1
|
Chakhunashvili DG, Chakhunashvili K, Kvirkvelia E. Visceral leishmaniasis misdiagnosed as an upper respiratory infection and iron-deficiency anemia in a 20-month-old male patient: a case report. J Med Case Rep 2024; 18:37. [PMID: 38291520 PMCID: PMC10829240 DOI: 10.1186/s13256-024-04356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Visceral Leishmaniasis should be suspected in every patient with a history of splenomegaly, fever, and pancytopenia. It is one of the most dangerous forms of infection and prompt recognition is the key to positive outcome. CASE PRESENTATION A 20-month-old Caucasian male patient was brought to our hospital as an outpatient with the complaint of persistent fever, which did not improve with empiric antibiotic treatment (> 96 hour after the initial dose). The antibiotic treatment had been prescribed by primary care physician at polyclinic, who also referred the patient to hematologist due to anemia, who prescribed iron supplement. Despite multiple subspecialist visits, bicytopenia was, unfortunately, left unidentified. Upon physical examination no specific signs were detected, however, spleen seemed slightly enlarged. Patient was admitted to the hospital for further work-up, management and evaluation. Abdominal ultrasound, complete blood count and c-reactive protein had been ordered. Hematologist and infectionist were involved, both advised to run serology for Epstein-Barr Virus and Visceral Leishmaniasis. The latter was positive; therefore, patient was transferred to the specialized clinic for specific management. CONCLUSION Both in endemic and non-endemic areas the awareness about VL should be increased among the medical professionals. We also recommend that our colleagues take the same approach when dealing with bicytopenia and fever, just as with pancytopenia and fever. The medical community should make sure that none of the cases of fever and pancytopenia are overlooked, especially if we have hepatomegaly and/or splenomegaly.
Collapse
Affiliation(s)
- Davit G Chakhunashvili
- Department of Pediatrics, Alte University, Tbilisi, Georgia
- Children's Clinic After I. Tsitsishvili, Tbilisi, Georgia
| | - Konstantine Chakhunashvili
- Department of Pediatrics, The University of Georgia, Tbilisi, Georgia.
- Children's Clinic After I. Tsitsishvili, Tbilisi, Georgia.
| | - Eka Kvirkvelia
- Department of Gynecology, Caucasus University, Tbilisi, Georgia
| |
Collapse
|
2
|
Asymptomatic Leishmania infection in humans: A systematic review. J Infect Public Health 2023; 16:286-294. [PMID: 36630836 DOI: 10.1016/j.jiph.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Leishmaniasis is a highly prevalent neglected tropical disease. It mainly presents as two forms: cutaneous and visceral leishmaniasis, the latter being the most severe form. However, asymptomatic cases of Leishmania infection result in an increase in the underreporting and transmission of the protozoan OBJECTIVES: In this study, articles on the incidence of asymptomatic Leishmania infection were systematically reviewed. METHODS The publications identified in the Medline/PubMed and Science Direct databases included 4568 articles. Inclusion, exclusion, and eligibility criterion analysis resulted in 83 articles being retained. These studies were mostly performed in Brazil (n = 26) and India (n = 15). RESULTS Several detection techniques have been used for diagnosis. Among the species found were L. infantum and L. donovani, which result in visceral leishmaniasis, and L. amazonensis, L. braziliensis, and L. panamensis. The incidence rates varied between the analyzed locations, largely due to sampling and the presence or absence of endemism in the regions. The largest populations analyzed were in two studies performed in India and Nepal. One of these studies evaluated 32,529 people and the incidence rate was 8.3% (n = 2702), while the other study evaluated 21,267 people and the incidence rate was 1.76% (n = 375). Only 14.28% of the studies investigated leishmaniasis in blood donors. Preexisting diseases have also been reported. CONCLUSION The findings of this systematic review present the incidence of cases of asymptomatic Leishmania infection worldwide, in addition to detailing the studies and offering information for researchers and health authorities to seek alternatives to reduce the number of leishmaniasis cases.
Collapse
|
3
|
Ibarra-Meneses AV, Corbeil A, Wagner V, Onwuchekwa C, Fernandez-Prada C. Identification of asymptomatic Leishmania infections: a scoping review. Parasit Vectors 2022; 15:5. [PMID: 34983616 PMCID: PMC8727076 DOI: 10.1186/s13071-021-05129-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Asymptomatic Leishmania infection may play an important role in the transmission of the parasite in endemic areas. At present there is no consensus on the definition of asymptomatic Leishmania infection, nor is there a safe and accessible gold standard test for its identification. METHODS This paper presents a scoping review to summarize definitions of asymptomatic Leishmania infection found in the literature, as well as to detail the approach (molecular, serological, cellular, and/or parasitological tests) used by researchers to identify this asymptomatic population. A scoping review of published and gray literature related to asymptomatic Leishmania infection was conducted; retrieved citations were screened based on predefined eligibility criteria, and relevant data items were extracted from eligible articles. The analysis is descriptive and is presented using tables, figures, and thematic narrative synthesis. RESULTS We conducted a screening of 3008 articles, of which 175 were selected for the full review. Of these articles, we selected 106 that met the inclusion criteria. These articles were published between 1991 and 2021, and in the last 5 years, up to 38 articles were reported. Most of the studies were conducted in Brazil (26%), Spain (14%), India (12%), Bangladesh (10%), and Ethiopia (7%). Of the studies, 84.9% were conducted in the immunocompetent population, while 15.1% were conducted in the immunosuppressed population (HIV, immunosuppressive drugs, and organ transplantation population). We report 14 different techniques and 10 strategies employed by researchers to define asymptomatic Leishmania infection in an endemic area. CONCLUSIONS The definition of asymptomatic Leishmania infection is not unified across the literature, but often includes the following criteria: residence (or extended stay) in a Leishmania-endemic area, no reported signs/symptoms compatible with leishmaniasis, and positive on a combination of serological, molecular, cellular, and/or parasitological tests. Caution is recommended when comparing results of different studies on the subject of asymptomatic infections, as the reported prevalence cannot be confidently compared between areas due to the wide variety of tests employed by research groups. More research on the importance of asymptomatic immunosuppressed and immunocompetent Leishmania-positive populations in leishmaniasis epidemiology is required.
Collapse
Affiliation(s)
- Ana Victoria Ibarra-Meneses
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada.,The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Saint Hyacinthe, Canada
| | - Audrey Corbeil
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada.,The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Saint Hyacinthe, Canada
| | - Victoria Wagner
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada.,The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Saint Hyacinthe, Canada
| | - Chukwuemeka Onwuchekwa
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Christopher Fernandez-Prada
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada. .,The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Saint Hyacinthe, Canada.
| |
Collapse
|
4
|
Mediterranean visceral leishmaniasis : update on biological diagnosis. LA TUNISIE MEDICALE 2022; 100:13-26. [PMID: 35822327 PMCID: PMC8996314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Visceral leishmaniasis (VL) is a severe life threatening parasitosis requiring early management of cases. It is an emerging disease in the Mediterranean region with a spread of endemic areas and an increase in case incidence. The patient profile has also evolved with more affected adults, presenting generally non-specific symptoms. Hence the interest of a systematic biological confirmation. The microscopic detection of Leishmania amastigotes in bone marrow aspirates (BMA) smears is the gold standard diagnostic technique. However, it requires invasive sampling. Serological tests searching for specific antibodies remain highly contributory, but their interpretation must always take into account the epidemiological context and the patient's clinical and biological features. Currently, the Western-Blot represents the most specific serological technique for diagnostic confirmation. VL diagnosis has greatly improved by the introduction of both rapid diagnostic tests (RDTs) and molecular biological techniques. RDTs using recombinant rk39 antigen are easy to perform and deliver results in less than 30 minutes. Real-time PCR (Polymerase Chain Reaction) is currently retained as the best technique for VL diagnosis. It is efficient on simple blood samples, allowing to avoid invasive BMA needed for microscopy. In addition, real time PCR estimates parasite load which is helpful for the post-treatment follow-up. In any case, the choice of techniques to be used should be strategic and adapted to the local epidemiology as well as to the means available.
Collapse
|
5
|
Lévêque MF, Lachaud L, Simon L, Battery E, Marty P, Pomares C. Place of Serology in the Diagnosis of Zoonotic Leishmaniases With a Focus on Visceral Leishmaniasis Due to Leishmania infantum. Front Cell Infect Microbiol 2020; 10:67. [PMID: 32158704 PMCID: PMC7052174 DOI: 10.3389/fcimb.2020.00067] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Abstract
Leishmaniases are a group of parasitic diseases transmitted through the bite of female phlebotomine sandflies. Depending on the Leishmania species, the reservoirs can be humans (anthroponosis) or different animals (zoonosis). Zoonotic leishmaniasis present several clinical forms in function of the species involved: visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and muco-cutaneous leishmaniasis (MCL). The biological diagnosis is of utmost importance because the clinical features are not specific. In addition to parasitological and molecular biology (polymerase chain reaction, PCR) assays, serology is routinely used for the diagnosis of leishmaniasis. Indeed, although PCR is more sensitive than serological assays, its implementation is limited to referral laboratories and research centers. Therefore, serology is still a key element for their diagnosis. Here, we discuss the different serological assays available for the diagnosis of zoonotic leishmaniasis. We will review the enzyme-linked immunosorbent assay, immunofluorescence antibody test, immunochromatography test (ICT), direct agglutination test, and western blot as well as the different diagnostic strategies in function of the clinical form (VL, CL, and MCL). We will also discuss the place of serology for detecting asymptomatic carriers and for the follow-up of VL. Depending on the laboratory, different assays can be used, from ICT, which is appropriate for field testing, to a combination of serological tests to improve the sensitivity.
Collapse
Affiliation(s)
- Maude F Lévêque
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire et Université de Montpellier, UMR MIVEGEC, Centre National de Référence des Leishmanioses, Montpellier, France
| | - Laurence Lachaud
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire et Université de Montpellier, UMR MIVEGEC, Centre National de Référence des Leishmanioses, Montpellier, France
| | - Loïc Simon
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire l'Archet, INSERM, U1065, C3M, Virulence microbienne et signalisation inflammatoire - Université de la Côte d'Azur, Faculté de Médecine, Laboratoire associé au Centre National de Référence des Leishmanioses, Nice, France
| | - Emilie Battery
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire et Université de Montpellier, UMR MIVEGEC, Centre National de Référence des Leishmanioses, Montpellier, France
| | - Pierre Marty
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire l'Archet, INSERM, U1065, C3M, Virulence microbienne et signalisation inflammatoire - Université de la Côte d'Azur, Faculté de Médecine, Laboratoire associé au Centre National de Référence des Leishmanioses, Nice, France
| | - Christelle Pomares
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire l'Archet, INSERM, U1065, C3M, Virulence microbienne et signalisation inflammatoire - Université de la Côte d'Azur, Faculté de Médecine, Laboratoire associé au Centre National de Référence des Leishmanioses, Nice, France
| |
Collapse
|
6
|
Andrade-Narvaez FJ, Loría-Cervera EN, Sosa-Bibiano EI, Van Wynsberghe NR. Asymptomatic infection with American cutaneous leishmaniasis: epidemiological and immunological studies. Mem Inst Oswaldo Cruz 2017; 111:599-604. [PMID: 27759762 PMCID: PMC5066330 DOI: 10.1590/0074-02760160138] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/14/2016] [Indexed: 11/22/2022] Open
Abstract
American cutaneous leishmaniasis (ACL) is a major public health problem caused by
vector-borne protozoan intracellular parasites from the genus Leishmania, subgenera
Viannia and Leishmania. Asymptomatic infection is the most common outcome after
Leishmania inoculation. There is incomplete knowledge of the biological processes
explaining the absence of signs or symptoms in most cases while other cases present a
variety of clinical findings. Most studies of asymptomatic infection have been
conducted in areas of endemic visceral leishmaniasis. In contrast, asymptomatic ACL
infection has been neglected. This review is focused on the following: (1)
epidemiological studies supporting the existence of asymptomatic ACL infection and
(2) immunological studies conducted to understand the mechanisms responsible for
controlling the parasite and avoiding tissue damage.
Collapse
Affiliation(s)
- Fernando J Andrade-Narvaez
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales Dr Hideyo Noguchi, Laboratorio de Inmunología, Mérida, Yucatán, México
| | - Elsy Nalleli Loría-Cervera
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales Dr Hideyo Noguchi, Laboratorio de Inmunología, Mérida, Yucatán, México
| | - Erika I Sosa-Bibiano
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales Dr Hideyo Noguchi, Laboratorio de Inmunología, Mérida, Yucatán, México
| | - Nicole R Van Wynsberghe
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales Dr Hideyo Noguchi, Laboratorio de Inmunología, Mérida, Yucatán, México
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Om Prakash Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | | | | | | |
Collapse
|