained from the selected articles. RESULTS The literature search identified 53 eligible studies, but only 17 articles met our criteria. Among these, 10 lupus patients with VL mimicking an SLE flare and 18 cases of VL leading to unappropriated suspicions of SLE were described. The most common manifestations in patients infected with VL were intermittent fever, pancytopenia, visceromegaly, and increased serum level of acute phase reactants. The most frequent autoantibodies were antinuclear antibodies, rheumatoid factor, and direct Coombs' test. CONCLUSION In endemic areas for VL, the diagnosis of SLE or its exacerbation may be a clinical dilemma. Hepatosplenomegaly or isolated splenomegaly was identified in the majority of the reported cases where VL occurred, leading to unappropriated suspicions of SLE or mimicking an SLE flare. Furthermore, the lack of response to steroids, the normal levels of complement proteins C3 and C4, and the increased level of transaminases suggest a possible infectious origin.
Collapse
Affiliation(s)
- Iuri Usêda Santana
- Serviço de Clínica Médica do Hospital Geral Roberto Santos, Salvador, Brazil
| | - Blenda Dias
- Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil
| | - Eduardo Araújo Santana Nunes
- Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil
| | | | | | - Mittermayer Barreto Santiago
- Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil.
| |
Collapse
|
30
|
Hernández M, González-Lama Y, Ramos A, Martínez-Ruiz R, Calvo M, Matallana V, Vera MI, Suarez C, Blázquez I, Abreu L. Visceral leishmaniasis as an unusual infectious complication in a patient with Crohn's disease treated with infliximab. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 38:411-2. [PMID: 25443540 DOI: 10.1016/j.gastrohep.2014.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/03/2014] [Accepted: 08/15/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Marta Hernández
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
| | - Yago González-Lama
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Antonio Ramos
- Infectious Diseases Unit, Internal Medicine Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Rocío Martínez-Ruiz
- Microbiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Marta Calvo
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Virginia Matallana
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - María Isabel Vera
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Cristina Suarez
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Isabel Blázquez
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Luis Abreu
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| |
Collapse
|