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Lopez Y, Arana B, Rizzo N, Duran E, Acosta-Serrano Á, Mendizabal-Cabrera R. A neglected among the neglected: a review of cutaneous leishmaniasis in Guatemala. Trans R Soc Trop Med Hyg 2023; 117:609-616. [PMID: 37103337 PMCID: PMC10472881 DOI: 10.1093/trstmh/trad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
Cutaneous leishmaniasis (CL) is a parasitic vector-borne disease affecting mostly low- and middle-income countries. CL is endemic in Guatemala, where an increase in the number of cases and incidence and a changing disease distribution in the past decade have been reported. Important research was conducted in Guatemala in the 1980s and 1990s to understand the epidemiology of CL and two Leishmania species were identified as the aetiologic agents. Several species of sand flies have been reported, five of which are naturally infected with Leishmania. Clinical trials conducted in the country evaluated different treatments against the disease and provided solid evidence for CL control strategies that are applicable worldwide. More recently, in the 2000s and 2010s, qualitative surveys were conducted to understand community perceptions of the disease and to highlight the challenges and enablers for disease control. However, limited recent data have been generated regarding the current CL situation in Guatemala, and key information necessary for effective disease control, such as incrimination of vectors and reservoirs, is still lacking. This review describes the current state of knowledge of CL in Guatemala, including the main parasite and sand fly species, disease reservoirs, diagnosis and control, as well as the perceptions of communities in endemic regions.
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Affiliation(s)
- Yaimie Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Byron Arana
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
| | - Nidia Rizzo
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
| | - Erick Duran
- Ministry of Health and Social Assistance, 3-45, 6a Avenida 3, Guatemala City 01011, Guatemala
| | | | - Renata Mendizabal-Cabrera
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
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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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Eldin C, l’Ollivier C, Ranque S, Gautret P, Parola P. "Chiclero's Ulcer" Due to Leishmania mexicana in Travelers Returning from Central America: A Case Report and Review of the Literature. Pathogens 2021; 10:pathogens10091112. [PMID: 34578145 PMCID: PMC8469509 DOI: 10.3390/pathogens10091112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/16/2022] Open
Abstract
Cutaneous leishmaniasis (CL) due to a New World species of Leishmania is increasingly seen among returning international travelers, and most cases arise from travel to Mexico, Central and South America. We described a case of CL in a women presenting a nonhealing ulceration under her right ear with slight increase of size of the left parotid gland under the skin lesion, evolving for 4 months. In her history of travel, she reported a ten-day stay in Mexico during the Christmas vacation in the Yucatan region with only half a day walking in the tropical forest. Diagnosis of CL due to Leishmania mexicana was done via PCR detection and sequencing from swab sampling of the lesion. The patient recovered without antiparasitic treatment. Clinicians should consider diagnosing Chiclero’s ulcer in patients returning from endemic areas such as Central America and Texas who present with chronic ulceration. A noninvasive sampling is sufficient for the PCR-based diagnosis of this disease.
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Affiliation(s)
- Carole Eldin
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, 13385 Marseille, France; (C.E.); (S.R.); (P.G.); (P.P.)
- IHU Méditerranée Infection, 13385 Marseille, France
| | - Coralie l’Ollivier
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, 13385 Marseille, France; (C.E.); (S.R.); (P.G.); (P.P.)
- IHU Méditerranée Infection, 13385 Marseille, France
- Correspondence:
| | - Stephane Ranque
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, 13385 Marseille, France; (C.E.); (S.R.); (P.G.); (P.P.)
- IHU Méditerranée Infection, 13385 Marseille, France
| | - Philippe Gautret
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, 13385 Marseille, France; (C.E.); (S.R.); (P.G.); (P.P.)
- IHU Méditerranée Infection, 13385 Marseille, France
| | - Philippe Parola
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, 13385 Marseille, France; (C.E.); (S.R.); (P.G.); (P.P.)
- IHU Méditerranée Infection, 13385 Marseille, France
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Chiclero's ulcer. Int J Infect Dis 2020; 94:12-13. [PMID: 32114198 DOI: 10.1016/j.ijid.2020.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/22/2022] Open
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Local Skin Inflammation in Cutaneous Leishmaniasis as a Source of Variable Pharmacokinetics and Therapeutic Efficacy of Liposomal Amphotericin B. Antimicrob Agents Chemother 2018; 62:AAC.00631-18. [PMID: 30082295 PMCID: PMC6153808 DOI: 10.1128/aac.00631-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/03/2018] [Indexed: 11/21/2022] Open
Abstract
Disfiguring skin lesions caused by several species of the Leishmania parasite characterize cutaneous leishmaniasis (CL). Successful treatment of CL with intravenous (i.v.) liposomal amphotericin B (LAmB) relies on the presence of adequate antibiotic concentrations at the dermal site of infection within the inflamed skin. Disfiguring skin lesions caused by several species of the Leishmania parasite characterize cutaneous leishmaniasis (CL). Successful treatment of CL with intravenous (i.v.) liposomal amphotericin B (LAmB) relies on the presence of adequate antibiotic concentrations at the dermal site of infection within the inflamed skin. Here, we have investigated the impact of the local skin inflammation on the pharmacokinetics (PK) and efficacy of LAmB in two murine models of localized CL (Leishmania major and Leishmania mexicana) at three different stages of disease (papule, initial nodule, and established nodule). Twenty-four hours after the administration of one 25 mg/kg of body weight LAmB (i.v.) dose to infected BALB/c mice (n = 5), drug accumulation in the skin was found to be dependent on the causative parasite species (L. major > L. mexicana) and the disease stage (papule > initial nodule > established nodule > healthy skin). Elevated tissue drug levels were associated with increased vascular permeability (Evans blue assay) and macrophage infiltration (histomorphometry) in the infected skin, two pathophysiological parameters linked to tissue inflammation. After identical treatment of CL in the two models with 5 × 25 mg/kg LAmB (i.v.), intralesional drug concentrations and reductions in lesion size and parasite load (quantitative PCR [qPCR]) were all ≥2-fold higher for L. major than for L. mexicana. In conclusion, drug penetration of LAmB into CL skin lesions could depend on the disease stage and the causative Leishmania species due to the influence of local tissue inflammation.
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Detection and identification of Leishmania spp.: application of two hsp70-based PCR-RFLP protocols to clinical samples from the New World. Parasitol Res 2017; 116:1843-1848. [DOI: 10.1007/s00436-017-5454-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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van der Snoek EM, Couwenberg SM, Stijnis C, Kortbeek LM, Schadd EM. Two cases of cutaneous leishmaniasis in Dutch military personnel treated with oral miltefosine. J ROY ARMY MED CORPS 2015; 163:68-70. [PMID: 26661280 DOI: 10.1136/jramc-2015-000530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/10/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the Netherlands, cutaneous leishmaniasis is most commonly seen in military personnel deployed on a mission or training abroad. The treatment of two Dutch soldiers who acquired cutaneous leishmaniasis with oral miltefosine was evaluated. Adverse effects were monitored and the improvement of skin lesions was assessed. CASE REPORTS A military nurse with a painless Chiclero's ulcer due to Leishmania (Viannia) braziliensis acquired in Belize and a military physical training instructor with itchy swelling and small ulcer of the back of his left elbow due to L. donovani/infantum complex acquired in Ibiza were treated with oral miltefosine 50 mg three times a day for 28 days. DISCUSSION Both patients responded well to oral miltefosine. Adverse effects were mild. Increase of creatinine levels was seen while liver transaminase levels were unremarkable. CONCLUSIONS Miltefosine proved to be a convenient, effective and well-tolerated treatment option in the treatment of cutaneous leishmaniasis in Dutch military personnel.
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Affiliation(s)
| | - S M Couwenberg
- Department of Dermatology, Central Military Hospital, Utrecht, The Netherlands
| | - C Stijnis
- Center for Tropical and Travel Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - L M Kortbeek
- Laboratory for Infectious Diseases and Perinatal Screening, RIVM, Bilthoven, The Netherlands
| | - E M Schadd
- Department of Internal Medicine, Central Military Hospital, Utrecht, The Netherlands
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Hotez PJ, Woc-Colburn L, Bottazzi ME. Neglected tropical diseases in Central America and Panama: review of their prevalence, populations at risk and impact on regional development. Int J Parasitol 2014; 44:597-603. [PMID: 24846528 DOI: 10.1016/j.ijpara.2014.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Abstract
A review of the literature since 2009 reveals a staggering health and economic burden resulting from neglected tropical diseases in Panama and the six countries of Central America (referred to collectively here as 'Central America'). Particularly at risk are the 10.2million people in the region who live on less than $2 per day, mostly in Guatemala, Honduras, Nicaragua and El Salvador. Indigenous populations are especially vulnerable to neglected tropical diseases. Currently, more than 8million Central American children require mass drug treatments annually (or more frequently) for their intestinal helminth infections, while vector-borne diseases are widespread. Among the vector-borne parasitic infections, almost 40% of the population is at risk for malaria (mostly Plasmodium vivax infection), more than 800,000 people live with Chagas disease, and up to 39,000 people have cutaneous leishmaniasis. In contrast, an important recent success story is the elimination of onchocerciasis from Central America. Dengue is the leading arbovirus infection with 4-5million people affected annually and hantavirus is an important rodent-borne viral neglected tropical disease. The leading bacterial neglected tropical diseases include leptospirosis and trachoma, for which there are no disease burden estimates. Overall there is an extreme dearth of epidemiological data on neglected tropical diseases based on active surveillance as well as estimates of their economic impact. Limited information to date, however, suggests that neglected tropical diseases are a major hindrance to the region's economic development, in both the most impoverished Central American countries listed above, as well as for Panama and Costa Rica where a substantial (but largely hidden) minority of people live in extreme poverty.
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Affiliation(s)
- Peter J Hotez
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, United States; James A. Baker III Institute for Public Policy, Rice University, Houston, TX, United States.
| | - Laila Woc-Colburn
- Department of Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Maria Elena Bottazzi
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, United States
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