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Switch to local therapy with metronidazole plus meglumine in a case of otic leishmaniasis due to hepatic toxicity of intramuscular meglumine. Travel Med Infect Dis 2023; 51:102513. [PMID: 36435447 DOI: 10.1016/j.tmaid.2022.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022]
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Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review. Pathogens 2022; 11:pathogens11080921. [PMID: 36015042 PMCID: PMC9415673 DOI: 10.3390/pathogens11080921] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Leishmaniases are human and animal parasitic diseases transmitted by phlebotomine sand flies. Globalization is an important driver of the burden and in the current dynamics of these diseases. A systematic review of articles published between 2000 and 2021 was conducted using the PubMed search engine to identify the epidemiology and clinical management of imported human leishmaniases as a fundamental step to better manage individual cases and traveler and migrant health from a global perspective. A total of 275 articles were selected, representing 10,341 human imported cases. Identified drivers of changing patterns in epidemiology include conflict and war, as well as host factors, such as immunosuppression, natural and iatrogenic. Leishmania species diversity associated with different clinical presentations implies diagnostic and treatment strategies often complex to select and apply, especially in non-endemic settings. Thus, diagnostic and management algorithms for medical clinical decision support are proposed. Increased surveillance of non-endemic cases, whether in vulnerable populations such as refugees/migrants and immunocompromised individuals or travelers, could improve individual health and mitigate the public health risk of introducing Leishmania species into new areas.
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Bezemer JM, van der Ende J, Limpens J, de Vries HJC, Schallig HDFH. Safety and efficacy of allylamines in the treatment of cutaneous and mucocutaneous leishmaniasis: A systematic review. PLoS One 2021; 16:e0249628. [PMID: 33826660 PMCID: PMC8026199 DOI: 10.1371/journal.pone.0249628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/22/2021] [Indexed: 12/28/2022] Open
Abstract
Cutaneous and mucocutaneous leishmaniasis affect a million people yearly, leading to skin lesions and potentially disfiguring mucosal disease. Current treatments can have severe side effects. Allylamine drugs, like terbinafine, are safe, including during pregnancy. This review assesses efficacy and safety of allylamines for the treatment of cutaneous and mucocutaneous leishmaniasis. It followed the PRISMA statement for reporting and was preregistered in PROSPERO(CRD4201809068). MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, Web of Science, Google Scholar, and clinical trial registers were searched from their creation to May 24th, 2020. All original human, animal, and in vitro studies concerning allylamines and cutaneous or mucocutaneous leishmaniasis were eligible for inclusion. Comparators—if any—included both placebo or alternative cutaneous or mucocutaneous leishmaniasis treatments. Complete cure, growth inhibition, or adverse events served as outcomes. The search identified 312 publications, of which 22 were included in this systematic review. There were one uncontrolled and two randomised controlled trials. The only well-designed randomised controlled trial that compared the treatment efficacy of oral terbinafine versus intramuscular meglumine antimoniate in 80 Leismania tropica infected patients showed a non-significant lower cure rate for terbinafine vs meglumine antimoniate (38% vs 53%). A meta-analysis could not be performed due to the small number of studies, their heterogeneity, and low quality. This systematic review shows that there is no evidence of efficacy of allylamine monotherapy against cutaneous and mucocutaneous leishmaniasis. Further trials of allylamines should be carefully considered as the outcomes of an adequately designed trial were disappointing and in vitro studies indicate minimal effective concentrations that are not achieved in the skin during standard doses. However, the in vitro synergistic effects of allylamines combined with triazole drugs warrant further exploration.
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Affiliation(s)
- Jacob M. Bezemer
- Experimental Parasitology Unit, Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Fundación Misión Cristiana de Salud, Shell, Pastaza, Ecuador
- * E-mail:
| | - Jacob van der Ende
- Fundación Quina Care Ecuador, Puerto el Carmen de Putumayo, Sucumbíos, Ecuador
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry J. C. de Vries
- Department of Dermatology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk D. F. H. Schallig
- Experimental Parasitology Unit, Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Dunya G, Loya A, Taraif S, Adib Houreih M, Khalifeh I. Clinical, microscopic and molecular presentation in pediatric versus adult old world cutaneous Leishmaniasis. Pediatr Dermatol 2020; 37:656-660. [PMID: 32424830 DOI: 10.1111/pde.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/20/2020] [Accepted: 04/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is an emerging uncontrolled tropical parasitic disease in endemic and nonendemic areas with a high prevalence in the pediatric age group. METHOD A total of 382 individuals from Lebanon, Saudi Arabia, Pakistan, and Syria diagnosed with CL by punch biopsy/scrapings were grouped into adults (>18 years) and pediatrics (≤18 years). Data recorded included clinical features [number, location, type, size, and extensiveness (size larger than 3 cm, more than 5 lesions per patient, lesion present for more than 12 months, special types, disfiguring lesion or closeness to vital sensory organs) of lesions] and microscopic findings [Ridley's Parasitic Index and Ridley's Pattern]. In addition, molecular confirmation and speciation were performed. RESULTS In comparison with adults, patients in the pediatric group (n = 158, 41.4%) showed significantly higher number of lesions, more facial involvement, and more extensive disease (P < .05). Microscopically, a more advanced Ridley's pattern was observed. The other variables did not show statistical difference between the two groups. CONCLUSION Historically, CL has been known to be a neglected tropical disease of poverty and pediatric predilection. In our pediatric group, CL manifests with more extensive disease clinically mirrored by more advanced lesions microscopically.
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Affiliation(s)
- Gabriel Dunya
- Department of Otolaryngology Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asif Loya
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Suad Taraif
- Department of Pathology, Temple University Hospital, Philadelphia, PA, USA
| | | | - Ibrahim Khalifeh
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Lindoso JAL, Cunha MA, Queiroz IT, Moreira CHV. Leishmaniasis-HIV coinfection: current challenges. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2016; 8:147-156. [PMID: 27785103 PMCID: PMC5063600 DOI: 10.2147/hiv.s93789] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Leishmaniasis – human immunodeficiency virus (HIV) coinfection can manifest itself as tegumentary or visceral leishmaniasis. Almost 35 countries have reported autochthonous coinfections. Visceral leishmaniasis is more frequently described. However, usual and unusual manifestations of tegumentary leishmaniasis have been reported mainly in the Americas, but the real prevalence of Leishmania infection in HIV-infected patients is not clear. Regarding the clinical manifestations, there are some reports showing unusual manifestations in visceral leishmaniasis and tegumentary leishmaniasis in HIV-infected patients; yet, the usual manifestations are more frequent. Leishmaniasis diagnosis relies on clinical methods, but serological tests are used to diagnose visceral leishmaniasis despite them having a low sensitivity to tegumentary leishmaniasis. The search for the parasite is used to diagnose both visceral leishmaniasis and tegumentary leishmaniasis. Nevertheless, in HIV-infected patients, the sensitivity of serology is very low. Drugs available to treat leishmaniasis are more restricted and cause severe side effects. Furthermore, in HIV-infected patients, these side effects are more prominent and relapses and lethality are more recurrent. In this article, we discuss the current challenges of tegumentary leishmaniasis and visceral leishmaniasis–HIV infection, focusing mainly on the clinical manifestations, diagnosis, and treatment of leishmaniasis.
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Affiliation(s)
- José Angelo Lauletta Lindoso
- Laboratory of Soroepidemiology (LIM HC-FMUSP), São Paulo University, São Paulo; Instituto de Infectologia Emilio Ribas-SES, São Paulo
| | - Mirella Alves Cunha
- Department of Infectious Disease, Faculty of Medicine, São Paulo University, São Paulo
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Motazedian MH, Mikaeili F, Mohebali M, Miri R, Habibi P, Kamarloie S. The antileishmanial effects of Lowsonia inermis and Cedrus libani on Leishmania major promastigotes: an in vitro study. J Parasit Dis 2016; 41:375-379. [PMID: 28615844 DOI: 10.1007/s12639-016-0809-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 06/22/2016] [Indexed: 11/25/2022] Open
Abstract
Leishmaniasis is a parasitic disease caused by different species of protozoan parasites belonging to the genus Leishmania. In this study, Leishmania major (MRHO/IR/75/ER) promastigotes were cultured at 23-25 °C in brain heart infusion (BHI) medium supplemented with 10 % heat-inactivated fetal bovine serum (FBS) and penicillin and streptomycin. Antileishmanial effects of Lowsonia inermis and Cedrus libani methanolic extracts (0.07, 0.15, 0.31, 0.62, 1.25, 2.5, 5, 10 mg/mL) on Leishmania major promastigotes were evaluated using the MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. All experiments were repeated at least three times. Cedrus libani methanolic extract did not show any activity while Lowsonia inermis methanolic extract inhibited the growth of promastigote forms of L. major in vitro after 72 h of incubation and had a 50 % inhibitory concentration (IC50) of 1.25 mg/mL. The methanolic extract of Lawsonia inermis (henna) can be a promising antileishmanial agent in the future. Further experiments are needed for isolation of active fractions and identification of the active components of methanolic extract.
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Affiliation(s)
| | - Fattaneh Mikaeili
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Mohebali
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Miri
- Medicinal and Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parvaneh Habibi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sakineh Kamarloie
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Saraiva L, Silva Reis A, Marteleto Nunes Rugani J, Sampaio Pereira AA, Rêgo FD, Vianna Mariano da Rocha Lima AC, Gontijo CMF, Andrade Filho JD. Survey of sand flies (Diptera: Psychodidae) in an environmentally protected area in Brazil. PLoS One 2015; 10:e0134845. [PMID: 26267484 PMCID: PMC4534452 DOI: 10.1371/journal.pone.0134845] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/15/2015] [Indexed: 11/18/2022] Open
Abstract
Brazil is one of the most important endemic areas for leishmaniasis worldwide. Protected areas that are tourist attractions likely present an important risk of transmission of cutaneous leishmaniasis (CL). Furthermore, with the geographical expansion of visceral leishmaniasis (VL), several studies have recorded the occurrence of its vector, Lutzomyia longipalpis, and cases of human and canine VL in such tourist areas. The Parque Estadual do Sumidouro is an environmentally protected area located in the Brazilian Cerrado biome and in an important area endemic for leishmaniasis in the state of Minas Gerais. The purpose of this study was to monitor the sand fly fauna in areas of tourist activity in the park. Sampling was performed every month, from September 2011 to August 2013, using CDC light traps at six sites of differing environmental characteristics. Sampled specimens were identified following Galati (2003), and females were submitted to molecular techniques for the detection and identification of Leishmania DNA. A total of 4,675 sand fly specimens of 25 species belonging to nine genera were collected. The most abundant species were Micropygomyia quinquefer, Lutzomyia renei and Pintomyia pessoai, although only Pi. pessoai is implicated in the transmission of Leishmania braziliensis. The species accumulation curve reached saturation on the 16th sampling event. Species richness, diversity and evenness differed among the sampled areas. The seasonal curve was not determined by a single unique species, and no single species was the most abundant in all environments sampled. The main vector of Leishmania (Leishmania) infantum, Lutzomyia longipalpis, accounted for only 5.35% of the specimens collected. Proven or suspected vectors of Leishmania (Viannia) braziliensis were recorded, and one female of the cortellezzii complex tested positive for Le. braziliensis DNA. Even with a low infection rate (0.62%), these data indicate the circulation of the parasite and reinforce the need for entomological and epidemiological surveillance in the park and its surroundings.
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Affiliation(s)
- Lara Saraiva
- Grupo de Estudos em Leishmanioses–Centro de Pesquisas René Rachou–FIOCRUZ–MINAS–Avenida Augusto de Lima, 1715 Barro Preto, CP 1743, 30190–002 Belo Horizonte, MG, Brazil
- * E-mail:
| | - Alanna Silva Reis
- Grupo de Estudos em Leishmanioses–Centro de Pesquisas René Rachou–FIOCRUZ–MINAS–Avenida Augusto de Lima, 1715 Barro Preto, CP 1743, 30190–002 Belo Horizonte, MG, Brazil
| | - Jeronimo Marteleto Nunes Rugani
- Grupo de Estudos em Leishmanioses–Centro de Pesquisas René Rachou–FIOCRUZ–MINAS–Avenida Augusto de Lima, 1715 Barro Preto, CP 1743, 30190–002 Belo Horizonte, MG, Brazil
| | - Agnes Antônia Sampaio Pereira
- Grupo de Estudos em Leishmanioses–Centro de Pesquisas René Rachou–FIOCRUZ–MINAS–Avenida Augusto de Lima, 1715 Barro Preto, CP 1743, 30190–002 Belo Horizonte, MG, Brazil
| | - Felipe Dutra Rêgo
- Grupo de Estudos em Leishmanioses–Centro de Pesquisas René Rachou–FIOCRUZ–MINAS–Avenida Augusto de Lima, 1715 Barro Preto, CP 1743, 30190–002 Belo Horizonte, MG, Brazil
| | - Ana Cristina Vianna Mariano da Rocha Lima
- Grupo de Estudos em Leishmanioses–Centro de Pesquisas René Rachou–FIOCRUZ–MINAS–Avenida Augusto de Lima, 1715 Barro Preto, CP 1743, 30190–002 Belo Horizonte, MG, Brazil
| | - Célia Maria Ferreira Gontijo
- Grupo de Estudos em Leishmanioses–Centro de Pesquisas René Rachou–FIOCRUZ–MINAS–Avenida Augusto de Lima, 1715 Barro Preto, CP 1743, 30190–002 Belo Horizonte, MG, Brazil
| | - José Dilermando Andrade Filho
- Grupo de Estudos em Leishmanioses–Centro de Pesquisas René Rachou–FIOCRUZ–MINAS–Avenida Augusto de Lima, 1715 Barro Preto, CP 1743, 30190–002 Belo Horizonte, MG, Brazil
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Molecular epidemiology of imported cases of leishmaniasis in Australia from 2008 to 2014. PLoS One 2015; 10:e0119212. [PMID: 25734905 PMCID: PMC4348169 DOI: 10.1371/journal.pone.0119212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/28/2015] [Indexed: 02/06/2023] Open
Abstract
Leishmaniasis is a vector borne disease caused by protozoa of the genus Leishmania. Human leishmaniasis is not endemic in Australia though imported cases are regularly encountered. This study aimed to provide an update on the molecular epidemiology of imported leishmaniasis in Australia. Of a total of 206 biopsies and bone marrow specimens submitted to St Vincent’s Hospital Sydney for leishmaniasis diagnosis by PCR, 55 were found to be positive for Leishmania DNA. All PCR products were subjected to restriction fragment length polymorphism analysis for identification of the causative species. Five Leishmania species/species complexes were identified with Leishmania tropica being the most common (30/55). Travel or prior residence in a Leishmania endemic region was the most common route of acquisition with ~47% of patients having lived in or travelled to Afghanistan. Cutaneous leishmaniasis was the most common manifestation (94%) with only 3 cases of visceral leishmaniasis and no cases of mucocutaneous leishmaniasis encountered. This report indicates that imported leishmaniasis is becoming increasingly common in Australia due to an increase in global travel and immigration. As such, Australian clinicians must be made aware of this trend and consider leishmaniasis in patients with suspicious symptoms and a history of travel in endemic areas. This study also discusses the recent identification of a unique Leishmania species found in native kangaroos and a potential vector host which could create the opportunity for the establishment of a local transmission cycle within humans.
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Mansueto P, Seidita A, Vitale G, Cascio A. Leishmaniasis in travelers: a literature review. Travel Med Infect Dis 2014; 12:563-81. [PMID: 25287721 DOI: 10.1016/j.tmaid.2014.09.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/17/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
Leishmaniasis is a vector-borne protozoan infection whose clinical spectrum ranges from asymptomatic infection to fatal visceral leishmaniasis. Over the last decades, an increase in imported leishmaniasis cases in developed, non-endemic countries, have been pointed-out from a review of the international literature. Among the possible causes are increasing international tourism, influx of immigrants from endemic regions and military operations. The main area for the acquisition of cutaneous leishmaniasis, especially for adventure travelers on long-term trips in highly-endemic forested areas, is represented from South America, whereas popular Mediterranean destinations are emerging as the main areas to acquire visceral variant. Leishmaniasis should be considered in the diagnostic assessment of patients presenting with a compatible clinical syndrome and a history of travel to an endemic area, even if this occurred several months or years before. Adventure travelers, researchers, military personnel, and other groups of travelers likely to be exposed to sand flies in endemic areas, should receive counseling regarding leishmaniasis and appropriate protective measures.
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Affiliation(s)
- Pasquale Mansueto
- Department of Internal Medicine and Biomedicine, University of Palermo, Italy.
| | - Aurelio Seidita
- Department of Internal Medicine and Biomedicine, University of Palermo, Italy
| | - Giustina Vitale
- Department of Internal Medicine and Biomedicine, University of Palermo, Italy
| | - Antonio Cascio
- Department of Human Pathology, University of Messina, Italy
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Goto H, Lindoso JAL. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Rev Anti Infect Ther 2014; 8:419-33. [DOI: 10.1586/eri.10.19] [Citation(s) in RCA: 287] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Clinical findings and management of imported cutaneous leishmaniasis: report of 14 cases from Austria. Travel Med Infect Dis 2013; 11:90-4. [PMID: 23522841 DOI: 10.1016/j.tmaid.2013.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/26/2013] [Accepted: 03/01/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The management of cutaneous leishmaniasis in non-endemic countries is challenging due to the wide variety of clinical manifestations and little information available on treatment modalities for travellers. METHODS Retrospective analysis and follow-up investigation in patients with imported cutaneous leishmaniasis managed at the General Hospital Vienna from 2004 to 2010. RESULTS In total, 14 patients with cutaneous leishmaniasis were analyzed. The time to diagnosis ranged between weeks and several months and up to four consultations were necessary before diagnosis was accomplished. Histological investigations performed in all patients were diagnostic for CL in 8 (57%) patients. PCR analyses were performed in 12 patients and were positive in 10 (83%) patients. All six patients with negative histological results for CL tested positive in the PCR analysis. Treatment regimens applied included systemic therapy with liposomal amphotericin B, miltefosine, or fluconazole, and local therapy with cryotherapy, paromomycin ointment, photodynamic therapy, surgery, and various combinations. CONCLUSIONS The present analysis strongly suggests that awareness of CL among physicians and travellers remains low and highlights the need to harmonize diagnostic and treatment guidelines for cutaneous and mucosal leishmaniasis in European travellers. Diagnostic outcome can be improved by combining histology and PCR in patients with suspected cutaneous leishmaniasis.
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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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Karram S, Loya A, Hamam H, Habib RH, Khalifeh I. Transepidermal elimination in cutaneous leishmaniasis: a multiregional study. J Cutan Pathol 2012; 39:406-12. [PMID: 22443392 DOI: 10.1111/j.1600-0560.2012.01890.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transepidermal elimination has been documented in a myriad of infectious diseases; however, its occurrence in cutaneous leishmaniasis has not been evaluated. METHODS Skin biopsies (n = 212) with cutaneous leishmaniasis in Lebanon (n = 46), Syria (n = 53), Saudi Arabia (n = 45) and Pakistan (n = 68) were evaluated. Clinical data collected included age, gender, eruption type (papule, nodule, verrucous or scar), duration and anatomic location. Histopathologically, multiple parameters were recorded including Ridley's parasitic index and pattern, transepidermal elimination, interface changes, ulceration and necrosis. Transepidermal elimination was defined as the presence of amastigotes in the epidermis in all layers, limited to the basal layer or present in a perforating plug. All cases were confirmed by polymerase chain reaction (PCR) analysis followed by restriction fragment length polymorphism analysis for molecular subspeciation. RESULTS Leishmania tropica was identified in 88.2% and Leishmania major in 11.8% of all cases. Transepidermal elimination was observed in 28.3% of cases (29 perforating plug, 19 all layers and 12 basal layer) with a significant prevalence of L. major in this group (35 vs. 2%, p < 0.001). Cases with transepidermal elimination were associated with interface changes and higher parasitic index (p < 0.001) but not with an increased ulceration rate (p > 0.05). Multivariate analysis showed that transepidermal elimination was independently predicted by L. major [OR (95% confidence interval) = 80 (9-712); p < 0.001], parasitic index [OR = 3.4 (2.1-5.3); p < 0.001], interface changes [OR = 6.24 (2.2-17.8); p < 0.001] and necrosis [OR = 0.2 (0.1-0.8);p = 0.026]. CONCLUSIONS We report the largest multiregional cutaneous leishmaniasis series with a 28.3% documented transepidermal elimination incidence of which 48% were perforating plug; a significant prevalence of L. major was also identified in the transepidermal elimination group. The association of transepidermal elimination with interface changes and a higher parasitic index, without an increased ulceration rate, may reflect a unique biologic alteration in the epidermis, serving to facilitate the extrusion of the parasites through the skin.
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Affiliation(s)
- Sarah Karram
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Wall EC, Watson J, Armstrong M, Chiodini PL, Lockwood DN. Epidemiology of imported cutaneous leishmaniasis at the Hospital for Tropical Diseases, London, United Kingdom: use of polymerase chain reaction to identify the species. Am J Trop Med Hyg 2012; 86:115-8. [PMID: 22232460 DOI: 10.4269/ajtmh.2012.10-0558] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study reviewed all patients diagnosed with imported cutaneous leishmaniasis (CL) at the Hospital for Tropical Diseases in London, United Kingdom, over an 11-year period. Diagnostic and epidemiologic information was collected prospectively for all patients with imported CL to this hospital during 1998-2009. A total of 223 patients were given a diagnosis of CL. Ninety patients were diagnosed with Old World CL, which was caused most commonly by Leishmania donovani complex (n = 20). A total of 71% were tourists to the Mediterranean region, 36% were migrants or visiting friends and relatives, and 17% were soldiers. One hundred thirty-three patients were given a diagnosis of New World CL. The Leishmania subgenus Viannia caused 97 of these cases; 44% of these were in backpackers and 29% were in soldiers. Polymerase chain reaction was more sensitive and faster for detecting Leishmania DNA (86% for Old World CL and 96% for New World CL) than culture. This is the largest study of imported leishmaniasis, and demonstrates that tourists to the Mediterranean and backpackers in Central and South America are at risk for this disease.
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Affiliation(s)
- Emma C Wall
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom.
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Imported cutaneous leishmaniasis in a short-term traveler returning from Central Mali – The role of PCR. Travel Med Infect Dis 2012; 10:97-100. [DOI: 10.1016/j.tmaid.2012.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 12/15/2011] [Accepted: 01/02/2012] [Indexed: 11/23/2022]
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Yehia L, Adib-Houreih M, Raslan WF, Kibbi AG, Loya A, Firooz A, Satti M, El-Sabban M, Khalifeh I. Molecular diagnosis of cutaneous leishmaniasis and species identification: analysis of 122 biopsies with varied parasite index. J Cutan Pathol 2012; 39:347-55. [DOI: 10.1111/j.1600-0560.2011.01861.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pavli A, Maltezou HC. Leishmaniasis, an emerging infection in travelers. Int J Infect Dis 2010; 14:e1032-9. [DOI: 10.1016/j.ijid.2010.06.019] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/30/2010] [Accepted: 06/16/2010] [Indexed: 02/06/2023] Open
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Flórez AF, Park D, Bhak J, Kim BC, Kuchinsky A, Morris JH, Espinosa J, Muskus C. Protein network prediction and topological analysis in Leishmania major as a tool for drug target selection. BMC Bioinformatics 2010; 11:484. [PMID: 20875130 PMCID: PMC2956735 DOI: 10.1186/1471-2105-11-484] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 09/27/2010] [Indexed: 02/06/2023] Open
Abstract
Background Leishmaniasis is a virulent parasitic infection that causes a worldwide disease burden. Most treatments have toxic side-effects and efficacy has decreased due to the emergence of resistant strains. The outlook is worsened by the absence of promising drug targets for this disease. We have taken a computational approach to the detection of new drug targets, which may become an effective strategy for the discovery of new drugs for this tropical disease. Results We have predicted the protein interaction network of Leishmania major by using three validated methods: PSIMAP, PEIMAP, and iPfam. Combining the results from these methods, we calculated a high confidence network (confidence score > 0.70) with 1,366 nodes and 33,861 interactions. We were able to predict the biological process for 263 interacting proteins by doing enrichment analysis of the clusters detected. Analyzing the topology of the network with metrics such as connectivity and betweenness centrality, we detected 142 potential drug targets after homology filtering with the human proteome. Further experiments can be done to validate these targets. Conclusion We have constructed the first protein interaction network of the Leishmania major parasite by using a computational approach. The topological analysis of the protein network enabled us to identify a set of candidate proteins that may be both (1) essential for parasite survival and (2) without human orthologs. These potential targets are promising for further experimental validation. This strategy, if validated, may augment established drug discovery methodologies, for this and possibly other tropical diseases, with a relatively low additional investment of time and resources.
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Affiliation(s)
- Andrés F Flórez
- Programa de Estudio y Control de Enfermedades Tropicales-PECET, Universidad de Antioquia, Calle 62 No 52-59, Lab. 632, Medellín, Colombia
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A practical approach to common skin problems in returning travellers. Travel Med Infect Dis 2009; 7:125-46. [DOI: 10.1016/j.tmaid.2009.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 03/09/2009] [Indexed: 11/22/2022]
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Affiliation(s)
- Johannes A Blum
- Medical Department, Swiss Tropical Institute, Basel, Switzerland.
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Schleucher RD, Zanger P, Gaessler M, Knobloch J. Successful diagnosis and treatment 50 years after exposure: is mucocutaneous leishmaniasis still a neglected differential diagnosis? J Travel Med 2008; 15:466-7. [PMID: 19090806 DOI: 10.1111/j.1708-8305.2008.00261.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of a long-term history of imported mucocutaneous leishmaniasis, illustrating the importance of this differential diagnosis even decades after exposure. Diagnostic pitfalls and the role of primary subspecies differentiation are demonstrated. Chemotherapy avoiding antimonials was successful and remarkably well tolerated by an elderly patient.
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Affiliation(s)
- Regina D Schleucher
- Institute of Tropical Medicine, University of Tuebingen, Tuebingen, Germany.
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Stark D, van Hal S, Lee R, Marriott D, Harkness J. Leishmaniasis, an emerging imported infection: report of 20 cases from Australia. J Travel Med 2008; 15:351-4. [PMID: 19006509 DOI: 10.1111/j.1708-8305.2008.00223.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Leishmaniasis is a protozoan infection rarely reported in Australia. However, with the advent of increased international tourism and migration of refugees from endemic regions, leishmaniasis has emerged as an increasingly imported infection. We report 20 cases (17 cutaneous, 2 visceral, and 1 post-kala-azar dermal leishmaniasis). These data highlight the range of species causing leishmaniasis imported in Australia and demonstrate the importance of species identification in determining proper treatment.
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Affiliation(s)
- Damien Stark
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, Australia.
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