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Ndiaye M, Cissé DF, Djigal A, Sow A, Lélo S, Ly F, Manga IA, Diouf MA, Sow D, Gaye O, Camara B, Faye B. A Case of Visceral Leishmaniasis in a 4-Year-Old Child Living in Nonendemic Area Located in Suburbs of Dakar, Senegal. Case Rep Infect Dis 2023; 2023:2354935. [PMID: 37720340 PMCID: PMC10505077 DOI: 10.1155/2023/2354935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023] Open
Abstract
Visceral leishmaniasis (VL) is an infectious disease caused by protozoa of the genus Leishmania. Sporadic cases are observed in nonendemic areas and often associated with limited foci; therefore, the disease is easily overlooked. In addition, other diseases have similar clinical symptoms, which make it difficult for clinicians to make an accurate diagnosis and to provide effective treatment. We identified visceral leishmaniasis in a 4-year-old child in Pikine, Senegal. The patient was admitted to the Pikine National Teaching Hospital for haemorrhagic, tumoral, and infectious syndromes. At admission, the patient presented with epistaxis and gingivorrhagia, a severe anaemic syndrome poorly tolerated, a systemic inflammatory response syndrome with fever at 39.5°C, a tumoral syndrome with 11 cm of hepatomegaly and 12 cm of type IV splenomegaly, and noninflammatory macropoly adenopathies. A spinal cord puncture was performed, and direct microscopy examination of the sample after GIEMSA staining revealed amastigote forms of Leishmania. The PCR amplification of extracted DNA from the bone marrow aspiration using specific primers for VL (forward and reverse) confirmed that VL was responsible for the infection. A treatment with meglumine antimoniate (Glucantime) was given and it gave a successful outcome with remission of clinical symptoms and favourable evolution with 3 months hindsight. Conclusion. This visceral leishmaniasis case diagnosis in Senegal has shown that, apart from haematological malignancies, this disease must be considered in combination with a tumor syndrome, haemorrhagic syndrome, and infectious syndrome.
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Affiliation(s)
- Magatte Ndiaye
- Parasitology-Mycology Department, Faculty of Medicine University Cheikh Anta Diop, Dakar, Senegal
- Laboratory Diagnostic, Pikine Teaching National Hospital, Pikine, Senegal
| | - Dienaba Fafa Cissé
- Paediatric Department, Pikine Teaching National Hospital, Pikine, Senegal
| | - Aicha Djigal
- Parasitology-Mycology Department, Faculty of Medicine University Cheikh Anta Diop, Dakar, Senegal
| | - Aminata Sow
- Paediatric Department, Pikine Teaching National Hospital, Pikine, Senegal
| | - Souléye Lélo
- Parasitology-Mycology Department, Faculty of Medicine University Cheikh Anta Diop, Dakar, Senegal
| | - Fatoumata Ly
- Paediatric Department, Pikine Teaching National Hospital, Pikine, Senegal
| | - Isaac A. Manga
- Parasitology-Mycology Department, Faculty of Medicine University Cheikh Anta Diop, Dakar, Senegal
| | - Mame Ami Diouf
- Paediatric Department, Pikine Teaching National Hospital, Pikine, Senegal
| | - Doudou Sow
- Parasitology-Mycology Department, Faculty of Medicine University Cheikh Anta Diop, Dakar, Senegal
| | - Oumar Gaye
- Parasitology-Mycology Department, Faculty of Medicine University Cheikh Anta Diop, Dakar, Senegal
| | - Boubacar Camara
- Paediatric Department, Pikine Teaching National Hospital, Pikine, Senegal
| | - Babacar Faye
- Parasitology-Mycology Department, Faculty of Medicine University Cheikh Anta Diop, Dakar, Senegal
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Clinical diversity and treatment results in Tegumentary Leishmaniasis: A European clinical report in 459 patients. PLoS Negl Trop Dis 2021; 15:e0009863. [PMID: 34644288 PMCID: PMC8544871 DOI: 10.1371/journal.pntd.0009863] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2021] [Accepted: 09/28/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management. METHODOLOGY Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients. PRINCIPAL FINDINGS Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%). CONCLUSION/SIGNIFICANCE CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates.
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Validation of Swab Sampling and SYBR Green-Based Real-Time PCR for the Diagnosis of Cutaneous Leishmaniasis in French Guiana. J Clin Microbiol 2021; 59:JCM.02218-20. [PMID: 33148706 PMCID: PMC8111157 DOI: 10.1128/jcm.02218-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/23/2020] [Indexed: 01/02/2023] Open
Abstract
Recent studies have highlighted the interest in noninvasive sampling procedures coupled with real-time PCR methods for the detection of Leishmania species in South America. In French Guiana, the sampling method still relied on skin biopsies. Noninvasive protocols should be tested on a large annual cohort to improve routine laboratory diagnosis of cutaneous leishmaniasis. Therefore, we evaluated the performance of a new Leishmania detection and species identification protocol involving cotton swabs and SYBR green-based real-time PCR of the Hsp70 gene, coupled with Sanger sequencing. Between May 2017 and May 2018, 145 patients with ulcerated lesions compatible with cutaneous leishmaniasis were included in the study at the Cayenne Hospital and its remote health centers. Each patient underwent scrapings for a smear, skin biopsies for parasite culture and PCR-restriction fragment length polymorphism (RFLP) (RNA polymerase II), and sampling with a cotton swab for SYBR green-based PCR. The most accurate diagnostic test was the SYBR green-based PCR on swab samples, showing 98% sensitivity. The mean PCR cycle threshold (CT ) was 24.4 (minimum CT , 17; maximum CT , 36) and was <35 in 97.6% of samples. All samples positive by SYBR green-based real-time PCR were successfully identified at the species level by DNA sequencing. This new method should be considered for routine diagnosis of cutaneous leishmaniasis in South America and especially for remote areas, since noninvasive collection tools are easier to use and require fewer precautions for transportation.
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Abstract
Cutaneous leishmaniasis is a parasitic infection caused by a flagellated parasite belonging to the genus Leishmania. In most cases, it is a zoonotic disease transmitted via a bite by bloodsucking sand-flies of the genus Phlebotomus. The disease reservoirs consist of wild or semi-domesticated animals, generally rodents or dogs. The disease itself is distributed extensively worldwide in the Americas, Asia, Europe and Africa. Epidemiology is affected by environmental, migratory and climatic factors. Identification of the different types of leishmaniasis is based chiefly on the biochemical characteristics (isoenzymes) on which their classification is based. The offending parasites are dimorphic intracellular organisms within the phagosome of the host's immune cells, and a single-cell flagellated protozoan with a kinetoplast contained in the gut of the vector and in culture. Three major clinical forms are seen: cutaneous leishmaniasis, mucosal leishmaniasis and visceral leishmaniasis. The clinical presentation depends on factors associated with the virulence of the parasite, with individual immune response and with the site of lesions. Although each type of leishmaniasis may have its own specific cutaneous signs and endemic regions, the most common presentations are crusted, ulcerated nodules and plaques. The natural history of leishmaniasis must also be considered when formulating therapeutic strategies. Cutaneous leishmaniasis resolves spontaneously within between one month and six years. While numerous therapeutic options have been considered in recent decades, very few have shown proven efficacy and safety. Antimony compounds administered either directly to the lesion or parenterally remain the standard treatment and their toxicity calls for vigilance and monitoring of therapy.
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Affiliation(s)
- M Mokni
- Faculté de médecine de Tunis, université Al Manar 2, service de dermatologie, hôpital La Rabta, rue Jabbari-Bab Saadoun, 1007 Tunis, Tunisie.
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Dardé ML, FougEre É, Buxeraud J. Les médicaments de la leishmaniose. ACTUALITES PHARMACEUTIQUES 2018. [DOI: 10.1016/j.actpha.2018.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rakotonarivo L, Lons-Danic D, Janier M. Plurifocal cutaneous leishmaniasis during treatment with ustekinumab. JAAD Case Rep 2018; 4:298-300. [PMID: 29693053 PMCID: PMC5911776 DOI: 10.1016/j.jdcr.2017.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Michel Janier
- Dermatology Department, Fondation Hôpital Saint-Joseph, Paris, France
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Use of the intramuscular route to administer pentamidine isethionate in Leishmania guyanensis cutaneous leishmaniasis increases the risk of treatment failure. Travel Med Infect Dis 2018; 24:31-36. [PMID: 29482012 DOI: 10.1016/j.tmaid.2018.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND New world cutaneous leishmaniasis (NWCL) can be found in French Guiana as well as in several other parts of Central and South America. Leishmania guyanensis accounts for nearly 90% of cases in French Guiana and is treated with pentamidine isethionate, given by either intramuscular or intravenous injection. The military population is particularly exposed due to repeated missions in the rainforest. The purpose of the present study was to identify the factors associated with pentamidine isethionate treatment failure in a series of service members with L. guyanensis NWCL acquired in French Guiana. METHOD All the French service members reported as having acquired leishmaniasis in French Guiana from December 2013 to June 2016 were included. RESULTS Seventy-three patients infected with L. guyanensis were included in the final analysis. Patients treated with IV pentamidine isethionate had better response rates than those treated with IM pentamidine isethionate (p = 0.002, adjusted odds ratio (AOR) = 0.15, 95% CI [0.04-0.50]). The rate of treatment success was 85.3% (95% CI [68.9-95.0]) for IV pentamidine isethionate and 51.3% (95% CI [34.8-67.6]) for IM pentamidine isethionate. CONCLUSIONS The use of intramuscular pentamidine isethionate in the treatment of Leishmania guyanensis cutaneous leishmaniasis is associated with more treatment failures than intravenous pentamidine isethionate.
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Guery R, Henry B, Martin-Blondel G, Rouzaud C, Cordoliani F, Harms G, Gangneux JP, Foulet F, Bourrat E, Baccard M, Morizot G, Consigny PH, Berry A, Blum J, Lortholary O, Buffet P. Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. PLoS Negl Trop Dis 2017; 11:e0006094. [PMID: 29155816 PMCID: PMC5714383 DOI: 10.1371/journal.pntd.0006094] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/04/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Background Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication. Methods We conducted a retrospective analysis of data from a French centralized referral treatment program and from the “LeishMan” European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines. Results From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28–803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3–27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03–32]) while infection with other species had no impact on outcome. Conclusion In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease. Cutaneous and muco-cutaneous leishmaniasis (CL/MCL) are disfiguring diseases caused by a worldwide distributed parasite called Leishmania and its 20 species. Clinical manifestations span a wide continuum from single nodular lesion to disseminated form with mucosal involvement. Though local treatment with cryotherapy and intralesionnal antimony or topical formulations of paromomycin is generally adequate in most of situations, some patients with complex CL/MCL require systemic therapy. No convenient regimen has been proved to be safe and effective for all infecting species, all clinical forms and all patients (e.g. children, pregnant women, adults with comorbidities or immunosuppression). In this study, the authors examined in returning travelers with CL/MCL the effectiveness of an antifungal agent “liposomal amphotericin B” (L-AmB), which is highly effective in visceral leishmaniasis. Surprisingly, rates of healing were lower than in previous reports in this unselected population that reflects clinical practice in non-endemic countries. The observations also suggest that some Leishmania species (namely, L. infantum) may be more susceptible to L-AmB than others. Occurrence of adverse events should raises the question of the benefit-risk balance of L-AmB in CL/MCL. Careful attention to comorbidities and adoption of strict protocols for administration are pre-requisites for the use of L-AmB in patients with CL/MCL.
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Affiliation(s)
- Romain Guery
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- * E-mail: (PB); (RG)
| | - Benoit Henry
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, INSERM U1043—CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Claire Rouzaud
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Florence Cordoliani
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Jean-Pierre Gangneux
- Service de Parasitologie-Mycologie, CHU de Rennes, INSERM U1085, Université Rennes 1, Rennes, France
| | - Françoise Foulet
- Unité de Mycologie, Département de Biologie-Pathologie, CHU Henri Mondor, DHU VIC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Emmanuelle Bourrat
- Service de Pédiatrie Général, Hôpital Robert Debré, Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | - Michel Baccard
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | | | - Paul-Henri Consigny
- Centre Médical de l'Institut Pasteur, Consultation de Maladies Infectieuses, Tropicales et de Médecine des Voyages, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
| | - Antoine Berry
- Service de Parasitologie-Mycologie, CHU de Toulouse, INSERM U1043—CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Buffet
- INTS, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence GR-Ex, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
- * E-mail: (PB); (RG)
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Lachaud L, Fernández-Arévalo A, Normand AC, Lami P, Nabet C, Donnadieu JL, Piarroux M, Djenad F, Cassagne C, Ravel C, Tebar S, Llovet T, Blanchet D, Demar M, Harrat Z, Aoun K, Bastien P, Muñoz C, Gállego M, Piarroux R. Identification of Leishmania by Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) Mass Spectrometry Using a Free Web-Based Application and a Dedicated Mass-Spectral Library. J Clin Microbiol 2017; 55:2924-2933. [PMID: 28724559 PMCID: PMC5625378 DOI: 10.1128/jcm.00845-17] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 01/16/2023] Open
Abstract
Human leishmaniases are widespread diseases with different clinical forms caused by about 20 species within the Leishmania genus. Leishmania species identification is relevant for therapeutic management and prognosis, especially for cutaneous and mucocutaneous forms. Several methods are available to identify Leishmania species from culture, but they have not been standardized for the majority of the currently described species, with the exception of multilocus enzyme electrophoresis. Moreover, these techniques are expensive, time-consuming, and not available in all laboratories. Within the last decade, mass spectrometry (MS) has been adapted for the identification of microorganisms, including Leishmania However, no commercial reference mass-spectral database is available. In this study, a reference mass-spectral library (MSL) for Leishmania isolates, accessible through a free Web-based application (mass-spectral identification [MSI]), was constructed and tested. It includes mass-spectral data for 33 different Leishmania species, including species that infect humans, animals, and phlebotomine vectors. Four laboratories on two continents evaluated the performance of MSI using 268 samples, 231 of which were Leishmania strains. All Leishmania strains, but one, were correctly identified at least to the complex level. A risk of species misidentification within the Leishmania donovani, L. guyanensis, and L. braziliensis complexes was observed, as previously reported for other techniques. The tested application was reliable, with identification results being comparable to those obtained with reference methods but with a more favorable cost-efficiency ratio. This free online identification system relies on a scalable database and can be implemented directly in users' computers.
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Affiliation(s)
- Laurence Lachaud
- Département de Parasitologie-Mycologie, Centre National de Référence des Leishmanioses, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Anna Fernández-Arévalo
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Secció de Parasitologia, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Center of International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Anne-Cécile Normand
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université d'Aix-Marseille, Marseille, France
| | - Patrick Lami
- Département de Parasitologie-Mycologie, Centre National de Référence des Leishmanioses, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Cécile Nabet
- Laboratoire Hospitalo-Universitaire de Parasito-Mycologie, EA 3593, EPaT Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Laboratoire Associé au CNR Leishmania, Cayenne, France
| | | | - Martine Piarroux
- Université Aix-Marseille, INSERM-IRD-AMU UMR 912, Marseille, France
| | - Farid Djenad
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université d'Aix-Marseille, Marseille, France
| | - Carole Cassagne
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université d'Aix-Marseille, Marseille, France
| | - Christophe Ravel
- Département de Parasitologie-Mycologie, Centre National de Référence des Leishmanioses, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Silvia Tebar
- Secció de Parasitologia, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Teresa Llovet
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Denis Blanchet
- Laboratoire Hospitalo-Universitaire de Parasito-Mycologie, EA 3593, EPaT Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Laboratoire Associé au CNR Leishmania, Cayenne, France
| | - Magalie Demar
- Laboratoire Hospitalo-Universitaire de Parasito-Mycologie, EA 3593, EPaT Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Laboratoire Associé au CNR Leishmania, Cayenne, France
| | - Zoubir Harrat
- Laboratoire d'Eco-Épidemiologie Parasitaire et Génétique des Populations, Institut Pasteur d'Algerie, Algiers, Algeria
| | - Karim Aoun
- Laboratoire de Parasitologie Médicale, Biotechnologies et Biomolécules, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Patrick Bastien
- Département de Parasitologie-Mycologie, Centre National de Référence des Leishmanioses, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Montserrat Gállego
- Secció de Parasitologia, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Center of International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Renaud Piarroux
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université d'Aix-Marseille, Marseille, France
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Alonso S, Tachfouti N, Najdi A, Sicuri E, Picado A. Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco. BMJ Glob Health 2017; 2:e000315. [PMID: 29018581 PMCID: PMC5620433 DOI: 10.1136/bmjgh-2017-000315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/15/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction Visceral leishmaniasis (VL) is a neglected parasitic disease with a high fatality rate if left untreated. Endemic in Morocco, as well as in other countries in the Mediterranean basin, VL mainly affects children living in rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow (BM) aspirates is used to diagnose VL and meglumine antimoniate (SB) is the first line of treatment. Less invasive, more efficacious and safer alternatives exist. In this study we estimate the cost-effectiveness of alternative diagnostic-therapeutic algorithms for paediatric VL in Morocco. Methods A decision tree was used to estimate the cost-effectiveness of using BM or rapid diagnostic tests (RDTs) as diagnostic tools and/or SB or two liposomal amphotericin B (L-AmB) regimens: 6-day and 2-day courses to treat VL. Incremental cost-effectiveness ratios, expressed as cost per death averted, were estimated by comparing costs and effectiveness of the alternative algorithms. A threshold analysis evaluated at which price L-AmB became cost-effective compared with current practices. Results Implementing RDT and/or L-AmB treatments would be cost-effective in Morocco according to the WHO thresholds. Introducing the 6-day course L-AmB, current second-line treatment, would be highly cost-effective if L-AmB price was below US$100/phial. The 2-day L-AmB treatment, current standard treatment of paediatric VL in France, is highly cost-effective, with L-AmB at its market price (US$165/phial). Conclusions The results of this study should encourage the implementation of RDT and/or short-course L-AmB treatments for paediatric VL management in Morocco and other North African countries.
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Affiliation(s)
- Sergi Alonso
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelon, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - Nabil Tachfouti
- Laboratory of Epidemiology, clinical Research and Community Health, Sidi Mohamed Ben Abdillah University, Fez, Morocco
| | - Adil Najdi
- Laboratory of Epidemiology, clinical Research and Community Health, Sidi Mohamed Ben Abdillah University, Fez, Morocco.,School of Medicine of Tangier, Tangier, Morocco
| | - Elisa Sicuri
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelon, Barcelona, Spain.,Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Albert Picado
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelon, Barcelona, Spain.,Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Pinazo MJ, Aldasoro E, Calvo-Cano A, Picado A, Muñoz J, Gascon J. Blood and Tissue Protozoa. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Aloui Z, Messaoud C, Haoues M, Neffati N, Bassoumi Jamoussi I, Essafi-Benkhadir K, Boussaid M, Guizani I, Karoui H. Asteraceae Artemisia campestris and Artemisia herba-alba Essential Oils Trigger Apoptosis and Cell Cycle Arrest in Leishmania infantum Promastigotes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:9147096. [PMID: 27807464 PMCID: PMC5078739 DOI: 10.1155/2016/9147096] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/06/2016] [Accepted: 08/10/2016] [Indexed: 11/17/2022]
Abstract
We report the chemical composition and anti-Leishmania and antioxidant activity of Artemisia campestris L. and Artemisia herba-alba Asso. essential oils (EOs). Our results showed that these extracts exhibit different antioxidant activities according to the used assay. The radical scavenging effects determined by DPPH assay were of IC50 = 3.3 mg/mL and IC50 = 9.1 mg/mL for Artemisia campestris and Artemisia herba-alba essential oils, respectively. However, antioxidant effects of both essential oils, determined by ferric-reducing antioxidant power (FRAP) assay, were in the same range (2.3 and 2.97 mg eq EDTA/g EO, resp.), while the Artemisia herba-alba essential oil showed highest chelating activity of Fe2+ ions (27.48 mM Fe2+). Interestingly, we showed that both EOs possess dose-dependent activity against Leishmania infantum promastigotes with IC50 values of 68 μg/mL and 44 μg/mL for A. herba-alba and A. campestris, respectively. We reported, for the first time, that antileishmanial activity of both EOs was mediated by cell apoptosis induction and cell cycle arrest at the sub-G0/G1 phase. All our results showed that EOs from A. herba-alba and A. campestris plants are promising candidates as anti-Leishmania medicinal products.
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Affiliation(s)
- Zohra Aloui
- Laboratoire d'Epidémiologie Moléculaire et Pathologie Expérimentale Appliquée aux Maladies Infectieuses LR11IPT04, Université de Tunis El Manar, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, 1002 Tunis, Tunisia
| | - Chokri Messaoud
- Unité Ressources Phytogénétiques et Biotechnologie Végétale, INSAT, BP 676, 1080 Tunis, Tunisia
| | - Meriam Haoues
- Laboratoire de Recherche sur la Transmission, le Contrôle et l'Immunobiologie des Infections LR11IPT02, Université de Tunis El Manar, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, 1002 Tunis, Tunisia
| | - Noura Neffati
- Laboratoire d'Epidémiologie Moléculaire et Pathologie Expérimentale Appliquée aux Maladies Infectieuses LR11IPT04, Université de Tunis El Manar, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, 1002 Tunis, Tunisia
| | - Imen Bassoumi Jamoussi
- Laboratoire d'Epidémiologie Moléculaire et Pathologie Expérimentale Appliquée aux Maladies Infectieuses LR11IPT04, Université de Tunis El Manar, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, 1002 Tunis, Tunisia
| | - Khadija Essafi-Benkhadir
- Laboratoire d'Epidémiologie Moléculaire et Pathologie Expérimentale Appliquée aux Maladies Infectieuses LR11IPT04, Université de Tunis El Manar, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, 1002 Tunis, Tunisia
| | - Mohamed Boussaid
- Unité Ressources Phytogénétiques et Biotechnologie Végétale, INSAT, BP 676, 1080 Tunis, Tunisia
| | - Ikram Guizani
- Laboratoire d'Epidémiologie Moléculaire et Pathologie Expérimentale Appliquée aux Maladies Infectieuses LR11IPT04, Université de Tunis El Manar, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, 1002 Tunis, Tunisia
| | - Habib Karoui
- Laboratoire d'Epidémiologie Moléculaire et Pathologie Expérimentale Appliquée aux Maladies Infectieuses LR11IPT04, Université de Tunis El Manar, Institut Pasteur de Tunis, 13 Place Pasteur, BP 74, 1002 Tunis, Tunisia
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Leishmaniose cutanée à Leishmania infantum : un grand polymorphisme clinique mais un arsenal thérapeutique limité. Ann Dermatol Venereol 2016; 143:587-589. [DOI: 10.1016/j.annder.2016.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Taquin H, Chiaverini C, Marty P, Lacour JP. [A multifocal form of cutaneous leishmaniasis caused by Leishmania infantum in an immunocompetent child treated with a short course of liposomal amphotericin B]. Ann Dermatol Venereol 2016; 143:622-624. [PMID: 27292718 DOI: 10.1016/j.annder.2016.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/25/2016] [Accepted: 03/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a parasitic infestation caused by various species of Leishmania protozoa transmitted by the bite of phlebotomine sand flies. Herein we report a case of multifocal CL due to Leishmania infantum in an immunocompetent child treated with liposomal amphotericin B. PATIENTS AND METHODS A 10-month-old baby was referred for multiple ulcerated nodules of the face and upper limbs present for 5 months and following travel to North Morocco. Histological and parasitological examinations resulted in a diagnosis of CL due to L. infantum. The child was treated with intravenous liposomal amphotericin B in accordance with the schedule for visceral leishmaniasis (10mg/kg over 2 days), and rapid improvement of the lesions was seen within 10 days. DISCUSSION Clinical polymorphism of CL exists according to the infecting species. The multifocal presentation in our patient is very unusual for CL due to L. infantum in an immunocompetent child. To our knowledge, there have been no previous reports of successful use of parenteral liposomal amphotericin B for CL caused by L. infantum as described in our case.
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Affiliation(s)
- H Taquin
- Service de dermatologie, hôpital Archet 2, CHU, route de Saint-Antoine-de-Ginestière, 06200 Nice, France.
| | - C Chiaverini
- Service de dermatologie, hôpital Archet 2, CHU, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - P Marty
- Service de parasitologie-mycologie, hôpital Archet 2, CHU, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - J-P Lacour
- Service de dermatologie, hôpital Archet 2, CHU, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
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[Cutaneous leishmaniasis due to Leishmania infantum associated with HIV]. Ann Dermatol Venereol 2016; 143:625-628. [PMID: 27156800 DOI: 10.1016/j.annder.2016.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/08/2016] [Accepted: 03/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND In Senegal, reported cases of cutaneous leishmaniasis are often due to Leishmania major. Immunosuppression related to HIV infection contributes to the emergence of leishmaniasis in humans and to cutaneous localization of viscerotropic species. We report the first observed case in Senegal of opportunistic cutaneous leishmaniasis due to Leishmania infantum associated with HIV. PATIENTS AND METHODS A 5-year-old boy presented crusted ulcerative lesions of the scalp and left forearm, together with axillary and cervical lymphadenopathy present for two months. Direct parasitological examination of the scalp and arm lesions, coupled with liquid aspiration of lymph nodes and bone marrow, enabled identification of amastigote forms of Leishmania. Polymerase chain reaction performed on skin, lymph node and bone marrow biopsy samples allowed identification of L. infantum. The child was positive for HIV1. Treatment of HIV infection and leishmaniasis resulted in clinical improvement. DISCUSSION Co-infection with cutaneous leishmaniasis due to L. infantum and HIV is a complex combination in terms of the related therapeutic issues. The clinical and laboratory outcomes depend on restoration of immunity and on the efficacy, safety and availability of anti-leishmaniasis drugs.
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Morizot G, Jouffroy R, Faye A, Chabert P, Belhouari K, Calin R, Charlier C, Miailhes P, Siriez JY, Mouri O, Yera H, Gilquin J, Tubiana R, Lanternier F, Mamzer MF, Legendre C, Peyramond D, Caumes E, Lortholary O, Buffet P. Antimony to Cure Visceral Leishmaniasis Unresponsive to Liposomal Amphotericin B. PLoS Negl Trop Dis 2016; 10:e0004304. [PMID: 26735920 PMCID: PMC4703342 DOI: 10.1371/journal.pntd.0004304] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/24/2015] [Indexed: 02/07/2023] Open
Abstract
We report on 4 patients (1 immunocompetent, 3 immunosuppressed) in whom visceral leishmaniasis had become unresponsive to (or had relapsed after) treatment with appropriate doses of liposomal amphotericin B. Under close follow-up, full courses of pentavalent antimony were administered without life-threatening adverse events and resulted in rapid and sustained clinical and parasitological cure. Visceral leishmaniasis causes fever, enlargement of internal organs like the liver and the spleen, and leads to death if no treatment is given. It is caused by a microbe called Leishmania and affects children and adults in warm and temperate regions of the world. Antimony in different forms has been used to treat Visceral Leishmaniasis for almost one century and is still in use in several countries despite the fact that it sometimes displays toxic effects, especially in patients with underlying health problems. Because it is better tolerated and at least as effective as antimony, liposomal amphotericin B is now used as the first treatment for Visceral Leishmaniasis in Southern Europe. We observed that a small proportion of patients—especially those with an impaired immune system—do not cure even after several courses of liposomal amphotericin B. In 4 such patients with “unresponsiveness” to liposomal amphotericin B, antimony provided a sustained cure without major side effects. We conclude that when multiple failures or relapses occur after treatment with liposomal amphotericin B, antimony is a reasonable, potentially life-saving treatment option. These observations also suggest that “unresponsiveness” to amphotericin B results from unusual resistance mechanisms.
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Affiliation(s)
| | - Romain Jouffroy
- Service d’anesthésie-réanimation, Hôpital Necker, Paris, France
| | - Albert Faye
- Service de Pédiatrie générale, Hôpital Robert Debré, Paris, France
| | - Paul Chabert
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Lyon, France
| | - Katia Belhouari
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Ruxandra Calin
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Caroline Charlier
- Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants malades, IHU Imagine, Paris, France
| | - Patrick Miailhes
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Lyon, France
| | - Jean-Yves Siriez
- Service d'Accueil des Urgences pédiatriques, Hôpital Robert Debré, Paris, France
| | - Oussama Mouri
- Service de Parasitologie-Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Hélène Yera
- Service de Parasitologie-Mycologie. Hôpital Cochin, Faculté de Médecine, Paris Descartes, Paris, France
| | - Jacques Gilquin
- Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants malades, IHU Imagine, Paris, France
| | - Roland Tubiana
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Fanny Lanternier
- Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants malades, IHU Imagine, Paris, France
| | | | | | - Dominique Peyramond
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Lyon, France
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants malades, IHU Imagine, Paris, France
| | - Pierre Buffet
- Service de Parasitologie-Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
- 945 INSERM, Université Paris 6, Paris, France
- * E-mail:
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Boukhris I, Azzabi S, Chérif E, Kéchaou I, Mahjoub S, Kooli C, Aoun K, Khalfallah N. [Hemophagocytosis and disseminated intravascular coagulation in visceral leishmaniasis in adults: three new cases]. Pan Afr Med J 2015; 22:96. [PMID: 26848343 PMCID: PMC4732622 DOI: 10.11604/pamj.2015.22.96.5662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 08/17/2015] [Indexed: 12/03/2022] Open
Abstract
Les atteintes cliniques et biologiques communes au syndrome d'activation macrophagique (SAM) et à la leishmaniose viscérale (LV) rendent le diagnostic étiologique du SAM très difficile. Cette association est rare et grave. Nous rapportons trois nouvelles observations de SAM secondaire à une LV, compliquées de coagulation intravasculaire disséminée (CIVD). Il s'agissait de trois hommes, âgés respectivement de 31, 20 et 60 ans. Le tableau était fait de fièvre et de splénomégalie associés à une pancytopénie et une CIVD. Le diagnostic de LV était fait par le myélogramme, les sérologies et la polymerase chain reaction. Chez l'un de nos patients, une deuxième sérologie était nécessaire. Tous nos patients étaient traités par Glucantime® avec une bonne évolution. Un cas de pancréatite aigue était noté. En en zones d'endémie, devant un SAM compliqué de CIVD, une LV doit être recherchée, en répétant si nécessaire certaines explorations initialement négatives. Le pronostic dépend de la rapidité du traitement spécifique.
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Affiliation(s)
- Imène Boukhris
- Service de Médecine Interne B, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, 1006 Bab Saadoun, Université de Tunis El Manar, Tunis, Tunisie
| | - Samira Azzabi
- Service de Médecine Interne B, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, 1006 Bab Saadoun, Université de Tunis El Manar, Tunis, Tunisie
| | - Eya Chérif
- Service de Médecine Interne B, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, 1006 Bab Saadoun, Université de Tunis El Manar, Tunis, Tunisie
| | - Ines Kéchaou
- Service de Médecine Interne B, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, 1006 Bab Saadoun, Université de Tunis El Manar, Tunis, Tunisie
| | - Sonia Mahjoub
- Laboratoire d'Hématologie, Hôpital la Rabta, Tunis, Tunisie
| | - Chékib Kooli
- Service de Médecine Interne B, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, 1006 Bab Saadoun, Université de Tunis El Manar, Tunis, Tunisie
| | - Karim Aoun
- Laboratoire de Parasitologie, Institut Pasteur de Tunis, Tunis, Tunisie
| | - Narjes Khalfallah
- Service de Médecine Interne B, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, 1006 Bab Saadoun, Université de Tunis El Manar, Tunis, Tunisie
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Murat JB, Maubon D, Ravel C, Templier I, Epaulard O. Superiority of local antimoniate over systemic liposomal amphotericin B therapy in a Leishmania infantum cutaneous leishmaniasis. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jean-Benjamin Murat
- Laboratoire Adaptation et Pathogénie des Micro-organismes (LAPM) UMR 5361 Université Joseph Fourier Grenoble 1 – CNRS, Grenoble, France
- Laboratory of Parasitology and Mycology, Grenoble University Hospital, Grenoble, France
| | - Danièle Maubon
- TheREx/TIMC-IMAG, UMR 5525 Université Joseph Fourier Grenoble 1 – CNRS, Grenoble, France
- Laboratory of Parasitology and Mycology, Grenoble University Hospital, Grenoble, France
| | - Christophe Ravel
- French National Reference Centre on Leishmaniasis, UMR5290 University of Montpellier – CNRS – IRD, Montpellier, France
| | - Isabelle Templier
- Department of Dermatology, Grenoble University Hospital, Grenoble, France
| | - Olivier Epaulard
- Unit of Virus Host Cell Interactions (UVHCI), UMI 3265 Université Joseph Fourier Grenoble 1 – EMBL – CNRS, Grenoble, France
- Department of Infectious Diseases, Grenoble University Hospital, Grenoble, France
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Abstract
Leishmania is an infectious protozoan parasite related to African and American trypanosomes. All Leishmania species that are pathogenic to humans can cause dermal disease. When one is confronted with cutaneous leishmaniasis, identification of the causative species is relevant in both clinical and epidemiological studies, case management, and control. This review gives an overview of the currently existing and most used assays for species discrimination, with a critical appraisal of the limitations of each technique. The consensus taxonomy for the genus is outlined, including debatable species designations. Finally, a numerical literature analysis is presented that describes which methods are most used in various countries and regions in the world, and for which purposes.
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Affiliation(s)
- Gert Van der Auwera
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium
| | - Jean-Claude Dujardin
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium Antwerp University, Department of Biomedical Sciences, Antwerp, Belgium
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Vassallo M, Moranne O, Ambrosetti D, Jeandel PY, Pomares C, Cassuto E, Boscagli A, Giraud G, Montagne N, Dentone C, Demacina I, Villaggio B, Secondo G, Ferrea G, Passeron C, Saudes L, Kaphan R, Marty P, Rosenthal E. Visceral leishmaniasis due to Leishmania infantum with renal involvement in HIV-infected patients. BMC Infect Dis 2014; 14:561. [PMID: 25358548 PMCID: PMC4216653 DOI: 10.1186/s12879-014-0561-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/14/2014] [Indexed: 11/12/2022] Open
Abstract
Background We describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings. Cases presentation Four HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete recovery of renal function after anti-parasitic treatment. Main clinical presentations were nephrotic or nephritic syndrome and/or acute renal failure secondary to membranoproliferative type III glomerulonephritis or acute interstitial nephritis. Clinical outcome was poor, probably as a consequence of insufficient immuno-virological control of the HIV infection. Conclusions Our findings suggest that the main histological findings in case of renal involvement due to Leishmania infantum infection in HIV-infected patients are type III MPGN and acute interstitial nephritis, with a histological specificity similar to that observed in canine leishmaniasis. Poor immune status in HIV-infected patients, altering the capacity for parasite clearance, and prolonged course of chronic active VL in this population may lead to the development of specific renal lesions. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0561-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matteo Vassallo
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Olivier Moranne
- Department of Nephrology, Dialysis and Transplantation, Nice University Hospital, Nice, France. .,Department of Public Health, Nice University Hospital, Nice, France. .,Laboratory of Human Motricity, Education and Health (LAMHESS), University of Nice Sophia-Antipolis, Nice, France.
| | - Damien Ambrosetti
- Department of Histopathology, Nice University Hospital, Nice, France.
| | | | - Christelle Pomares
- Parasitology and Mycology, Nice University Hospital and Inserm U 1065, Nice-Sophia Antipolis University, Equipe 6, Centre Méditerranéen de Médicine Moléculaire, Nice, France.
| | - Elisabeth Cassuto
- Department of Nephrology, Dialysis and Transplantation, Nice University Hospital, Nice, France.
| | - Annick Boscagli
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Guillaume Giraud
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Nathalie Montagne
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Chiara Dentone
- Department of Infectious Diseases, Sanremo General Hospital, Sanremo, Italy.
| | - Ilaria Demacina
- Department of Infectious Diseases, Sanremo General Hospital, Sanremo, Italy.
| | - Barbara Villaggio
- Department of Histopathology, Genoa University Hospital, Genoa, Italy.
| | - Giovanni Secondo
- Department of Infectious Diseases, Sanremo General Hospital, Sanremo, Italy.
| | - Giuseppe Ferrea
- Department of Infectious Diseases, Sanremo General Hospital, Sanremo, Italy.
| | - Corinne Passeron
- Department of Nephrology, Cannes General Hospital, Cannes, France.
| | - Laurence Saudes
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Regis Kaphan
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Pierre Marty
- Parasitology and Mycology, Nice University Hospital and Inserm U 1065, Nice-Sophia Antipolis University, Equipe 6, Centre Méditerranéen de Médicine Moléculaire, Nice, France.
| | - Eric Rosenthal
- Department of Internal Medicine, Nice University Hospital, Nice, France.
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Niclot J, Stansal A, Lazareth I, Galloula A, Duchatelle V, Laurent-Bellue A, Priollet P. [Ankle and foot ulcerations in a diabetic patient revealing cutaneous leishmaniasis]. ACTA ACUST UNITED AC 2014; 39:430-3. [PMID: 25201090 DOI: 10.1016/j.jmv.2014.07.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 07/28/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cutaneous leishmaniasis is a parasitic disease that typically manifests as a typical crusted ulcer called the oriental sore. Its localization on the lower limbs can be mistaken for a leg ulcer. CASE REPORT An 81-year-old male, native of Algeria, with type 2 diabetes, arterial hypertension and arteriopathy developed a chronic ulceration of the right ankle and foot compatible with the diagnosis of infectious diabetic foot. Non-improvement with antibiotics, local treatment and rest, and the absence of any hemodynamic arteriopathy led to skin biopsies. Polymerase chain reaction performed on biopsy samples for parasitological investigations yielded the diagnosis of cutaneous leishmaniasis due to Leishmania major. Complete healing was obtained with topical care alone, the patient having declined an etiological treatment. DISCUSSION Cutaneous leishmaniasis is one of the rare infectious etiologies of chronic leg ulcers. Several therapeutic options, including abstention, can be proposed.
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Affiliation(s)
- J Niclot
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Stansal
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - I Lazareth
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Galloula
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - V Duchatelle
- Service d'anatomopathologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Laurent-Bellue
- Service d'anatomopathologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Mouri O, Morizot G, Van der Auwera G, Ravel C, Passet M, Chartrel N, Joly I, Thellier M, Jauréguiberry S, Caumes E, Mazier D, Marinach-Patrice C, Buffet P. Easy identification of leishmania species by mass spectrometry. PLoS Negl Trop Dis 2014; 8:e2841. [PMID: 24902030 PMCID: PMC4046964 DOI: 10.1371/journal.pntd.0002841] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/23/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis is caused by several Leishmania species that are associated with variable outcomes before and after therapy. Optimal treatment decision is based on an accurate identification of the infecting species but current methods to type Leishmania isolates are relatively complex and/or slow. Therefore, the initial treatment decision is generally presumptive, the infecting species being suspected on epidemiological and clinical grounds. A simple method to type cultured isolates would facilitate disease management. METHODOLOGY We analyzed MALDI-TOF spectra of promastigote pellets from 46 strains cultured in monophasic medium, including 20 short-term cultured isolates from French travelers (19 with CL, 1 with VL). As per routine procedure, clinical isolates were analyzed in parallel with Multilocus Sequence Typing (MLST) at the National Reference Center for Leishmania. PRINCIPAL FINDINGS Automatic dendrogram analysis generated a classification of isolates consistent with reference determination of species based on MLST or hsp70 sequencing. A minute analysis of spectra based on a very simple, database-independent analysis of spectra based on the algorithm showed that the mutually exclusive presence of two pairs of peaks discriminated isolates considered by reference methods to belong either to the Viannia or Leishmania subgenus, and that within each subgenus presence or absence of a few peaks allowed discrimination to species complexes level. CONCLUSIONS/SIGNIFICANCE Analysis of cultured Leishmania isolates using mass spectrometry allows a rapid and simple classification to the species complex level consistent with reference methods, a potentially useful method to guide treatment decision in patients with cutaneous leishmaniasis.
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Affiliation(s)
- Oussama Mouri
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
| | - Gloriat Morizot
- Unité d'Immunologie Moléculaire des Parasites, Institut Pasteur de Paris, Paris, France
| | - Gert Van der Auwera
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christophe Ravel
- Centre National de Référence des Leishmanioses, Montpellier, France
| | - Marie Passet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
| | - Nathalie Chartrel
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
| | - Isabelle Joly
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
| | - Marc Thellier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- Institut National de la Santé et de la Recherche Médicale U945, Paris, France
| | - Stéphane Jauréguiberry
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladie Infectieuse, Paris, France
| | - Eric Caumes
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladie Infectieuse, Paris, France
| | - Dominique Mazier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- Institut National de la Santé et de la Recherche Médicale U945, Paris, France
| | - Carine Marinach-Patrice
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- Institut National de la Santé et de la Recherche Médicale U945, Paris, France
| | - Pierre Buffet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- Institut National de la Santé et de la Recherche Médicale U945, Paris, France
- * E-mail:
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Species-directed therapy for leishmaniasis in returning travellers: a comprehensive guide. PLoS Negl Trop Dis 2014; 8:e2832. [PMID: 24787001 PMCID: PMC4006727 DOI: 10.1371/journal.pntd.0002832] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
Background Leishmaniasis is increasingly reported among travellers. Leishmania species vary in sensitivity to available therapies. Fast and reliable molecular techniques have made species-directed treatment feasible. Many treatment trials have been designed poorly, thus developing evidence-based guidelines for species-directed treatment is difficult. Published guidelines on leishmaniasis in travellers do not aim to be comprehensive or do not quantify overall treatment success for available therapies. We aimed at providing comprehensive species-directed treatment guidelines. Methodology/Principal Findings English literature was searched using PubMed. Trials and observational studies were included if all cases were parasitologically confirmed, the Leishmania species was known, clear clinical end-points and time points for evaluation of treatment success were defined, duration of follow-up was adequate and loss to follow-up was acceptable. The proportion of successful treatment responses was pooled using mixed effects methods to estimate the efficacy of specific therapies. Final ranking of treatment options was done by an expert panel based on pooled efficacy estimates and practical considerations. 168 studies were included, with 287 treatment arms. Based on Leishmania species, symptoms and geography, 25 clinical categories were defined and therapy options ranked. In 12/25 categories, proposed treatment agreed with highest efficacy data from literature. For 5/25 categories no literature was found, and in 8/25 categories treatment advise differed from literature evidence. For uncomplicated cutaneous leishmaniasis, combination of intralesional antimony with cryotherapy is advised, except for L. guyanensis and L. braziliensis infections, for which systemic treatment is preferred. Treatment of complicated (muco)cutaneous leishmaniasis differs per species. For visceral leishmaniasis, liposomal amphotericin B is treatment of choice. Conclusions/Significance Our study highlights current knowledge about species-directed therapy of leishmaniasis in returning travellers and also demonstrates lack of evidence for treatment of several clinical categories. New data can easily be incorporated in the presented overview. Updates will be of use for clinical decision making and for defining further research. Human leishmaniasis is caused by unicellular parasites that are injected into the skin by sand-flies, small, flying insects. Many different Leishmania species cause various manifestations of disease, both of the skin and internal organs. Leishmaniasis is a curable disease but clear guidelines on the best available treatment are lacking. Leishmania species differ in sensitivity to available drugs. Until recently, identification of the infecting Leishmania parasite was laborious, thus therapy could not precisely be targeted to the infecting species, in contrast to many other infectious diseases. Nowadays, Leishmania parasites can be identified relatively easily with new DNA techniques. We studied efficacy of therapies for diseases due to different Leishmania species, limited to the English literature. Efficacy was summarized and presented in an easy to read format. Because of difficulties with identification of parasite species in earlier studies, quality of evidence was often limited. Our findings are a major help for clinicians to easily find optimal treatment for specific patients. Moreover, our results demonstrate where additional research is needed to further improve treatment of leishmaniasis.
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Blum J, Buffet P, Visser L, Harms G, Bailey MS, Caumes E, Clerinx J, van Thiel PPAM, Morizot G, Hatz C, Dorlo TPC, Lockwood DNJ. LeishMan recommendations for treatment of cutaneous and mucosal leishmaniasis in travelers, 2014. J Travel Med 2014; 21:116-29. [PMID: 24745041 DOI: 10.1111/jtm.12089] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment of cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML) in travelers is still controversial. Over the last decade, national and international consortia have published recommendations for treating CL in travelers. These guidelines harmonize many issues, but there are some discrepancies. METHODS Leishmania parasites causing CL can now be genotyped by polymerase chain reaction techniques for detecting Leishmania DNA. Therefore, treatment recommendations can now be species based rather than based on geographical exposure. To review the evidence on which the recommendations were based, "LeishMan" (Leishmaniasis Management), a group of experts from 13 institutions in eight European countries, performed a PubMed MEDLINE) literature search and considered unpublished evidence and the experts' own personal experiences. The Oxford evidence grading system was used to evaluate the information. RESULTS AND CONCLUSION In this article, the authors provide practical treatment recommendations for imported CL and ML in Europe, drawn up from the review by the European experts.
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Leignel S, Schuster JP, Hoertel N, Poulain X, Limosin F. Mental health and substance use among self-employed lawyers and pharmacists. Occup Med (Lond) 2014; 64:166-71. [DOI: 10.1093/occmed/kqt173] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Alkyl galactofuranosides strongly interact with Leishmania donovani membrane and provide antileishmanial activity. Antimicrob Agents Chemother 2014; 58:2156-66. [PMID: 24468785 DOI: 10.1128/aac.01350-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We investigated the in vitro effects of four alkyl-galactofuranoside derivatives, i.e., octyl-β-D-galactofuranoside (compound 1), 6-amino-β-D-galactofuranoside (compound 2), 6-N-acetamido-β-D-galactofuranoside (compound 3), and 6-azido-β-D-galactofuranoside (compound 4), on Leishmania donovani. Their mechanism of action was explored using electron paramagnetic resonance spectroscopy (EPR) and nuclear magnetic resonance (NMR), and ultrastructural alterations were analyzed by transmission electron microscopy (TEM). Compound 1 showed the most promising effects by inhibiting promastigote growth at a 50% inhibitory concentration (IC50) of 8.96±2.5 μM. All compounds exhibit low toxicity toward human macrophages. Compound 1 had a higher selectivity index than the molecule used for comparison, i.e., miltefosine (159.7 versus 37.9, respectively). EPR showed that compound 1 significantly reduced membrane fluidity compared to control promastigotes and to compound 3. The furanose ring was shown to support this effect, since the isomer galactopyranose had no effect on parasite membrane fluidity or growth. NMR showed a direct interaction of all compounds (greatest with compound 1, followed by compounds 2, 3, and 4, in descending order) with the promastigote membrane and with octyl-galactopyranose and octanol, providing evidence that the n-octyl chain was primarily involved in anchoring with the parasite membrane, followed by the putative crucial role of the furanose ring in the antileishmanial activity. A morphological analysis of compound 1-treated promastigotes by TEM revealed profound alterations in the parasite membrane and organelles, but this was not the case with compound 3. Quantification of annexin V binding by flow cytometry confirmed that compound 1 induced apoptosis in >90% of promastigotes. The effect of compound 1 was also assessed on intramacrophagic amastigotes and showed a reduction in amastigote growth associated with an increase of reactive oxygen species (ROS) production, thus validating its promising effect.
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Lavergne RA, Iriart X, Martin-Blondel G, Chauvin P, Menard S, Fillaux J, Cassaing S, Roques-Malecaze C, Arnaud S, Valentin A, Magnaval JF, Marchou B, Berry A. Contribution of molecular diagnosis to the management of cutaneous leishmaniasis in travellers. Clin Microbiol Infect 2014; 20:O528-30. [PMID: 24279601 DOI: 10.1111/1469-0691.12487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 11/29/2022]
Abstract
Cutaneous leishmaniasis is one of the most frequent skin diseases occurring after travelling in endemic areas. Optimal management requires identification of the species of Leishmania involved. In this study we aimed to evaluate the use of molecular diagnosis as routine, in comparison with direct examination and culture. Thirty positive diagnoses were carried out between 2007 and 2013. Classical PCR enabled 11 positive cases to be identified that were found to be negative by conventional methods. Sequencing led to the identification of eight different species. Routine use of PCR and sequencing appears very efficient in the management of cutaneous leishmaniasis.
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Affiliation(s)
- R A Lavergne
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM, U1043, Toulouse, France; CNRS, U5282, Toulouse, France; Université de Toulouse, UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France
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Lenvers P, Marty P, Peyron F. Ulcération chronique du visage : penser à une leishmaniose cutanée métropolitaine due à Leishmania infantum. Ann Dermatol Venereol 2013; 140:704-7. [DOI: 10.1016/j.annder.2013.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 06/11/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Neumayr A, Hatz C, Blum J. Not to be missed! Differential diagnoses of common dermatological problems in returning travellers. Travel Med Infect Dis 2013; 11:337-49. [DOI: 10.1016/j.tmaid.2013.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/20/2013] [Accepted: 09/25/2013] [Indexed: 12/01/2022]
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30
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Neumayr AL, Morizot G, Visser LG, Lockwood DN, Beck BR, Schneider S, Bellaud G, Cordoliani F, Foulet F, Laffitte EA, Buffet P, Blum JA. Clinical aspects and management of cutaneous leishmaniasis in rheumatoid patients treated with TNF-α antagonists. Travel Med Infect Dis 2013; 11:412-20. [DOI: 10.1016/j.tmaid.2013.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/09/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
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Ejazi SA, Ali N. Developments in diagnosis and treatment of visceral leishmaniasis during the last decade and future prospects. Expert Rev Anti Infect Ther 2013; 11:79-98. [PMID: 23428104 DOI: 10.1586/eri.12.148] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Human visceral leishmaniasis (VL) continues to be a life-threatening neglected tropical disease, with close to 200 million people at risk of infection globally. Epidemics and resurgence of VL are associated with negligence by the policy makers, economic decline and population movements. Control of the disease is hampered by the lack of proficient vaccination, rapid diagnosis in a field setting and severe side effects of current drug therapies. The diagnosis of VL relied largely on invasive techniques of detecting parasites in splenic and bone marrow aspirates. rK39 and PCR, despite problems related to varying sensitivities and specificities and field adaptability, respectively, are considered the best options for VL diagnosis today. No single therapy of VL currently offers satisfactory efficacy along with safety. The field of VL research only recently shifted toward actively identifying new drugs for safe and affordable treatment. Oral miltefosine and safe AmBisome along with better use of amphotericin B have been rapidly implemented in the last decade. A combination therapy will substantially reduce the required dose and duration of drug administration and reduce the chance of the development of resistance. In addition, identification of asymptomatic cases, vector control and treatment of post-kala-azar dermal leishmaniasis would allow new perspectives in VL control and management.
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Affiliation(s)
- Sarfaraz Ahmad Ejazi
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, 4 Raja S.C. Mullick Road, Kolkata 700032, India
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Blum J, Lockwood DNJ, Visser L, Harms G, Bailey MS, Caumes E, Clerinx J, van Thiel PPAM, Morizot G, Hatz C, Buffet P. Local or systemic treatment for New World cutaneous leishmaniasis? Re-evaluating the evidence for the risk of mucosal leishmaniasis. Int Health 2013; 4:153-63. [PMID: 24029394 DOI: 10.1016/j.inhe.2012.06.004] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This review addresses the question of whether the risk of developing mucosal leishmaniasis (ML) warrants systemic treatment in all patients with New World cutaneous leishmaniasis (CL) or whether local treatment might be an acceptable alternative. The risk of patients with New World CL developing ML after the initial infection has been the main argument for systemic treatment. However, this statement needs re-evaluation and consideration of all the available data. The putative benefit of preventing ML should outweigh the toxicity of systemic antileishmanial therapy. To assess the need for and risk of systemic treatment the following factors were reviewed: the incidence and prevalence of ML in endemic populations and in travellers; the severity of mucosal lesions; the efficacy of current options to treat ML; the toxicity and, to a lesser extent, the costs of systemic treatment; the risk of developing ML after local treatment; and the strengths and limitations of current estimates of the risk of developing ML in different situations. Local treatment might be considered as a valuable treatment option for travellers suffering from New World CL, provided that there are no risk factors for developing ML such as multiple lesions, big lesions (>4 cm(2)), localisation of the lesion on the head or neck, immunosuppression or acquisition of infection in the high Andean countries, notably Bolivia.
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Affiliation(s)
- Johannes Blum
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
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Van der Auwera G, Maes I, De Doncker S, Ravel C, Cnops L, Van Esbroeck M, Van Gompel A, Clerinx J, Dujardin JC. Heat-shock protein 70 gene sequencing for Leishmania species typing in European tropical infectious disease clinics. ACTA ACUST UNITED AC 2013; 18:20543. [PMID: 23929181 DOI: 10.2807/1560-7917.es2013.18.30.20543] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe Leishmania species determination on clinical samples on the basis of partial sequencing of the heat-shock protein 70 gene (hsp70), without the need for parasite isolation. The method is especially suited for use in non-endemic infectious disease clinics dealing with relatively few cases on an annual basis, for which no fast high throughput diagnostic tests are needed. We show that the results obtained from this gene are in nearly perfect agreement with those from multilocus enzyme electrophoresis, which is still considered by many clinicians and the World Health Organization (WHO) as the gold standard in Leishmania species typing. Currently, 203 sequences are available that cover the entire hsp70 gene region analysed here, originating from a total of 41 leishmaniasis endemic countries, and representing 15 species and sub-species causing human disease. We also provide a detailed laboratory protocol that includes a step-by-step procedure of the typing methodology, to facilitate implementation in diagnostic laboratories.
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Affiliation(s)
- G Van der Auwera
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
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Cutaneous leishmaniasis in Switzerland: first experience with species-specific treatment. Infection 2013; 41:1177-82. [PMID: 23835701 DOI: 10.1007/s15010-013-0500-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Different species of the genus Leishmania can cause cutaneous (CL) and mucosal leishmaniasis (ML). PCR-based tests allow a rapid diagnosis and determination of the species, thereby enabling species-oriented treatment. Such treatment procedures have not been evaluated to date. METHODS Patients presenting with CL and ML between 1999 and 2011 were analysed retrospectively. PCR technology was used to diagnose the disease and identify the protozoan to the species level. RESULTS A total of 61 cases were reviewed, including 58 patients with CL and three patients with ML. Treatment was effective in most patients. Treatment failure was reported in six patients with L. panamensis (one fluconazole, one ketoconazole), L. infantum (one excision, one fluconazole), L. tropica (one paromomycin/methylbenzethonium), L. braziliensis (1 paromomycin/methylbenzethonium). In 11 (18 %) patients treatment had to be interrupted due to adverse events, and in eight patients (13 %) a second treatment had to be applied. Treatment with meglumine antimoniate had to be interrupted in six patients, with QTc prolongation the reason for the interruption in three patients. CONCLUSIONS Species-related, targeted treatment resulted in good responses in CL and ML lesions. Treatment recommendations for L. panamensis were changed from ketoconazole to miltefosine because of new evidence of treatment failures. Meglumine antimoniate should be restricted to species with poor response to alternative medications and should be used with caution in patients older than 60 years because of its toxicity. Treatment in immunosuppressed patients was successful, but relapses were observed when the immune system could not be restored. This is the first report on L. aethiopica from Egypt.
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Cenderello G, Pasa A, Dusi A, Dentone C, Toscanini F, Bobbio N, Bondi E, Del Bono V, Izzo M, Riccio G, Anselmo M, Giacchino R, Marazzi MG, Pagano G, Cassola G, Viscoli C, Ferrea G, De Maria A. Varied spectrum of clinical presentation and mortality in a prospective registry of visceral leishmaniasis in a low endemicity area of Northern Italy. BMC Infect Dis 2013; 13:248. [PMID: 23718708 PMCID: PMC3674923 DOI: 10.1186/1471-2334-13-248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 05/22/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls. METHODS Demographic data, clinical, laboratory features and therapeutic findings were recorded in patients identified by a regional VL disease registry from January 2007 to December 2010. RESULTS A total of 55 patients (36 adults mean age 48.7 years, 19 children median age 37.5 months) were observed presenting with 65 episodes. All childen were immunocompetent, whereas adults affected by VL included both immunocompetent (n°17) and immunesuppressed (n°19) patients. The clinical presentation was homogeneous in children with predominance of fever and hepato-splenomegaly. A wider spectrum of clinical presentations was observed in immunocompromised adults. Bone marrow detection of intracellular parasites (Giemsa staining) and serology (IFAT) were the most frequently used diagnostic tools. In addition, detection of urinary antigen was used in adult patients with good specificity (90%). Liposomal amphotericin B was the most frequently prescribed first line drug (98.2% of cases) with 100% clinical cure. VL relapses (n°10) represented a crucial finding: they occurred only in adult patients, mainly in immunocompromised patients (40% of HIV, 22% of non-HIV immunocompromised patients, 5,9% of immunocompetent patients). Furthermore, three deaths with VL were reported, all occurring in relapsing immunocompromised patients accounting for a still high overall mortality in this group (15.8%). CONCLUSIONS The wide spectrum of clinical presentation in immunesuppresed patients and high recurrence rates still represent a clinical challenge accounting for high mortality. Early clinical identification and satisfactory treatment performance with liposomal amphotericin B are confirmed in areas with low-level endemicity and good clinical standards. VL needs continuing attention in endemic areas where increasing numbers of immunocompromised patients at risk are dwelling.
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Affiliation(s)
| | - Ambra Pasa
- S.C. Oncologia Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Andrea Dusi
- SSD Microbiologia ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | - Chiara Dentone
- SC. Malattie Infettive, ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | | | - Nicoletta Bobbio
- S.C. Malattie Infettive Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Elisabetta Bondi
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Valerio Del Bono
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Manuela Izzo
- SC Malattie infettive Ospedale Santa Maria della Misericordia Albenga ASL-2, Albenga (SV), Italy
| | - Giovanni Riccio
- SC Malattie infettive Ospedale Santa Maria della Misericordia Albenga ASL-2, Albenga (SV), Italy
| | - Marco Anselmo
- SC Malattie Infettive Ospedale San Paolo ASL2, Savona, Italy
| | - Raffaella Giacchino
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Maria Grazia Marazzi
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Gabriella Pagano
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Giovanni Cassola
- S.C. Malattie Infettive Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Claudio Viscoli
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Giuseppe Ferrea
- SC. Malattie Infettive, ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | - Andrea De Maria
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
- S.S.Infettivologia, IRCCS AOU San Martino-IST Genova, Genova, Italy
- A.D.M, University of Genova, Largo R.Benzi 10, Genova, 16132, Italy
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Ben Salah A, Ben Messaoud N, Guedri E, Zaatour A, Ben Alaya N, Bettaieb J, Gharbi A, Belhadj Hamida N, Boukthir A, Chlif S, Abdelhamid K, El Ahmadi Z, Louzir H, Mokni M, Morizot G, Buffet P, Smith PL, Kopydlowski KM, Kreishman-Deitrick M, Smith KS, Nielsen CJ, Ullman DR, Norwood JA, Thorne GD, McCarthy WF, Adams RC, Rice RM, Tang D, Berman J, Ransom J, Magill AJ, Grogl M. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med 2013; 368:524-32. [PMID: 23388004 DOI: 10.1056/nejmoa1202657] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a need for a simple and efficacious treatment for cutaneous leishmaniasis with an acceptable side-effect profile. METHODS We conducted a randomized, vehicle-controlled phase 3 trial of topical treatments containing 15% paromomycin, with and without 0.5% gentamicin, for cutaneous leishmaniasis caused by Leishmania major in Tunisia. We randomly assigned 375 patients with one to five ulcerative lesions from cutaneous leishmaniasis to receive a cream containing 15% paromomycin-0.5% gentamicin (called WR 279,396), 15% paromomycin alone, or vehicle control (with the same base as the other two creams but containing neither paromomycin nor gentamicin). Each lesion was treated once daily for 20 days. The primary end point was the cure of the index lesion. Cure was defined as at least 50% reduction in the size of the index lesion by 42 days, complete reepithelialization by 98 days, and absence of relapse by the end of the trial (168 days). Any withdrawal from the trial was considered a treatment failure. RESULTS The rate of cure of the index lesion was 81% (95% confidence interval [CI], 73 to 87) for paromomycin-gentamicin, 82% (95% CI, 74 to 87) for paromomycin alone, and 58% (95% CI, 50 to 67) for vehicle control (P<0.001 for each treatment group vs. the vehicle-control group). Cure of the index lesion was accompanied by cure of all other lesions except in five patients, one in each of the paromomycin groups and three in the vehicle-control group. Mild-to-moderate application-site reactions were more frequent in the paromomycin groups than in the vehicle-control group. CONCLUSIONS This trial provides evidence of the efficacy of paromomycin-gentamicin and paromomycin alone for ulcerative L. major disease. (Funded by the Department of the Army; ClinicalTrials.gov number, NCT00606580.).
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Buffet P. [Cutaneous leishmaniasis: can the infective agent be determined on clinical grounds alone?]. Ann Dermatol Venereol 2012; 139:515-7. [PMID: 22963958 DOI: 10.1016/j.annder.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aït-Oudhia K, Gazanion E, Sereno D, Oury B, Dedet J, Pratlong F, Lachaud L. In vitro susceptibility to antimonials and amphotericin B of Leishmania infantum strains isolated from dogs in a region lacking drug selection pressure. Vet Parasitol 2012; 187:386-93. [DOI: 10.1016/j.vetpar.2012.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 01/18/2012] [Accepted: 01/26/2012] [Indexed: 10/14/2022]
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