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Karampas G, Koulouraki S, Daikos GL, Nanou C, Aravantinos L, Eleftheriades M, Metallinou D, Christopoulos P. Visceral Leishmaniasis in a Twin Pregnancy: A Case Report and Review of the Literature. J Clin Med 2024; 13:2400. [PMID: 38673673 PMCID: PMC11051246 DOI: 10.3390/jcm13082400] [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: 02/18/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of clinical manifestations from cutaneous ulcers to multisystem disease. Differential diagnosis is challenging as symptoms and signs are insidious, mimicking other diseases. Misdiagnosis can result in severe adverse perinatal outcomes, even maternal/neonatal death. Early treatment with liposomal amphotericin-B (LAmB) is currently the first choice with adequate effectiveness. We report a rare case of VL in a twin pregnancy with onset at the second trimester, presenting with periodic fever with rigors, right flank pain, and gradual dysregulation of all three cell lines. The positive rK39 enzyme-linked immunosorbent assay test confirmed the diagnosis. Treatment with LAmB resulted in clinical improvement within 48 h and in the delivery of two late-preterm healthy neonates with no symptoms or signs of vertical transmission. The one-year follow-up, of the mother and the neonates, was negative for recurrence. To our knowledge, this is the first reported case of VL in a twin pregnancy, and consequently treatment and perinatal outcome are of great importance.
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Affiliation(s)
- Grigorios Karampas
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Sevasti Koulouraki
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - George L. Daikos
- Mitera Hospital, 6, Erythrou Stavrou Str., 151 23 Athens, Greece;
| | - Christina Nanou
- Department of Midwifery, University of West Attica, 122 43 Athens, Greece;
| | - Leon Aravantinos
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Makarios Eleftheriades
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 122 43 Athens, Greece;
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
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Yimer M, Takele Y, Yizengaw E, Nibret E, Sumova P, Volf P, Yismaw G, Alehegn M, Rowan A, Müller I, Cotton JA, Chapman LAC, Kropf P. Demographic characteristics and prevalence of asymptomatic Leishmania donovani infection in migrant workers working in an endemic area in Northwest Ethiopia. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1367387. [PMID: 38655403 PMCID: PMC11035784 DOI: 10.3389/fepid.2024.1367387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
Introduction Visceral leishmaniasis (VL), a neglected tropical disease that causes substantial morbidity and mortality, is a serious health problem in Ethiopia. Infections are caused by Leishmania (L.) donovani parasites. Most individuals remain asymptomatic, but some develop VL, which is generally fatal if not treated. We identified the area of Metema-Humera in Northwest Ethiopia as a setting in which we could follow migrant workers when they arrived in an endemic area. The demographic characteristics of this population and factors associated with their risk of asymptomatic infection are poorly characterised. Methods We divided our cohort into individuals who visited this area for the first time (first comers, FC) and those who had already been in this area (repeat comers, RC). We followed them from the beginning (Time 1, T1) to the end of the agricultural season (Time 2, T2), performing tests for sand fly bite exposure (anti-sand fly saliva antibody ELISA) and serology for Leishmania infection (rK39 rapid diagnostic test and the direct agglutination test) at each time point and collecting information on risk factors for infection. Results Our results show that most migrant workers come from non-endemic areas, are male, young (median age of 20 years) and are farmers or students. At T1, >80% of them had been already exposed to sand fly bites, as shown by the presence of anti-saliva antibodies. However, due to seasonality of sand flies there was no difference in exposure between FC and RC, or between T1 and T2. The serology data showed that at T1, but not at T2, a significantly higher proportion of RC were asymptomatic. Furthermore, 28.6% of FC became asymptomatic between T1 and T2. Over the duration of this study, one FC and one RC developed VL. In multivariable logistic regression of asymptomatic infection at T1, only age and the number of visits to Metema/Humera were significantly associated with asymptomatic infection. Conclusion A better understanding of the dynamics of parasite transmission and the risk factors associated with the development of asymptomatic infections and potentially VL will be essential for the development of new strategies to prevent leishmaniasis.
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Affiliation(s)
- Mulat Yimer
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Yegnasew Takele
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Endalew Yizengaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
- Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalkachew Nibret
- Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Petra Sumova
- Department of Parasitology, Faculty of Science, Charles University, Prague, Czechia
| | - Petr Volf
- Department of Parasitology, Faculty of Science, Charles University, Prague, Czechia
| | | | - Michael Alehegn
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aileen Rowan
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Ingrid Müller
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - James A. Cotton
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Lloyd A. C. Chapman
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Pascale Kropf
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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Humoral Responses and Ex Vivo IFN-γ Production after Canine Whole Blood Stimulation with Leishmania infantum Antigen or KMP11 Recombinant Protein. Vet Sci 2022; 9:vetsci9030116. [PMID: 35324844 PMCID: PMC8954708 DOI: 10.3390/vetsci9030116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 11/25/2022] Open
Abstract
The effect of Leishmania infantum soluble antigen (LSA) and recombinant Kinetoplastid Membrane Protein 11 (rKMP11) on the induction of ex vivo specific IFN-γ (n = 69) and antibody responses (n = 108) was determined in dogs. All dogs were tested for serological response to both antigens and divided into Group 1: healthy (Asturias, Spain, n = 26), Group 2: sick (n = 46), Group 3: healthy Ibizan hounds (Mallorca, Spain, n = 22) and Group 4: healthy (Bari, Italy, n = 14). Antibody levels were higher for LSA when compared to rKMP11 (p = 0.001). Ibizan hounds were all seronegative to rKMP11 and 18% were low seropositive to LSA. Sick dogs presented higher antibody response to both antigens compared to the rest of the groups (p < 0.0001). All groups showed higher IFN-γ levels after LSA compared to rKMP11 responses (p < 0.05). The highest response to LSA was found in Ibizan hounds (p < 0.05). IFN-γ to LSA and rKMP11 stimulation was observed in 34% and in 2.8% of the sick dogs, respectively. Here, we demonstrated that anti-rKMP11 antibodies are mainly present in dogs with moderate to severe disease. Furthermore, cellular immune response measured by specific ex vivo IFN-γ production was more intense to LSA than stimulated to rKMP11.
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Carrasco-Antón N, Ibarra-Meneses AV, Carrillo E, Fernández-Ruiz M, Hernández-Jiménez P, Aguado JM, Moreno J, López-Medrano F. An exploratory analysis of C-X-C motif chemokine ligand 10 as a new biomarker of asymptomatic Leishmania infantum infection in Solid-Organ Transplant Recipients. J Infect 2022; 84:573-578. [PMID: 35101535 DOI: 10.1016/j.jinf.2022.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Sensitive and less laborious assays are needed to detect asymptomatic Leishmania among solid organ transplant (SOT) recipients. Using SLA-stimulated plasma from SOT recipients living where an outbreak of Leishmania infantum occurred, we examined potential biomarkers to identify asymptomatic Leishmania infections. METHODS Concentrations of cytokines/chemokines in plasma from whole blood stimulated with specific Leishmania antigen (SLA) were compared against infection status as determined by a currently used cell proliferation assay. RESULTS Twenty-six percent (13/50) of the SOT recipients had a cell proliferation assay (CPA) indicating asymptomatic infection, and showed higher processed plasma C-X-C motif chemokine ligand 10 (CXCL10 or IP-10) concentrations than did non-infected subjects (median 2272.0 pg/ml [IQR-1570-2772] vs. 18.2 pg/ml [IQR 1-150.1]; p<0.0001). CXCL10 showed a sensitivity of 93% and a specificity of 95% compared to CPA. In addition, we demonstrated that the number of asymptomatic infections detected using CXCL10, decreased with distance from a park at the centre of the mentioned outbreak. CONCLUSION CXCL10 in plasma from SLA-stimulated blood could be a robust biomarker of asymptomatic L. infantum infection in solid organ transplant recipients.
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Affiliation(s)
- Nerea Carrasco-Antón
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain, CIBERINFEC.
| | - Ana Victoria Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, CIBERINFEC.
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, CIBERINFEC.
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain, CIBERINFEC.
| | - Pilar Hernández-Jiménez
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain, CIBERINFEC.
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain, CIBERINFEC.
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, CIBERINFEC.
| | - Francisco López-Medrano
- WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, CIBERINFEC.
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Abstract
The leishmanin skin test (LST) has been used for decades to detect exposure and immunity to the parasite Leishmania, the causative agent of the neglected tropical disease leishmaniasis. In the LST, Leishmania antigen (leishmanin) is intradermally injected into the forearm. In an individual who has been previously infected, a delayed-type hypersensitivity (DTH) reaction results in a measurable induration at the site of the injection, indicating that previous exposure to Leishmania has resulted in the development of cell-mediated immunity. LST positivity is associated with long-lasting protective immunity against reinfection, most notably as reported for visceral leishmaniasis (VL). Despite efforts over the past few decades, leishmanin antigen is no longer produced under good manufacturing practice (GMP) conditions anywhere in the world. Consequently, the use of the LST in epidemiological studies has declined in favor of serological and molecular tests. In this review, we provide a historical overview of the LST and justification for the reintroduction of leishmanin. A GMP-grade leishmanin can be used to detect immunity in vivo by the LST and can be investigated for use in an interferon-γ release assay (IGRA), which may serve as an in vitro version of the LST. The LST will be a valuable tool for surveillance and epidemiological studies in support of the VL elimination programs and as a surrogate marker of immunity in vaccine clinical trials.
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Requião-Moura LR, Daher EDF, Moreira Albino CR, de Oliveira Brilhante S, da Silva Junior GB, Costa SD, de Sandes-Freitas TV. Tropical Infections in the Context of Kidney Transplantation in Latin America. Am J Trop Med Hyg 2021; 105:564-572. [PMID: 34181579 PMCID: PMC8592343 DOI: 10.4269/ajtmh.19-0926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/12/2021] [Indexed: 11/07/2022] Open
Abstract
Reports on tropical infections among kidney transplant (KT) recipients have increased in recent years, mainly because of the growing number of KT programs located in tropical and subtropical areas, and greater mobility or migration between different areas of the world. Endemic in emerging and developing regions, like most countries in Latin America, tropical infections are an important cause of morbidity and mortality in this population. Tropical infections in KT recipients may exhibit different pathways for acquisition compared with those in nonrecipients, such as transmission through a graft and reactivation of a latent infection triggered by immunosuppression. Clinical presentation may differ compared with that in immunocompetent patients, and there are also particularities in diagnostic aspects, treatment, and prognosis. KT patients must be screened for latent infections and immunized properly. Last, drug-drug interactions between immunosuppressive agents and drugs used to treat tropical infections are an additional challenge in KT patients. In this review, we summarize the management of tropical infections in KT patients.
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Affiliation(s)
- Lúcio R. Requião-Moura
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Nephrology Division, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Silvana Daher Costa
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | - Tainá Veras de Sandes-Freitas
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
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Elmahallawy EK, Alkhaldi AAM, Saleh AA. Host immune response against leishmaniasis and parasite persistence strategies: A review and assessment of recent research. Biomed Pharmacother 2021; 139:111671. [PMID: 33957562 DOI: 10.1016/j.biopha.2021.111671] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 12/13/2022] Open
Abstract
Leishmaniasis, a neglected parasitic disease caused by a unicellular protozoan of the genus Leishmania, is transmitted through the bite of a female sandfly. The disease remains a major public health problem and is linked to tropical and subtropical regions, with an endemic picture in several regions, including East Africa, the Mediterranean basin and South America. The different causative species display a diversity of clinical presentations; therefore, the immunological data on leishmaniasis are both scarce and controversial for the different forms and infecting species of the parasite. The present review highlights the main immune parameters associated with leishmaniasis that might contribute to a better understanding of the pathogenicity of the parasite and the clinical outcomes of the disease. Our aim was to provide a concise overview of the immunobiology of the disease and the factors that influence it, as this knowledge may be helpful in developing novel chemotherapeutic and vaccine strategies.
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Affiliation(s)
- Ehab Kotb Elmahallawy
- Department of Zoonoses, Faculty of Veterinary Medicine, Sohag University, Sohag 82524, Egypt.
| | | | - Amira A Saleh
- Department of Medical Parasitology, Faculty of Medicine, Zagazig University, Zgazig, Egypt
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Rostami MN, Khamesipour A. Potential biomarkers of immune protection in human leishmaniasis. Med Microbiol Immunol 2021; 210:81-100. [PMID: 33934238 PMCID: PMC8088758 DOI: 10.1007/s00430-021-00703-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/22/2021] [Indexed: 12/30/2022]
Abstract
Leishmaniasis is a vector-borne neglected tropical disease endemic in over 100 countries around the world. Available control measures are not always successful, therapeutic options are limited, and there is no vaccine available against human leishmaniasis, although several candidate antigens have been evaluated over the last decades. Plenty of studies have aimed to evaluate the immune response development and a diverse range of host immune factors have been described to be associated with protection or disease progression in leishmaniasis; however, to date, no comprehensive biomarker(s) have been identified as surrogate marker of protection or exacerbation, and lack of enough information remains a barrier for vaccine development. Most of the current understanding of the role of different markers of immune response in leishmaniasis has been collected from experimental animal models. Although the data generated from the animal models are crucial, it might not always be extrapolated to humans. Here, we briefly review the events during Leishmania invasion of host cells and the immune responses induced against Leishmania in animal models and humans and their potential role as a biomarker of protection against human leishmaniasis.
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Affiliation(s)
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, 14155-6383, Tehran, Iran.
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Botana L, Matía B, San Martin JV, Romero-Maté A, Castro A, Molina L, Fernandez L, Ibarra-Meneses A, Aguado M, Sánchez C, Horrillo L, Chicharro C, Nieto J, Ortega S, Ruiz-Giardin JM, Carrillo E, Moreno J. Cellular Markers of Active Disease and Cure in Different Forms of Leishmania infantum-Induced Disease. Front Cell Infect Microbiol 2018; 8:381. [PMID: 30483480 PMCID: PMC6243388 DOI: 10.3389/fcimb.2018.00381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/09/2018] [Indexed: 11/13/2022] Open
Abstract
Increased numbers of peripheral blood mononucleocytes (PBMC) and increased IFN-γ secretion following in vitro challenge of blood samples with soluble Leishmania antigen (SLA), have been proposed as biomarkers of specific cell-mediated immunity, indicating that treatment of visceral leishmaniasis (VL) has been successful. However, Leishmania infantum infection may manifest as cutaneous leishmaniasis (CL), and less commonly as localized leishmanial lymphadenopathy (LLL) or mucosal leishmaniasis (ML). The present work examines the value of these biomarkers as indicators of cured leishmaniasis presenting in these different forms. Blood samples were collected before and after treatment from patients living in Fuenlabrada (Madrid, Spain), an L. infantum-endemic area recently the center of a leishmaniasis outbreak. All samples were subjected to Leishmania-specific PCR, serological tests (IFAT and rK39-ICT), and the SLA-cell proliferation assay (SLA-CPA), recording PBMC proliferation and the associated changes in IFN-γ production. Differences in the results recorded for the active and cured conditions were only significant for VL. PCR returned positive results in 67% of patients with active VL and in 3% of those with cured leishmaniasis. Similarly, rK39-ICT returned a positive result in 77% of active VL samples vs. 52% in cured VL samples, and IFAT in 90% vs. 56%; in the SLA-CPA, PBMC proliferation was seen in 16% vs. 90%, and an associated increase in IFN-γ production of 14 and 84%, respectively. The present findings reinforce the idea that PBMC proliferation and increased IFN-γ production in SLA-stimulated PBMC provide biomarkers of clinical cure in VL. Other tests are urgently needed to distinguish between the cured and active forms of the other types of clinical leishmaniasis caused by L. infantum.
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Affiliation(s)
- Laura Botana
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Matía
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.,Programa de Doctorado en Ciencias de la Salud, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Mostoles, Spain
| | | | | | - Alicia Castro
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Laura Molina
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Laura Fernandez
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Aguado
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Horrillo
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Nieto
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Sheila Ortega
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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Sundar S, Singh OP, Chakravarty J. Visceral leishmaniasis elimination targets in India, strategies for preventing resurgence. Expert Rev Anti Infect Ther 2018; 16:805-812. [PMID: 30289007 DOI: 10.1080/14787210.2018.1532790] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Visceral leishmaniasis (VL) is a fatal parasitic disease caused by a parasite belonging to the Leishmania donovani complex and transmitted by infected female Phlebotomous argentipes sand flies. The VL elimination strategy in the Indian subcontinent (ISC), which has a current goal of reducing the incidence of VL to below 1/10,000 of population by the year 2020, consists of rapid detection and treatment of VL to reduce the number of human reservoirs as well as vector control using indoor residual spraying (IRS). However, as the incidence of VL declines toward the elimination goal, greater targeting of control methods will be required to ensure appropriate early action to prevent the resurgence of VL. Area covered: We discuss the current progress and challenges in the VL elimination program and strategies to be employed to ensure sustained elimination of VL. Expert commentary: The VL elimination initiative has saved many human lives; however, for VL elimination to become a reality in a sustained way, an intense effort is needed, as substantial numbers of endemic subdistricts (primary health centers (PHCs) blocks level) are yet to reach the elimination target. In addition to effective epidemiological surveillance, appropriate diagnostic and treatment services for VL at PHCs will be needed to ensure long-term sustainability and prevent reemergence of VL.
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Affiliation(s)
- Shyam Sundar
- a Department of Medicine , Institute of Medical Sciences, Banaras Hindu University , Varanasi , India
| | - Om Prakash Singh
- a Department of Medicine , Institute of Medical Sciences, Banaras Hindu University , Varanasi , India
| | - Jaya Chakravarty
- a Department of Medicine , Institute of Medical Sciences, Banaras Hindu University , Varanasi , India
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Parasite Specific Antibody Levels, Interferon-γ and TLR2 and TLR4 Transcripts in Blood from Dogs with Different Clinical Stages of Leishmaniosis. Vet Sci 2018; 5:vetsci5010031. [PMID: 29547503 PMCID: PMC5876572 DOI: 10.3390/vetsci5010031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023] Open
Abstract
Canine leishmaniosis has a wide range of disease severity from mild (stage I), to severe (stages II–III), or very severe disease (stage IV). The objective of the study was to evaluate and compare serum antibody levels, Leishmania infantum specific IFN-γ production and TLR2 and TLR4 transcripts in non-stimulated blood from dogs with different clinical stages at the time of diagnosis as well as blood parasitemia. Enzyme-Linked ImmunoSorbent Assay (ELISAs) were performed to determine serum antibody levels and IFN-γ production and quantitative polymerase chain reaction (qPCRs) in order to determine blood parasite load and TLR2 and TLR4 transcripts. Older dogs were significantly affected by more severe disease with higher antibody levels and blood parasitemia than dogs with mild disease. IFN-γ production was significantly higher in dogs with stage I disease when compared to dogs with more severe disease. Relative quantification of TLR2 in dogs with mild disease was similar to that of control dogs. On the other hand, TLR2 transcripts were significantly higher in dogs with severe disease as compared with that from control healthy dogs. No differences were found in TLR4 relative quantification between groups. This study demonstrates that dogs with different clinical stages of leishmaniosis present different levels of biological markers indicative of different immune responses.
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Singh T, Fakiola M, Oommen J, Singh AP, Singh AK, Smith N, Chakravarty J, Sundar S, Blackwell JM. Epitope-Binding Characteristics for Risk versus Protective DRB1 Alleles for Visceral Leishmaniasis. THE JOURNAL OF IMMUNOLOGY 2018; 200:2727-2737. [PMID: 29507109 DOI: 10.4049/jimmunol.1701764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/08/2018] [Indexed: 11/19/2022]
Abstract
HLA-DRB1 is the major genetic risk factor for visceral leishmaniasis (VL). We used SNP2HLA to impute HLA-DRB1 alleles and SNPTEST to carry out association analyses in 889 human cases and 977 controls from India. NetMHCIIpan 2.1 was used to map epitopes and binding affinities across 49 Leishmania vaccine candidates, as well as across peptide epitopes captured from dendritic cells treated with crude Leishmania Ag and identified using mass spectrometry and alignment to amino acid sequences of a reference Leishmania genome. Cytokines were measured in peptide-stimulated whole blood from 26 cured VL cases and eight endemic healthy controls. HLA-DRB1*1501 and DRB1*1404/DRB1*1301 were the most significant protective and risk alleles, respectively, with specific residues at aa positions 11 and 13 unique to protective alleles. We observed greater peptide promiscuity in sequence motifs for 9-mer core epitopes predicted to bind to risk (*1404/*1301) compared with protective (*1501) DRB1 alleles. There was a higher frequency of basic amino acids in DRB1*1404/*1301-specific epitopes compared with hydrophobic and polar amino acids in DRB1*1501-specific epitopes at anchor residues pocket 4 and pocket 6, which interact with residues at DRB1 positions 11 and 13. Cured VL patients made variable, but robust, IFN-γ, TNF, and IL-10 responses to 20-mer peptides based on captured epitopes, with peptides based on DRB1*1501-captured epitopes resulting in a higher proportion (odds ratio 2.23, 95% confidence interval 1.17-4.25, p = 0.017) of patients with IFN-γ/IL-10 ratios > 2-fold compared with peptides based on DRB1*1301-captured epitopes. Our data provide insight into the molecular mechanisms underpinning the association of HLA-DRB1 alleles with risk versus protection in VL in humans.
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Affiliation(s)
- Toolika Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi OS 221 005, India
| | - Michaela Fakiola
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, United Kingdom
| | - Joyce Oommen
- Telethon Kids Institute, The University of Western Australia, Subiaco, Western Australia 6008, Australia; and
| | - Akhil Pratap Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi OS 221 005, India
| | - Abhishek K Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi OS 221 005, India
| | - Noel Smith
- Lonza Biologics PLC, Great Abington, Cambridge CB21 6GS, United Kingdom
| | - Jaya Chakravarty
- Institute of Medical Sciences, Banaras Hindu University, Varanasi OS 221 005, India
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi OS 221 005, India
| | - Jenefer M Blackwell
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, United Kingdom; .,Telethon Kids Institute, The University of Western Australia, Subiaco, Western Australia 6008, Australia; and
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13
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Zribi L, El-Goulli AF, Ben-Abid M, Gharbi M, Ben-Sghaier I, Boufaden I, Aoun K, Bouratbine A. Use of an Interferon Gamma Release Assay (IGRA) to test T-cell responsiveness to soluble Leishmania infantum antigen in whole blood of dogs from endemic areas. Vet Parasitol 2017; 246:88-92. [PMID: 28969786 DOI: 10.1016/j.vetpar.2017.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
Interferon-Gamma (IFN-γ) Release Assays (IGRAs) are easy tests that allow rapid screening of primed memory T-cells immunity in response to antigen. The aim of this study was to use IGRA to assess IFN-γ release in response to Soluble Leishmania infantum antigen (SLA) in whole blood of dogs living in endemic area of visceral leishmaniasis and to interpret IGRA results according to clinical examination, specific anti-Leishmania humoral response and presence of L. infantum DNA in blood. The study was carried out on 56 dogs living in greater Tunis area. Physical examination, quantitative serology and PCR on blood were used to characterize dogs' status in relation to Leishmania infection and disease. IGRA consisted on testing by ELISA for IFN-γ-secretion in whole blood after a 20-h challenge with SLA. PBS and Phytohemagglutinin (PHA) stimulations were used as controls. Four groups of dogs were characterized: 31 were negative by both serology and PCR, two had doubtful serology, 10 presented no to mild clinical signs but low antibodies levels and 13 were affected by Canine Leishmaniasis (CanL). In seronegative dogs, IGRA was little contributory in 4 puppies (age <6months) and 5 old dogs (median age=72months, IQR: 45-84 months) that didn't respond to PHA stimulation, IGRA was negative in 19 and positive in three animals with lymph node enlargement. In dogs with doubtful serology, IGRA was positive in one dog and negative in the other. In infected dogs with no to mild clinical signs, one dog exhibited high level of IFN-γ in absence of antigenic stimulation and all the other were positive by IGRA. CanL dogs showed variable IGRA results. Negative IGRAs (n=4) were shown in animals with the highest parasitic burden whereas positive IGRAs (n=5) were shown in dogs with negative PCR or low parasitic load. The 4 remaining dogs either didn't respond to PHA (n=2) or showed non-specific secretion in PBS tube (n=2). The results of this study showed that IGRA is a useful new tool that can assess exposure to Leishmania in dogs with no to mild clinical signs in endemic area. Further comparative investigations using assays exploring cellular immunity are needed to determine its accuracy.
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Affiliation(s)
- Lilia Zribi
- Department of Clinical Parasitology, Laboratoire de recherche LR 11-IPT-06 "Parasitologie Médicale, Biotechnologies et Biomolécules", Institut Pasteur de Tunis, Université Tunis El-Manar, 13 Place Pasteur, BP 74, 1002, Tunis, Tunisia; Faculté des Sciences de Bizerte, Université de Carthage, Bizerte, Tunisia.
| | - Amel F El-Goulli
- Service de Pathologie médicale des équidés et des carnivores domestiques, Ecole Nationale de Médecine Vétérinaire de Sidi-Thabet, Université de la Manouba, 2020, Sidi-Thabet, Tunisia.
| | - Meriem Ben-Abid
- Department of Clinical Parasitology, Laboratoire de recherche LR 11-IPT-06 "Parasitologie Médicale, Biotechnologies et Biomolécules", Institut Pasteur de Tunis, Université Tunis El-Manar, 13 Place Pasteur, BP 74, 1002, Tunis, Tunisia.
| | - Mohamed Gharbi
- Laboratoire de Parasitologie, Ecole Nationale de Médecine Vétérinaire de Sidi-Thabet, Université de la Manouba, 2020, Sidi-Thabet, Tunisia.
| | - Ines Ben-Sghaier
- Department of Clinical Parasitology, Laboratoire de recherche LR 11-IPT-06 "Parasitologie Médicale, Biotechnologies et Biomolécules", Institut Pasteur de Tunis, Université Tunis El-Manar, 13 Place Pasteur, BP 74, 1002, Tunis, Tunisia.
| | - Imed Boufaden
- Direction générale de la Garde Nationale, Route de la Marsa, Tunis, Tunisia.
| | - Karim Aoun
- Department of Clinical Parasitology, Laboratoire de recherche LR 11-IPT-06 "Parasitologie Médicale, Biotechnologies et Biomolécules", Institut Pasteur de Tunis, Université Tunis El-Manar, 13 Place Pasteur, BP 74, 1002, Tunis, Tunisia.
| | - Aïda Bouratbine
- Department of Clinical Parasitology, Laboratoire de recherche LR 11-IPT-06 "Parasitologie Médicale, Biotechnologies et Biomolécules", Institut Pasteur de Tunis, Université Tunis El-Manar, 13 Place Pasteur, BP 74, 1002, Tunis, Tunisia.
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14
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Martínez-Orellana P, Marí-Martorell D, Montserrat-Sangrà S, Ordeix L, Baneth G, Solano-Gallego L. Leishmania infantum-specific IFN-γ production in stimulated blood from dogs with clinical leishmaniosis at diagnosis and during treatment. Vet Parasitol 2017; 248:39-47. [PMID: 29173539 DOI: 10.1016/j.vetpar.2017.10.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/19/2022]
Abstract
There is limited data regarding Leishmania infantum specific T cell mediated immunity in naturally infected sick dogs at the time of diagnosis and during anti-Leishmania treatment. Our aim was to investigate the kinetics of L. infantum specific IFN-γ production in dogs with leishmaniosis at the time of diagnosis and during treatment and to correlate it with specific L. infantum antibodies, blood parasitemia and clinicopathological findings. Thirty-four dogs were diagnosed with leishmaniosis based on physical examination, routine laboratory tests and L. infantum-specific antibody levels by quantitative ELISA. Heparinized whole blood was stimulated with L. infantum soluble antigen (LSA) and concanavalin A (ConA) and incubated for 5days. IFN-γ concentration was evaluated in supernatants of stimulated blood using a commercial sandwich ELISA. Leishmania real-time PCR was also performed for assessing blood parasitemia. Dogs were treated with meglumine antimoniate and allopurinol. Sixteen dogs were classified as IFN-γ non-producers after LSA stimulation (mean±SD: 0±0pg/mL) and 18 dogs as IFN-γ producers (mean±SD: 2885.3±4436.1pg/mL) at the time of diagnosis (P<0.0001). IFN-γ non-producers were classified in a more severe clinical staging than IFN-γ producers that presented a mild to moderate clinical staging (P=0.03). In the IFN-γ non-producer group, production of IFN-γ after LSA stimulation was significantly increased during treatment especially at day 365 (P=0.018) together with clinical improvement when compared with day 0. In contrast, IFN-γ producers maintained their IFN-γ production after LSA stimulation and no statistically significant changes were found during treatment follow-up. At diagnosis, IFN-γ non-producers showed a significantly higher blood parasitemia versus IFN-γ -producers (P=0.005). IFN-γ non-producers drastically reduced blood parasitemia to minimum values at day 365 when compared with day 0 (P=0.017). No significant differences were found at day 365 in blood parasitemia of IFN-γ producers compared to pre-treatment. At diagnosis, L. infantum specific antibodies were higher in IFN-γ non-producers than IFN-γ producers (P=0.014). A marked reduction of antibody levels was found at day 365 when compared with day 0 in IFN-γ non-producers (P=0.005) and producers (P=0.001). These results demonstrate that IFN-γ concentration increases with long-term anti-Leishmania treatment together with clinical improvement in dogs that do not produce IFN-γ at diagnosis. Together with clinical recovery, reduction in blood parasitemia and L. infantum specific antibodies, tracking IFN-γ concentration could constitute an important prognostic tool for immune monitoring in CanL.
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Affiliation(s)
- Pamela Martínez-Orellana
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Daniel Marí-Martorell
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Sara Montserrat-Sangrà
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Laura Ordeix
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain; Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Gad Baneth
- School of Veterinary Medicine, Hebrew University, Israel.
| | - Laia Solano-Gallego
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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15
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Dias DS, Ribeiro PAF, Martins VT, Lage DP, Portela ÁSB, Costa LE, Salles BCS, Lima MP, Ramos FF, Santos TTO, Caligiorne RB, Chávez-Fumagalli MA, Silveira JAG, Magalhães-Soares DF, Gonçalves DU, Oliveira JS, Roatt BM, Duarte MC, Menezes-Souza D, Silva ES, Galdino AS, Machado-de-Ávila RA, Teixeira AL, Coelho EAF. Recombinant small glutamine-rich tetratricopeptide repeat-containing protein of Leishmania infantum: Potential vaccine and diagnostic application against visceral leishmaniasis. Mol Immunol 2017; 91:272-281. [PMID: 28988041 DOI: 10.1016/j.molimm.2017.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/23/2017] [Accepted: 09/27/2017] [Indexed: 12/20/2022]
Abstract
Different Leishmania proteins have been evaluated in order to find a potential vaccine candidate or diagnostic marker capable of providing long lasting protection against infection or helping to identify infected mammalian hosts, respectively. However, just few molecules have fulfilled all the requirements to be evaluated. In the current study, we evaluated the prophylactic and diagnostic value against visceral leishmaniasis (VL) of a small glutamine-rich tetratricopeptide repeat-containing (SGT) protein from Leishmania infantum species. In a first step, the immune response elicited by the immunization using the recombinant protein (rSGT) plus saponin was evaluated in BALB/c mice. Immunized animals had a low parasitism in all evaluated organs. They developed a specific Th1 immune response, which was based on protein-specific production of IFN-γ, IL-12 and GM-CSF, and a humoral response dominated by antibodies of the IgG2a isotype. Both CD4+ and CD8+ T cells contributed to the IFN-γ production, showing that both T cell subtypes contribute to the resistance against infection. Regarding its value as a diagnostic marker, rSGT showed maximum sensitivity and specificity to serologically identify L. infantum-infected dog and human sera. No cross-reactivity with sera from humans or dogs that had other diseases was found. Although further studies are necessary to validate these findings, data showed here suggest immunogenicity of rSGT and its protective effect against murine VL, as well as its potential for the serodiagnosis of human and canine VL.
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Affiliation(s)
- Daniel S Dias
- 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
| | - Patrícia A F Ribeiro
- 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
| | - Vívian T Martins
- 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
| | - Daniela P Lage
- 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
| | - Áquila S B Portela
- 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
| | - Lourena E Costa
- 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
| | - Beatriz C S Salles
- 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 P Lima
- 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 F Ramos
- 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
| | - Thaís T O Santos
- 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
| | - Rachel B Caligiorne
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Miguel A Chávez-Fumagalli
- 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
| | - Julia A G Silveira
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Danielle F Magalhães-Soares
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise U 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
| | - Jamil S Oliveira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruno M Roatt
- Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana C 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
| | - Eduardo S Silva
- Programa de Pós-Graduação em Biotecnologia, Universidade Federal de São João Del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Alexsandro S Galdino
- Programa de Pós-Graduação em Biotecnologia, Universidade Federal de São João Del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Ricardo A Machado-de-Ávila
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Antonio L Teixeira
- 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; Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, 1941 East Road, Houston, TX, 77041, United States
| | - Eduardo A F 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.
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16
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Elimination of visceral leishmaniasis on the Indian subcontinent. THE LANCET. INFECTIOUS DISEASES 2016; 16:e304-e309. [PMID: 27692643 DOI: 10.1016/s1473-3099(16)30140-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/26/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023]
Abstract
Visceral leishmaniasis is a serious public health problem on the Indian subcontinent, causing high morbidity and mortality. The governments in the region launched a visceral leishmaniasis elimination initiative in 2005. We review knowledge gaps and research priorities. Key challenges include low coverage of health services for those most at risk, drug resistance, the absence of a vaccine, and the complex biology of the sandfly-human host transmission cycle. Vector control is an essential component, but innovation in this field is insufficient. Substantial progress has been made in the area of diagnostic, therapeutic, and vaccine development, but there are still many hurdles to overcome. For visceral leishmaniasis elimination to become a reality, effective deployment of these existing and new tools is essential. A strong commitment at community level is imperative, and appropriate diagnostic and treatment services as well as effective epidemiological surveillance need to be ensured.
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Solano-Gallego L, Montserrrat-Sangrà S, Ordeix L, Martínez-Orellana P. Leishmania infantum-specific production of IFN-γ and IL-10 in stimulated blood from dogs with clinical leishmaniosis. Parasit Vectors 2016; 9:317. [PMID: 27260142 PMCID: PMC4893235 DOI: 10.1186/s13071-016-1598-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/18/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is limited information available on cytokine profiles in dogs with different degrees of disease severity due to natural infection of Leishmania infantum. The aim of this study was to investigate L. infantum-specific IFN-γ and IL-10 production in blood from dogs with leishmaniosis at diagnosis and correlate these findings with disease severity, humoral immune response and blood parasitemia. METHODS Sixty dogs were diagnosed based on physical examination, routine laboratory tests, L. infantum-specific antibody levels measured by quantitative ELISA and blood parasitemia by real-time PCR. Heparin whole blood was stimulated with L. infantum soluble antigen (LSA) and concanavalin A (ConA) and incubated for 5 days. IFN-γ and IL-10 concentrations were measured in supernatants with sandwich ELISAs. RESULTS The majority of dogs (n = 36) were classified as LeishVet stage II (moderate disease). The rest of the dogs were classified as stage I (n = 10), III (n = 10) and IV (n = 4). Dogs classified with stage I and IIa presented significantly higher (P = 0.02) LSA IFN-γ concentrations, lower (P <0.0001) antibody levels and a tendency for lower blood parasitemia (P = 0.1) than dogs classified with stages IIb, III or IV while no differences in ConA IFN-γ or IL-10 concentrations were observed among groups. Thirty-five dogs produced significantly higher LSA IFN-γ (mean ± SD: 2320 ± 3960 pg/ml) and ConA IFN-γ (mean ± SD: 7887 ± 7273 pg/ml) when compared with 25 dogs that did not produce detectable LSA IFN-γ but produced ConA IFN-γ (mean ± SD: 4917 ± 5233 pg/ml). IFN-γ producer dogs presented lower (mean ± SD: 5750 ± 14,082 ELISA units (EU), P = 0.001) antibody levels and blood parasitemia (mean ± SD: 5 ± 10 parasites/ml, P = 0.001) when compared with IFN-γ non-producers (mean ± SD: 19,638 ± 28,596 EU and 1100 ± 5112 parasites/ml), respectively. LSA IL-10 was not detectable in 34 dogs while 49 dogs secreted ConA IL-10 (mean ± SD of 90 ± 103 pg/ml). LSA IFN-γ concentration was negatively correlated with blood parasitemia and antibody levels and positively correlated with ConA IFN-γ and LSA IL-10 concentrations. CONCLUSIONS The results of this study demonstrate that sick dogs lacking L. infantum specific IFN-γ production in stimulated whole blood produce a strong humoral response, have a high blood parasitemia and severe clinical disease. IL-10 does not appear to be a marker of disease severity.
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Affiliation(s)
- Laia Solano-Gallego
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Sara Montserrrat-Sangrà
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Laura Ordeix
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pamela Martínez-Orellana
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
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18
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Ibarra-Meneses AV, Carrillo E, Sánchez C, García-Martínez J, López Lacomba D, San Martin JV, Alves F, Alvar J, Moreno J. Interleukin-2 as a marker for detecting asymptomatic individuals in areas where Leishmania infantum is endemic. Clin Microbiol Infect 2016; 22:739.e1-4. [PMID: 27265372 DOI: 10.1016/j.cmi.2016.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/18/2016] [Accepted: 05/22/2016] [Indexed: 11/30/2022]
Abstract
No field method exists for identifying asymptomatic individuals in areas where Leishmania infantum is endemic. This work reports that, 24 h after stimulating whole blood with soluble Leishmania antigen (SLA), plasma interferon-γ (IFN-γ) and interleukin-2 (IL-2) become significantly elevated in samples from asymptomatic individuals (n=47) compared with those from negative controls (n=50), all of them recruited from a blood bank. When compared with the reference test SLA-lymphoproliferative assay, IL-2 appears as a new, 100% sensitive and specific marker for asymptomatic individuals with a positive cellular response (compared with 100% and 84.78%, respectively, for IFN-γ). Further studies in other transmission areas and in other cohorts of exposed people need to be performed to confirm these results. Once validated, IFN-γ and IL-2 levels in SLA-stimulated whole blood could be reliably used in the field to estimate the prevalence of those asymptomatic individuals with Leishmania-specific cellular immune responses.
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Affiliation(s)
- A V Ibarra-Meneses
- Instituto de Salud Carlos III, Centro Nacional de Microbiología, WHO Collaborating Centre for Leishmaniasis, Madrid, Spain
| | - E Carrillo
- Instituto de Salud Carlos III, Centro Nacional de Microbiología, WHO Collaborating Centre for Leishmaniasis, Madrid, Spain.
| | - C Sánchez
- Instituto de Salud Carlos III, Centro Nacional de Microbiología, WHO Collaborating Centre for Leishmaniasis, Madrid, Spain
| | - J García-Martínez
- Hospital Universitario de Fuenlabrada, Blood Bank and Haemotherapy Department, Laboratory Medicine, Fuenlabrada, Madrid, Spain
| | - D López Lacomba
- Hospital Universitario de Fuenlabrada, Blood Bank and Haemotherapy Department, Laboratory Medicine, Fuenlabrada, Madrid, Spain
| | - J V San Martin
- Hospital Universitario de Fuenlabrada, Department of Infectious Diseases, Internal Medicine, Fuenlabrada, Madrid, Spain
| | - F Alves
- Visceral Leishmaniasis Program, Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - J Alvar
- Visceral Leishmaniasis Program, Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - J Moreno
- Instituto de Salud Carlos III, Centro Nacional de Microbiología, WHO Collaborating Centre for Leishmaniasis, Madrid, Spain
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Developments in Diagnosis of Visceral Leishmaniasis in the Elimination Era. J Parasitol Res 2015; 2015:239469. [PMID: 26843964 PMCID: PMC4710934 DOI: 10.1155/2015/239469] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/06/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022] Open
Abstract
Visceral leishmaniasis (VL) is the most devastating parasitic infection worldwide causing high morbidity and mortality. Clinical presentation of VL ranges from asymptomatic or subclinical infection to severe and complicated symptomatic disease. A major challenge in the clinical management of VL is the weakness of health systems in disease endemic regions. People affected by VL mostly present to primary health care centers (PHCs), often late in their therapeutic itinerary. PHC physicians face a major challenge: they do not deal with a single disease issue but with patients presenting with complaints pointing to several diagnostic possibilities. Risk exists when some patients having less clinical manifestations are misdiagnosed. Therefore, field based accurate, sensitive, and cost effective rapid diagnostic tools that can detect disease in its mildest form are essential for effective control and reaching the goal of VL elimination. In this review, we discuss the current status and challenges of various diagnostic tools for the diagnosis of VL and assess their application in resource poor settings.
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Singh OP, Sundar S. Immunotherapy and targeted therapies in treatment of visceral leishmaniasis: current status and future prospects. Front Immunol 2014; 5:296. [PMID: 25183962 PMCID: PMC4135235 DOI: 10.3389/fimmu.2014.00296] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 06/07/2014] [Indexed: 11/13/2022] Open
Abstract
Visceral leishmaniasis (VL) is a vector-borne chronic infectious disease caused by the protozoan parasite Leishmania donovani or Leishmania infantum. VL is a serious public health problem, causing high morbidity and mortality in the developing world with an estimated 0.2-0.4 million new cases each year. In the absence of a vaccine, chemotherapy remains the favored option for disease control, but is limited by a narrow therapeutic index, significant toxicities, and frequently acquired resistance. Improved understanding of VL pathogenesis offers the development and deployment of immune based treatment options either alone or in combination with chemotherapy. Modulations of host immune response include the inhibition of molecular pathways that are crucial for parasite growth and maintenance; and stimulation of host effectors immune responses that restore the impaired effector functions. In this review, we highlight the challenges in treatment of VL with a particular emphasis on immunotherapy and targeted therapies to improve clinical outcomes.
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Affiliation(s)
- Om Prakash Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi , Uttar Pradesh, India
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi , Uttar Pradesh, India
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Singh OP, Hasker E, Sacks D, Boelaert M, Sundar S. Asymptomatic Leishmania infection: a new challenge for Leishmania control. Clin Infect Dis 2014; 58:1424-9. [PMID: 24585564 DOI: 10.1093/cid/ciu102] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Visceral leishmaniasis (VL) is a serious parasitic disease, causing high morbidity and mortality in the developing world. The pathogenesis of VL is complex, and the clinical presentation ranges from asymptomatic infection to severe and fatal disease. Despite a wealth of research on the full-blown "clinical VL" syndrome, asymptomatic leishmania infections remain poorly understood. Asymptomatic infection could present a major challenge for control programs if its infectiousness is confirmed. In this viewpoint, we highlight the crucial knowledge gaps as well as the obstacles in research on asymptomatic leishmanial infection. Research in this area is essential for the development of more-effective VL control strategies.
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Affiliation(s)
- Om Prakash Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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