1
|
Valencia-Portillo RT, Lindoso JA, Celeste BJ, Bittencourt AA, de Brito MEF, Duthie MS, Guderian J, Guerra J, Oliveira ALL, Reed S, Rocha MC, Santos NT, Silveira FT, Goto H, Sanchez MCA. ELISA with recombinant antigen Lb6H validated for the diagnosis of American tegumentary leishmaniasis. PLoS One 2024; 19:e0304268. [PMID: 38838004 DOI: 10.1371/journal.pone.0304268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
American tegumentary leishmaniasis (ATL) diagnosis is an open question, and the search for a solution is urgent. The available tests that detect the etiological agent of the infection are specific for ATL diagnosis. However, they present disadvantages, such as low sensitivity and the need for invasive procedures to obtain the samples. Immunological methods (leishmanin skin test and search for anti-Leishmania antibodies) are good alternatives to the etiological diagnosis of ATL. Presently, we face problems with disease confirmation due to the discontinuity in the production of leishmanin skin test antigen, particularly in resource-poor settings. Aiming to diagnose ATL, we validated rLb6H-ELISA for IgG antibodies using 1,091 samples from leishmaniasis patients and healthy controls, divided into four panels, living in 19 Brazilian endemic and non-endemic states. The rLb6H-ELISA showed a sensitivity of 98.6% and a specificity of 100.0%, with the reference panel comprising 70 ATL patient samples and 70 healthy controls. The reproducibility evaluation showed a coefficient of variation of positive samples ≤ 8.20% for repeatability, ≤ 17,97% for reproducibility, and ≤ 8.12% for homogeneity. The plates sensitized with rLb6H were stable at 4°C and -20°C for 180 days and 37°C for seven days, indicating 12 months of validity. In samples of ATL patients from five research and healthcare centers in endemic and non-endemic areas, rLb6H-ELISA showed a sensitivity of 84.0%; no significant statistical difference was observed among the five centers (chi-square test, p = 0.13). In samples of healthy controls from four areas with different endemicity, a specificity of 92.4% was obtained; lower specificity was obtained in a visceral leishmaniasis high endemicity locality (chi-square test, p<0.001). Cross-reactivity was assessed in 166 other disease samples with a positivity of 13.9%. Based on the good diagnostic performance and the reproducibility and stability of the antigen, we suggest using ELISA-rLb6H to diagnose ATL.
Collapse
Affiliation(s)
- Ruth Tamara Valencia-Portillo
- Faculdade de Medicina, Instituto de Medicina Tropical de Sao Paulo, Laboratório de Soroepidemiologia, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - José Angelo Lindoso
- Faculdade de Medicina, Instituto de Medicina Tropical de Sao Paulo, Laboratório de Soroepidemiologia, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
- Instituto de Infectologia Emílio Ribas, Secretaria de Saúde do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
- Faculdade de Medicina, Instituto de Medicina Tropical de Sao Paulo, Laboratório de Protozoologia, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Beatriz Julieta Celeste
- Faculdade de Medicina, Instituto de Medicina Tropical de Sao Paulo, Laboratório de Soroepidemiologia, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
- Faculdade de Medicina, Departamento de Medicina Preventiva, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Amanda Azevedo Bittencourt
- Instituto de Infectologia Emílio Ribas, Secretaria de Saúde do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
- Global Medical Affairs, MSD in Brazil, Sao Paulo, São Paulo, Brazil
| | | | | | - Jeffery Guderian
- Access to Advanced Health Institute, Seattle, Washington, United States of America
| | - Jorge Guerra
- Fundacao de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Ana Lúcia Lyrio Oliveira
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Steven Reed
- Host Directed Therapeutics, Seattle, Washington, United States of America
| | - Mussya Cisotto Rocha
- Laboratório de Investigação Médica (LIM 48), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Nicolle Tayná Santos
- Fundacao de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Fernando Tobias Silveira
- Departamento de Parasitologia, Instituto Evandro Chagas, Pará, Pará, Brazil
- Núcleo de Medicina Tropical, Universidade Federal de Para, Pará, Brazil
| | - Hiro Goto
- Faculdade de Medicina, Instituto de Medicina Tropical de Sao Paulo, Laboratório de Soroepidemiologia, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
- Faculdade de Medicina, Departamento de Medicina Preventiva, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Maria Carmen Arroyo Sanchez
- Faculdade de Medicina, Instituto de Medicina Tropical de Sao Paulo, Laboratório de Soroepidemiologia, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
- Faculdade de Medicina, Departamento de Medicina Preventiva, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Amane M, El Mazini S, Echchakery M, Hafidi M, Lemrani M, Boussaa S. Entomological, parasitological and molecular investigations in a new focus of cutaneous leishmaniasis in Youssoufia region, Morocco. Zoonoses Public Health 2024; 71:248-257. [PMID: 38105536 DOI: 10.1111/zph.13105] [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] [Received: 08/26/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Leishmaniasis is a neglected tropical infection caused by Leishmania parasite that affect human and animal. In Morocco, the cutaneous leishmaniasis has spread substantially to the new areas. The surveillance limited to active foci may underestimate the occurrence of cutaneous leishmaniasis (CL). This study aims to investigate the local transmission of CL in rural districts of Youssoufia province, central Morocco, as a potential focus of CL. METHODS For this purpose, parasitological, molecular and entomological investigations were carried out in this area. Data collection concerns potential vectors and human cases. Thus, 402 patients were examined for suspected leishmaniasis lesions in three localities of the province of Youssoufia. In these same localities, 983 sand flies were collected by CDC light traps and sticky paper during one-night per month during 6 months. These sand flies were all identified morphologically using the Moroccan identification key. RESULTS The results showed that among the 25 skin lesions detected in a population of 402 individuals, 18 were confirmed by kDNA nested PCR as CL positive patients, of which only 25% were positive by direct examination. Leishmania tropica and Leishmania major were identified as causative agents of CL in the study area. Direct parasitological examination showed a low sensitivity (27.78%), especially for L. major, although its specificity was evaluated at 100%. Regarding entomological results, both genera of the Moroccan sand fly were collected in the study area: Genus/Phlebotomus (75.28%) and Sergentomyia (24.72%). Phlebotomus (P) papatasi, the proven vector of L. major, was the most abundant species (33.98%), followed by Paralongicollum sergenti (22.58%), the confirmed vector of L. tropica; while Sergentomyia (S) minuta, P. longicuspis, S. fallax and P. kazeruni were collected with, respectively, 17.60%, 16.99%, 7.12% and 1.73%. CONCLUSION This study constitutes the first report of CL in the study areas, as well as the coexistence of L. tropica and L. major in these rural localities. Local transmission of CL is highly probable, as indicated by the prevalence of the two proven vectors of L. major and L. tropica. To control the spread of this disease, our results suggest the use of highly sensitive molecular methods to detect CL cases in potential leishmaniasis foci, which will improve surveillance.
Collapse
Affiliation(s)
- Mounia Amane
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
| | - Sara El Mazini
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
- Laboratory of Microbial Biotechnology and Bioactive Molecules, Faculty of Sciences and Technologies, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - Mohamed Echchakery
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
- Epidemiology and Biomedical Unit, Laboratory of Sciences and Health Technologies, Higher Institute of Health Sciences, Hassan First University, Settat, Morocco
| | - Mohamed Hafidi
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
| | - Meryem Lemrani
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Samia Boussaa
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
- ISPITS-Higher Institute of Nursing and Technical Health Occupations, Ministry of Health and Social Protection, Rabat, Morocco
| |
Collapse
|
3
|
Rai T, Shrestha S, Prajapati S, Bastola A, Parajuli N, Ghimire PG, Bhandari P, Pandey K, Jain M, Matlashewski G, Bras-Goncalves R, Manandhar KD. Leishmania donovani persistence and circulation causing cutaneous leishmaniasis in unusual-foci of Nepal. Sci Rep 2023; 13:12329. [PMID: 37516780 PMCID: PMC10387047 DOI: 10.1038/s41598-023-37458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/22/2023] [Indexed: 07/31/2023] Open
Abstract
Cutaneous leishmaniasis cases have increased dramatically in recent years in Nepal. The study offers molecular identification of the Leishmania species using 40 patient's aspiration biopsy samples, targeting markers kinetoplast minicircle DNA (kDNA) and internal transcribed spacer-1 (ITS1). Among molecularly diagnosed 22 cutaneous leishmaniasis cases, L. donovani complex was identified in 13 instances and L. major in 9 cases. The ITS1 PCR was positive in 12 of the positive nested- kDNA PCR cases (12/22), confirming L. donovani complex in seven of the cases and L. major in five of the cases. In addition, the study conclude that concurrent occurrence of atypical cutaneous infections caused by L. donovani parasite in 59.1% of cases and typical cutaneous infections caused by L. major parasite in 40.9% of cases. A Phylogentic analaysis showed that the detected L. donovani species present null genetic distances from seven references of L. donovani, but slight differences between ITS1 sequences and not grouped into a significant monophyletic cluster.
Collapse
Affiliation(s)
- Tinmaya Rai
- Central Department of Biotechnology, Tribhuvan University, Kirtipur, Kathmandu, 44600, Nepal
| | - Srijan Shrestha
- Central Department of Biotechnology, Tribhuvan University, Kirtipur, Kathmandu, 44600, Nepal
| | - Sabita Prajapati
- Central Department of Biotechnology, Tribhuvan University, Kirtipur, Kathmandu, 44600, Nepal
| | - Anup Bastola
- Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, 44600, Nepal
| | | | | | | | - Kishor Pandey
- Central Department of Zoology, Tribhuvan University, Kirtipur, Kathmandu, 44600, Nepal
| | - Manju Jain
- Department of Biochemistry, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Greg Matlashewski
- Department of Microbiology and Immunology, McGill University, Montreal, QC, H3A 0G4, Canada
| | | | - Krishna Das Manandhar
- Central Department of Biotechnology, Tribhuvan University, Kirtipur, Kathmandu, 44600, Nepal.
| |
Collapse
|
4
|
Reina AM, Mewa JC, Calzada JE, Saldaña A. Characterization of Leishmania spp. Causing Cutaneous Lesions with a Negative Parasitological Diagnosis in Panama. Trop Med Infect Dis 2022; 7:tropicalmed7100282. [PMID: 36288023 PMCID: PMC9609048 DOI: 10.3390/tropicalmed7100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
A total of 123 DNA samples from Panamanian patients with cutaneous leishmaniasis (CL) lesions were evaluated. These samples were previously confirmed with CL by a specific KDNA-Viannia PCR but had a negative parasitological diagnosis (Group A). Epidemiological variables, such as age, sex, geographic origin, evolution time, and the number and location of the lesions, were analyzed. No significant differences (p < 0.05) were found when these variables were evaluated against a control panel of 123 CL lesion samples from CL patients with positive parasitological diagnoses (Group B). Of the 123 samples (Group A), 67% (82/123) gave positive results when re-analyzed by PCR-hsp70. An analysis of 69 of these samples via PCR-hsp70-RFLP showed that 59.4% (41/69) of the found restriction patterns corresponded to Leishmania (Viannia) panamensis and 40.6% (28/69) to Leishmania (Viannia) guyanensis. Finally, the sequence and phylogenetic analysis of 32 of the samples confirmed the species in 21 (65.6%, 21/32) samples, originally characterized as L. (V.) panamensis. However, 11 samples (34.4%, 11/32), initially identified via RFLP-Hsp70 as L. (V.) guyanensis, matched the sequence of a genetic variant known as Leishmania sp.1. These results point out the species/genetic variants of Leishmania in the case of CL lesions with an apparently low parasite load.
Collapse
Affiliation(s)
- Adelys M. Reina
- Departamento de Investigación en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama 0816, Panama
| | - Juan Castillo Mewa
- Departamento de Investigación en Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama 0816, Panama
| | - José E. Calzada
- Departamento de Investigación en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama 0816, Panama
| | - Azael Saldaña
- Departamento de Investigación en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama 0816, Panama
- Centro de Investigación y Diagnóstico de Enfermedades Parasitarias (CIDEP), Facultad de Medicina, Universidad de Panamá, Panama 0824, Panama
- Correspondence: ; Tel.: +507-523-4920
| |
Collapse
|
5
|
Medeiros RMTE, Carvalho AMRS, Ferraz IDA, Medeiros FAC, Cruz LDR, Rocha MODC, Coelho EAF, Gonçalves DU, Mendes TADO, Duarte MC, Menezes-Souza D. Mapping linear B-cell epitopes of the Tryparedoxin Peroxidase and its implications in the serological diagnosis of tegumentary leishmaniasis. Acta Trop 2022; 232:106521. [PMID: 35595092 DOI: 10.1016/j.actatropica.2022.106521] [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] [Received: 03/03/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 12/01/2022]
Abstract
Diagnosis of tegumentary leishmaniasis (TL) is essential to avoid permanent damage and severe functional sequelae and there is an urgent need to discover new antigens. The present study aimed to comprehensively evaluate the potential use of the Tryparedoxin Peroxidase (TryP) as an antigen for serological tests. The proposal integrates data from immunoproteomics with immunoinformatics, in addition to a precise analysis of protein levels in the evolutionary stages of the parasite by flow cytometry. To evaluate the performance in the diagnosis of TL, Enzyme-Linked Immunosorbent Assay (ELISA) assays were performed using the recombinant protein and the respective B-cell epitope, followed by an analysis of the contribution of this peptide in the recognition of the protein by patients, evaluated by serum depletion assays. We showed that the TryP has a linear B-cell epitope with high divergence compared to orthologs from Trypanosoma cruzi and Homo sapiens. The results also show high expression and positive cells for TryP (TryP+) in the infective metacyclic promastigotes (MET) and intracellular (24 and 48 hours) stages. From the depletion assays, it was possible to confirm the contribution of the peptide in the specific recognition of the TryP protein by patients with TL (13.7-15.9%). ELISA using the peptide showed high performance in the diagnosis compared to the recombinant TryP (rTryP), Soluble Leishmania braziliensis Antigen (sLba) and Immunofluorescence Assay (IFA) with accuracy of 94.29, 89.29, 65.00 and 37.14%, respectively). We can conclude that the MNEPAPP peptide is a potential antigen for the diagnosis of TL.
Collapse
Affiliation(s)
- Rutyanne Maria Tonelli Elisei Medeiros
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Maria Ravena Severino Carvalho
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabela de Andrade Ferraz
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Alvarenga Cardoso Medeiros
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luiza Dos Reis Cruz
- Laboratorio de Química Orgânica Sintética, Instituto de Química, Universidade de Campinas, Campinas, Brazil
| | - Manoel Otávio da Costa Rocha
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eduardo Antonio Ferraz Coelho
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise Utsch Gonçalves
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Mariana Costa Duarte
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Menezes-Souza
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| |
Collapse
|
6
|
de Morais RCS, de Melo MGN, de Goes TC, Pessoa e Silva R, de Morais RF, Guerra JADO, de Brito MEF, Brandão-Filho SP, de Paiva Cavalcanti M. Clinical-therapeutic follow-up of patients with American cutaneous leishmaniasis caused by different Leishmania spp. in Brazil. Exp Parasitol 2022; 240:108338. [DOI: 10.1016/j.exppara.2022.108338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
|
7
|
Freire ML, Rego FD, Lopes KF, Coutinho LA, Grenfell RFQ, Avelar DM, Cota G, Pascoal-Xavier MA, Oliveira E. Anti-mitochondrial Tryparedoxin Peroxidase Monoclonal Antibody-Based Immunohistochemistry for Diagnosis of Cutaneous Leishmaniasis. Front Microbiol 2022; 12:790906. [PMID: 35295679 PMCID: PMC8918995 DOI: 10.3389/fmicb.2021.790906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Cutaneous leishmaniasis (CL) remains a globally spreading public health problem. Among Latin America countries, Brazil has the greatest number of recorded CL cases with several Leishmania species being associated with human cases. Laboratory diagnosis is one of the major challenges to disease control due to the low accuracy of parasitological techniques, the restricted use of molecular techniques, and the importance of differential diagnosis with regard to several dermatological and systemic diseases. In response, we have developed and validated an immunohistochemistry (IHC) technique for CL diagnosis using anti-mTXNPx monoclonal antibody (mAb). Recombinant Leishmania–mTXNPx was produced and used as an immunogen for mAb production through the somatic hybridization technique. The viability of mAb labeling of Leishmania amastigotes was tested by IHC performed with skin biopsies from hamsters experimentally infected with Leishmania amazonensis, Leishmania braziliensis, and Leishmania guyanensis. The enzymes horseradish peroxidase (IHC-HRP) and alkaline phosphatase (IHC-AP), both biotin-free polymer detection systems, were used in the standardization step. The IHC was further validated with skin biopsies from 49 CL patients diagnosed by clinical examination and quantitative real-time polymerase chain reaction and from 37 patients presenting other dermatological infectious diseases. Other parasitological techniques, such as direct examination and culture, were also performed for confirmed CL patients. Histopathology and IHC were performed for all included patients. Overall, the highest sensitivity was observed for IHC-AP (85.7%), followed by IHC-HRP (79.6%), direct examination (77.6%), histopathological examination (HE; 65.3%), and in vitro culture (49%). Only IHC and HE presented specificity over 90% and were able to detect CL patients regardless of parasite burden (odds ratio > 1.94; 95%CI: 0.34–11.23). A significant increase in positivity rates was observed when IHC-AP was combined with direct examination (95.9%) and HE (93.9%). The IHC techniques evaluated in here detected the main Leishmania species causing CL in Brazil and can support diagnostic strategies for controlling this neglected disease, especially if used in combination with other approaches for an integrative laboratorial diagnosis.
Collapse
Affiliation(s)
| | - Felipe Dutra Rego
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | | | | | | | | | - Gláucia Cota
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Marcelo Antônio Pascoal-Xavier
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Edward Oliveira
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- *Correspondence: Edward Oliveira,
| |
Collapse
|
8
|
Lana JT, Mallipudi A, Ortiz EJ, Arevalo JH, Llanos-Cuentas A, Pan WK. Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru. Trop Med Health 2021; 49:40. [PMID: 34001266 PMCID: PMC8130303 DOI: 10.1186/s41182-021-00332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND American cutaneous leishmaniasis (CL) is a neglected tropical disease typically associated with men working in remote, sylvatic environments. We sought to identify CL risk factors in a highly deforested region where anecdotal reports suggested an atypical proportion of women and children were infected with CL raising concern among authorities that transmission was shifting towards domestic spaces and population centers. METHODS We describe the characteristics of CL patients from four participating clinics after digitizing up to 10 years of patient data from each clinic's CL registries. We assessed risk factors of CL associated with intradomestic, peridomestic, or non-domestic transmission through a matched case-control study with 63 patients who had visited these same clinics for CL (cases) or other medical reasons (controls) between January 2014 and August 2016. The study consisted of an in-home interview of participants by a trained field worker using a standard questionnaire. Risk factors were identified using bivariable and multivariable conditional logistic regression. RESULTS Between 2007 and 2016, a total of 529 confirmed CL positives were recorded in the available CL registries. Children and working aged women made up 58.6% of the cases. Our final model suggests that the odds of sleeping in or very near an agricultural field were five times greater in cases than controls (p = 0.025). Survey data indicate that women, children, and men have similar propensities to both visit and sleep in or near agricultural fields. CONCLUSIONS Women and children may be underappreciated as CL risk groups in agriculturally dependent regions. Despite the age-sex breakdown of clinical CL patients and high rates of deforestation occurring in the study area, transmission is mostly occurring outside of the largest population centers. Curbing transmission in non-domestic spaces may be limited to decreasing exposure to sandflies during the evening, nighttime, and early morning hours. Our paper serves as a cautionary tale for those relying solely on the demographic information obtained from clinic-based data to understand basic epidemiological trends of vector-borne infections.
Collapse
Affiliation(s)
- Justin T Lana
- Nicholas School of the Environment, Duke University, Durham, NC, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Andrés Mallipudi
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ernesto J Ortiz
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jairo H Arevalo
- Facultad de Medicina San Fernando, Universidad Nacional de San Martin Tarapoto, Tarapoto, San Martin, Perú
- Laboratorio Referencial de Salud Publica San Martin, Tarapoto, San Martin, Peru
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Lima, Peru
| | - William K Pan
- Nicholas School of the Environment, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| |
Collapse
|
9
|
Melo MGND, Morais RCSD, Goes TCD, Silva RPE, Morais RFD, Guerra JADO, Brito MEFD, Brandão Filho SP, Cavalcanti MDP. Clinical and epidemiological profiles of patients with American cutaneous leishmaniasis from the states of Pernambuco and Amazonas, Brazil. Rev Soc Bras Med Trop 2020; 53:e20200083. [PMID: 33263681 PMCID: PMC7723372 DOI: 10.1590/0037-8682-0083-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION: Brazil has a high number of cases of American cutaneous leishmaniasis (ACL)
in the north and northeast regions. Therefore, continuous surveillance of
environmental and socioeconomic factors in endemic areas is needed to
develop strategic control measures. This study aimed to describe the
clinical and epidemiological profiles of patients with ACL. METHODS: All patients were from the states of Amazonas and Pernambuco, and
examinations were carried out between 2015 and 2018. All patients had a
clinical and epidemiological history compatible with ACL after positive
diagnostic tests. Information obtained from medical records included gender,
employment activity, level of education, age, and number and sites of
lesions. RESULTS: A total of 213 patients were included, of whom 30.98% were female and 69.02%
were male. The main employment activity was agriculture (27.56%). The most
common level of education was elementary (62.42%). The average age was
approximately 39 years. The majority of the patients presented only with one
lesion (54.87%), and legs/feet were the most commonly affected area
(48.25%), followed by the arms/hands (44.75%). CONCLUSIONS: These data demonstrated that irrespective of the patients’ places of origin,
interventions need to be focused on men of economically productive age, in
view of the high risk of exposure to the vector in this group. Education
activities need to be directed to farmers about the importance of protection
against ACL vectors during work. Such information must also be directed to
employers as a way of implementing and maintaining appropriate working
conditions and stepping up vector control.
Collapse
|
10
|
Cutaneous Leishmaniasis: The Complexity of Host's Effective Immune Response against a Polymorphic Parasitic Disease. J Immunol Res 2019; 2019:2603730. [PMID: 31871953 PMCID: PMC6913332 DOI: 10.1155/2019/2603730] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 10/05/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022] Open
Abstract
This review is aimed at providing a comprehensive outline of the immune response displayed against cutaneous leishmaniasis (CL), the more common zoonotic infection caused by protozoan parasites of the genus Leishmania. Although of polymorphic clinical presentation, classically CL is characterized by leishmaniotic lesions on the face and extremities of the patients, which can be ulcerative, and even after healing can lead to permanent injuries and disfigurement, affecting significantly their psychological, social, and economic well-being. According a report released by the World Health Organization, the disability-adjusted life years (DALYs) lost due to leishmaniasis are close to 2.4 million, annually there are 1.0–1.5 million new cases of CL, and a numerous population is at risk in the endemic areas. Despite its increasing worldwide incidence, it is one of the so-called neglected tropical diseases. Furthermore, this review provides an overview of the existing knowledge of the host innate and acquired immune response to cutaneous species of Leishmania. The use of animal models and of in vitro studies has improved the understanding of parasite-host interplay and the complexity of immune mechanisms involved. The importance of diagnosis accuracy associated with effective patient management in CL reduction is highlighted. However, the multiple factors involved in CL epizoology associated with the unavailability of vaccines or drugs to prevent infection make difficult to formulate an effective strategy for CL control.
Collapse
|
11
|
Borges AF, Gomes RS, Ribeiro-Dias F. Leishmania (Viannia) guyanensis in tegumentary leishmaniasis. Pathog Dis 2018; 76:4950396. [PMID: 29722820 DOI: 10.1093/femspd/fty025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 03/20/2018] [Indexed: 12/20/2022] Open
Abstract
Leishmania (Viannia) guyanensis is a causal agent of American tegumentary leishmaniasis (ATL). This protozoan has been poorly investigated; however, it can cause different clinical forms of ATL, ranging from a single cutaneous lesion to severe lesions that can lead to destruction of the nasopharyngeal mucosa. L. (V.) guyanensis and the disease caused by this species can present unique aspects revealing the need to better characterize this parasite species to improve our knowledge of the immunopathological mechanisms and treatment options for ATL. The mechanisms by which some patients develop a more severe form of ATL remain unclear. It is known that the host immune profile and parasite factors may influence the clinical manifestations of the disease. Besides intrinsic parasite factors, Leishmaniavirus RNA 1 (LRV1) infecting L. guyanensis can contribute to ATL immunopathogenesis. In this review, general aspects of L. guyanensis infection in humans and mouse models are presented.
Collapse
Affiliation(s)
- Arissa Felipe Borges
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiás, Brazil
| | - Rodrigo Saar Gomes
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiás, Brazil
| | - Fátima Ribeiro-Dias
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiás, Brazil
| |
Collapse
|
12
|
Lamm R, Alves C, Perrotta G, Murphy M, Messina C, Sanchez JF, Perez E, Rosales LA, Lescano AG, Smith E, Valdivia H, Fuhrer J, Ballard SB. Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru. Am J Trop Med Hyg 2018; 99:331-337. [PMID: 29869605 DOI: 10.4269/ajtmh.17-0909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ2 test, t-test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted odds ration [OR] = 1.93 [1.06-3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.
Collapse
Affiliation(s)
- Ryan Lamm
- Stony Brook University School of Medicine, Stony Brook, New York.,Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.,US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Grace Perrotta
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Meagan Murphy
- Stony Brook University School of Medicine, Stony Brook, New York
| | | | - Juan F Sanchez
- Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru.,US Naval Medical Research Unit No. 6, Lima, Peru
| | - Erika Perez
- US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Andres G Lescano
- Universidad Peruana Cayetano Heredia, Lima, Peru.,US Naval Medical Research Unit No. 6, Lima, Peru
| | - Edward Smith
- US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Jack Fuhrer
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Sarah-Blythe Ballard
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,US Naval Medical Research Unit No. 6, Lima, Peru
| |
Collapse
|
13
|
Chagas ECDS, Silva AS, Fé NF, Ferreira LS, Sampaio VDS, Terrazas WCM, Guerra JAO, Souza RAFD, Silveira H, Guerra MDGVB. Composition of sand fly fauna (Diptera: Psychodidae) and detection of Leishmania DNA (Kinetoplastida: Trypanosomatidae) in different ecotopes from a rural settlement in the central Amazon, Brazil. Parasit Vectors 2018. [PMID: 29534747 PMCID: PMC5848579 DOI: 10.1186/s13071-018-2743-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Phlebotomine sand flies (Diptera: Psychodidae) are vectors of Leishmania species, the etiological agents of leishmaniasis, which is one of the most important emerging infectious diseases in the Americas. In the state of Amazonas in Brazil, anthropogenic activities encourage the presence of these insects around rural homes. The present study aimed to describe the composition and distribution of sand fly species diversity among the ecotopes (intradomicile, peridomicile and forest) in an area of American cutaneous leishmaniasis transmission and detect natural infection with Leishmania DNA to evaluate which vectors are inside houses and whether the presence of possible vectors represents a hazard of transmission. Results Phlebotomine sand flies were collected using light traps. A total of 2469 specimens representing 54 species, predominantly females (71.2%), were collected from four sites. Polymerase chain reaction analysis was performed on 670 samples to detect Leishmania DNA. Most of the samples (79.5%) were collected in the forest, with areas closer to rural dwellings yielding a greater abundance of suspected or proven vectors and a larger number of species containing Leishmania DNA. Nyssomyia umbratilis and Bichromomyia flaviscutellata were found near rural homes, and Ny. umbratilis was also found inside homes. Leishmania DNA was detected in different species of sand flies in all ecotopes, including species with no previous record of natural infection. Conclusions There is no evidence that vectors of American cutaneous leishmaniasis are becoming established inside homes, but there are sand flies, including Ny. umbratilis and other possible vectors, in environments characterized by a human presence. These species continue to be predominant in the forest but are prevalent in areas closer to ecotopes with a greater human presence. The existence of proven or suspected vectors in this ecotope is due to the structural organization of rural settlements and may represent a hazard of transmission. Although the detection of Leishmania DNA in species that were not previously considered vectors does not mean that they are transmitting the parasite, it does show that the parasite is circulating in ecotopes where these species are found.
Collapse
Affiliation(s)
- Erica Cristina da Silva Chagas
- Universidade do Estado do Amazonas (Programa de Pós-graduação em Medicina Tropical/Programa de Pos-graduação em Clima e Ambiente), Manaus, Amazonas, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.,Fundação de Vigilância em Saúde do Estado do Amazonas, Manaus, Amazonas, Brasil
| | - Arineia Soares Silva
- Universidade do Estado do Amazonas (Programa de Pós-graduação em Medicina Tropical/Programa de Pos-graduação em Clima e Ambiente), Manaus, Amazonas, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil
| | - Nelson Ferreira Fé
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil
| | - Lucas Silva Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil
| | | | | | - Jorge Augusto Oliveira Guerra
- Universidade do Estado do Amazonas (Programa de Pós-graduação em Medicina Tropical/Programa de Pos-graduação em Clima e Ambiente), Manaus, Amazonas, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil
| | - Rodrigo Augusto Ferreira de Souza
- Universidade do Estado do Amazonas (Programa de Pós-graduação em Medicina Tropical/Programa de Pos-graduação em Clima e Ambiente), Manaus, Amazonas, Brasil
| | - Henrique Silveira
- Instituto de Higiene e Medicina Tropical de Lisboa, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria das Graças Vale Barbosa Guerra
- Universidade do Estado do Amazonas (Programa de Pós-graduação em Medicina Tropical/Programa de Pos-graduação em Clima e Ambiente), Manaus, Amazonas, Brasil. .,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.
| |
Collapse
|
14
|
Evidence for Seroprevalence in Human Localized Cutaneous Leishmaniasis Caused by Leishmania donovani in Sri Lanka. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9320367. [PMID: 29581989 PMCID: PMC5822831 DOI: 10.1155/2018/9320367] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/21/2017] [Accepted: 12/13/2017] [Indexed: 01/19/2023]
Abstract
Visceral leishmaniasis (VL) is considered as a major health threat in the Indian subcontinent. Leishmania donovani, a usually visceralizing species, causes cutaneous leishmaniasis (CL) in Sri Lanka. However, visceralizing potential of the local L. donovani is not yet fully understood. This project studied the seroprevalence of local CL by using an in-house ELISA. An IgG-based ELISA using crude Leishmania antigen (Ag) was developed and validated. A total of 50 laboratory confirmed cases of locally acquired CL were examined using the newly developed ELISA. According to the optimized ELISA, seroprevalence of anti-Leishmania IgG antibodies in the study group was 34.0% (n = 17/50). Majority of seropositive individuals were males (n = 13/17), representing 76%. Nearly half of the seropositive individuals were young adults (20–40 years, n = 9/17, 53%). Higher proportions of single lesions, large lesions, and nodular lesions were associated with a seroconversion. A proportion of local L. donovani infections leading to CL have the ability to raise an antibody response in the host. This may indicate early systemic involvement as one possibility. Study of a large number of patients with adequate follow-up would be useful.
Collapse
|
15
|
Paniz-Mondolfi AE, Talhari C, García Bustos MF, Rosales T, Villamil-Gomez WE, Marquez M, Pérez Alvarez AM, Tálamo Sánchez AI, Rodriguez-Morales AJ. American cutaneous leishmaniasis in infancy and childhood. Int J Dermatol 2017; 56:1328-1341. [PMID: 28741648 DOI: 10.1111/ijd.13664] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/12/2017] [Accepted: 04/25/2017] [Indexed: 12/26/2022]
Abstract
Infant and young child skin diseases are among the most common features of morbidity throughout the tropics. Because the skin is directly exposed to the environment, it is considerably affected by climatic and local conditions such as vectors and microorganisms, as in the case of leishmaniasis. In America the observed magnitude of cutaneous leishmaniasis in children has led to the study of increased risk of exposure of this group due to the possibility of peri- and intradomiciliary transmission. The present review pretends to make a concrete approach all through the broad and main figures of this parasitic disease, including the clinical, physiopathological, epidemiological, diagnostic, and therapeutic aspects, in order to be used as a practical source of reference for pediatricians leading with tropical cutaneous pathology in the region.
Collapse
Affiliation(s)
- Alberto E Paniz-Mondolfi
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Laboratory of Biochemistry, Instituto de Biomedicina/IVSS, Caracas, Venezuela
| | - Carolina Talhari
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Universidade Nilton Lins, Manaus, Amazonas, Brasil
| | - María F García Bustos
- Instituto de Patología Experimental, Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina
| | | | - Wilmer E Villamil-Gomez
- Infectious Diseases and Infection Control Reserch Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia
| | - Marilianna Marquez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto, Venezuela
| | - Alexandra M Pérez Alvarez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela
| | - Alejandra I Tálamo Sánchez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto, Venezuela
| | - Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| |
Collapse
|