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Laroumagne S, Tronchetti J, Dutau H, Astoul P. Visceral Leishmaniasis Masquerading as Drug-Induced Pancytopenia in Lung Cancer Patients. Curr Oncol 2024; 31:2274-2277. [PMID: 38668071 PMCID: PMC11048982 DOI: 10.3390/curroncol31040168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Maintenance chemotherapy is a standard treatment in patients with non-progressive advance staged IV non-squamous non-small cell lung cancer after induction therapy. Here, we report the case of a 53-year-old man undergoing a maintenance monotherapy with pemetrexed who presented prolonged pancytopenia despite filgrastim injections. A bone marrow aspiration revealed a macrophage activation syndrome with Leishmania amastigotes. A Polymerase Chest Reaction testing confirmed the diagnosis of visceral leishmaniasis. Treatment with liposomal amphotericin B was started. Oncologists should bear in mind that visceral leishmaniasis in endemic areas can potentially induce severe and prolonged pancytopenia in immunosuppressed patients, during chemotherapy in particular.
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Affiliation(s)
- Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (S.L.); (J.T.); (H.D.)
| | - Julie Tronchetti
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (S.L.); (J.T.); (H.D.)
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (S.L.); (J.T.); (H.D.)
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (S.L.); (J.T.); (H.D.)
- Faculty La Timone, Aix-Marseille University, 13005 Marseille, France
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2
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Carvalho DG, Vasconcelos DDM, Santos ACR, Lindoso JAL. Visceral Leishmaniasis Revealing Undiagnosed Inborn Errors of Immunity. Rev Soc Bras Med Trop 2023; 56:e03222023. [PMID: 37970879 PMCID: PMC10637728 DOI: 10.1590/0037-8682-0322-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
Visceral Leishmaniasis (VL) is a potentially fatal disease and may be associated with primary or acquired immunodeficiencies. There are few reports, in the literature, of inborn errors of immunity. Here, we report two cases of VL as a marker of inborn errors of immunity, namely, GATA2 and RAB27A deficiency. Our data suggest that VL patients should be screened for primary immunodeficiency, particularly in cases of VL relapse.
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Affiliation(s)
| | - Dewton de Moraes Vasconcelos
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Dermatologia e Imunodeficiência, São Paulo, Brasil
| | - Andreia Cristiane Rangel Santos
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Pediatria, São Paulo, Brasil
| | - Jose Angelo Lauletta Lindoso
- Instituto de Infectologia Emílio Ribas, São Paulo, Brasil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana, São Paulo, Brasil
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3
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Abirami M, Karan Kumar B, Dey S, Johri S, Reguera RM, Balaña-Fouce R, Gowri Chandra Sekhar KV, Sankaranarayanan M. Molecular-level strategic goals and repressors in Leishmaniasis - Integrated data to accelerate target-based heterocyclic scaffolds. Eur J Med Chem 2023; 257:115471. [PMID: 37257213 DOI: 10.1016/j.ejmech.2023.115471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023]
Abstract
Leishmaniasis is a complex of neglected tropical diseases caused by various species of leishmanial parasites that primarily affect the world's poorest people. A limited number of standard medications are available for this disease that has been used for several decades, these drugs have many drawbacks such as resistance, higher cost, and patient compliance, making it difficult to reach the poor. The search for novel chemical entities to treat leishmaniasis has led to target-based scaffold research. Among several identified potential molecular targets, enzymes involved in the purine salvage pathway include polyamine biosynthetic process, such as arginase, ornithine decarboxylase, S-adenosylmethionine decarboxylase, spermidine synthase, trypanothione reductase as well as enzymes in the DNA cell cycle, such as DNA topoisomerases I and II plays vital role in the life cycle survival of leishmanial parasite. This review mainly focuses on various heterocyclic scaffolds, and their specific inhibitory targets against leishmaniasis, particularly those from the polyamine biosynthesis pathway and DNA topoisomerases with estimated activity studies of various heterocyclic analogs in terms of their IC50 or EC50 value, reported molecular docking analysis from available published literatures.
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Affiliation(s)
- M Abirami
- Medicinal Chemistry Research Laboratory, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Pilani, 333031, India
| | - Banoth Karan Kumar
- Medicinal Chemistry Research Laboratory, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Pilani, 333031, India; Department of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, AP, India
| | - Sanchita Dey
- Medicinal Chemistry Research Laboratory, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Pilani, 333031, India
| | - Samridhi Johri
- Medicinal Chemistry Research Laboratory, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Pilani, 333031, India
| | - Rosa M Reguera
- Department of Biomedical Sciences, University of León, 24071, León, Spain
| | | | - Kondapalli Venkata Gowri Chandra Sekhar
- Department of Chemistry, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Hyderabad, 500078, Telangana, India
| | - Murugesan Sankaranarayanan
- Medicinal Chemistry Research Laboratory, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Pilani, 333031, India.
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4
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Visceral Leishmaniasis after Anti-Interleukin 17A (IL-17A) Therapy in a Patient Affected by Psoriatic Arthritis. Trop Med Infect Dis 2022; 7:tropicalmed7100319. [PMID: 36288060 PMCID: PMC9609957 DOI: 10.3390/tropicalmed7100319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
The reactivation of latent Leishmania infection in chronic diseases and immunocompromised hosts is a broad and heterogeneous field in medicine and infectious diseases. We reported one of the first cases of Visceral Leishmaniasis occurring in a Caucasian middle-aged man living in an endemic country (Italy) for Leishmania infantum infection following secukinumab treatment for psoriatic arthritis. The patient was cured with a Liposomal Amphotericin B (L-AmB, 3 mg/Kg on days 1–5, followed by a dose on days 10, 17, 24, 31 and 38) regimen, after which his anti-interleukin 17 treatment was restarted—without recurrence in the follow-up.
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5
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Tomaino MV, Barletta JA, Andreani M, Sisto A, Abusamra L, Guelfand L, Rolón MJ. Hemophagocytic lymphohistiocytosis secondary to AIDS-related histoplasmosis and visceral leishmaniasis. Int J STD AIDS 2022; 33:873-876. [PMID: 35775465 DOI: 10.1177/09564624221110986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hemophagocytic Lymphohistiocytosis (HLH) is a rare, highly aggressive syndrome involving dysregulated immune response. Most cases are secondary to underlying diseases including infections, autoimmune disorders and malignancies. The burden of disease of histoplasmosis and leishmaniosis associated with advanced HIV is still significant in low-and-middle income countries (LMIC). We present a case of histoplasmosis and leishmaniasis associated HLH in a man with an AIDS diagnosis.
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Affiliation(s)
- María V Tomaino
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - José Ae Barletta
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariana Andreani
- Microbiology Section, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alicia Sisto
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lorena Abusamra
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Liliana Guelfand
- Microbiology Section, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - María J Rolón
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
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Schranz T, Klaus J, Kratzer W, Schmidberger J, Güthle M. A comparison of spleen size measured by ultrasound in a random population sample and a matched sample of patients at a university hospital, and the determination of normal values and influencing factors. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:438-445. [PMID: 33752244 DOI: 10.1055/a-1404-4097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to compare spleen sizes in a hospital and a population sample using ultrasound and define normal values and factors influencing spleen size. METHODS Both samples' spleen sizes (n = 1520) were measured using ultrasound under the same conditions. Blood counts and other laboratory parameters were determined under the same conditions in both samples. RESULTS In the hospital sample (n = 760), the mean spleen size was 114.7 mm, and in the population sample (n = 760), it was 99.1 mm. In both, spleen size in men was significantly higher than in women (p < 0.0001) and influenced by body height, weight, and BMI (body mass index) (p < 0.0001). In the hospital sample, there was a correlation with higher values for ALT (p = 0.0160), AST (p = 0.0394), AP (p = 0.0482), and ferritin (p = 0.0008) and lower values for HDL (p = 0.0091) and thrombocytes (p < 0.0001). In the multivariate analysis, higher values for AP (p = 0.0059) and lower values for hemoglobin (p = 0.0014) and thrombocytes (p = 0.0001) were found. Stratified for sex (men, women), spleen size increased with higher values for ALT (p = 0.0116, p = 0.0113), AST (p = 0.0014, p = 0.0113), and AP (p = 0.0001, p = 0.0012), and with lower values of hemoglobin (p = 0.0057, p = 0.0016), thrombocytes (p < 0.0001, p = 0.0003), and albumin (p = 0.0029, p = 0.0432). In women, there was a discordant correlation with red blood cells (p = 0.0005) and a concordant correlation with GGT (p = 0.0241), and in men discordant correlations with cholesterol (p = 0.0010) and HDL (p = 0.0404). CONCLUSIONS The already proven impact of anthropometric data on spleen size was confirmed. The role of laboratory values should be further analyzed.
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Affiliation(s)
| | - Jochen Klaus
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm
| | | | | | - Melanie Güthle
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm
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7
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Curtin JM, Aronson NE. Leishmaniasis in the United States: Emerging Issues in a Region of Low Endemicity. Microorganisms 2021; 9:578. [PMID: 33799892 PMCID: PMC7998217 DOI: 10.3390/microorganisms9030578] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Leishmaniasis, a chronic and persistent intracellular protozoal infection caused by many different species within the genus Leishmania, is an unfamiliar disease to most North American providers. Clinical presentations may include asymptomatic and symptomatic visceral leishmaniasis (so-called Kala-azar), as well as cutaneous or mucosal disease. Although cutaneous leishmaniasis (caused by Leishmania mexicana in the United States) is endemic in some southwest states, other causes for concern include reactivation of imported visceral leishmaniasis remotely in time from the initial infection, and the possible long-term complications of chronic inflammation from asymptomatic infection. Climate change, the identification of competent vectors and reservoirs, a highly mobile populace, significant population groups with proven exposure history, HIV, and widespread use of immunosuppressive medications and organ transplant all create the potential for increased frequency of leishmaniasis in the U.S. Together, these factors could contribute to leishmaniasis emerging as a health threat in the U.S., including the possibility of sustained autochthonous spread of newly introduced visceral disease. We summarize recent data examining the epidemiology and major risk factors for acquisition of cutaneous and visceral leishmaniasis, with a special focus on implications for the United States, as well as discuss key emerging issues affecting the management of visceral leishmaniasis.
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Affiliation(s)
- John M. Curtin
- Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Infectious Diseases Division, Uniformed Services University, Bethesda, MD 20814, USA;
| | - Naomi E. Aronson
- Infectious Diseases Division, Uniformed Services University, Bethesda, MD 20814, USA;
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8
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Visceral Dissemination of Mucocutaneous Leishmaniasis in a Kidney Transplant Recipient. Pathogens 2020; 10:pathogens10010018. [PMID: 33396614 PMCID: PMC7824171 DOI: 10.3390/pathogens10010018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/20/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022] Open
Abstract
Intracellular protozoan of the genus Leishmania, endemic in the Mediterranean basin, are the cause of cutaneous (CL), mucocutaneous (MCL), and visceral leishmaniasis (VL). A 75-year-old woman was admitted nine years after a second kidney transplant (KT), due to persistent pancytopenia and fever. She presented edema and erythema of the nose in the last two years and an exophytic nodular lesion located on the left arm, with areas of peripheral necrosis and central ulceration in the last 18 months. A bone marrow biopsy revealed features compatible with Leishmania amastigotes, and polymerase chain reaction test (PCR) for Leishmania infantum was positive. Moreover, biopsy and PCR for L. infantum of the cutaneous lesion on the patient's left arm and nose and PCR from peripheral blood were positive. Thus, a diagnosis of CL, MCL, and VL was made, and liposomal amphotericin B was initiated, but the patient had an unfavorable outcome and died. This is the first report of a KT recipient presenting with the entire spectrum of leishmaniasis. In Portugal, this infection is rare-so a high degree of clinical suspicion is required for its diagnosis, especially in endemic regions, as visceral leishmaniasis is a potentially life-threatening infection.
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9
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Batista MA, Calvo-Fortes F, Silveira-Nunes G, Camatta GC, Speziali E, Turroni S, Teixeira-Carvalho A, Martins-Filho OA, Neretti N, Maioli TU, Santos RR, Brigidi P, Franceschi C, Faria AMC. Inflammaging in Endemic Areas for Infectious Diseases. Front Immunol 2020; 11:579972. [PMID: 33262758 PMCID: PMC7688519 DOI: 10.3389/fimmu.2020.579972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022] Open
Abstract
Immunosenescence is marked by a systemic process named inflammaging along with a series of defects in the immunological activity that results in poor responses to infectious agents and to vaccination. Inflammaging, a state of low-grade chronic inflammation, usually leads to chronic inflammatory diseases and frailty in the elderly. However, some elderly escape from frailty and reach advanced age free of the consequences of inflammaging. This process has been called immunological remodeling, and it is the hallmark of healthy aging as described in the studies of centenarians in Italy. The biological markers of healthy aging are still a matter of debate, and the studies on the topic have focused on inflammatory versus remodeling processes and molecules. The sub-clinical inflammatory status associated with aging might be a deleterious event for populations living in countries where chronic infectious diseases are not prevalent. Nevertheless, in other parts of the world where they are, two possibilities may occur. Inflammatory responses may have a protective effect against these infectious agents. At the same time, the long-term consequences of protective immune responses during chronic infections may result in accelerated immunosenescence in these individuals. Therefore, the biological markers of healthy aging can vary according to environmental, cultural, and geographical settings that reflect worldwide, and in a non-biased, non-westernized perspective, the changes that we experience regarding our contacts with microorganisms and the outcomes of such contacts.
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Affiliation(s)
- Marina Andrade Batista
- Programa de Pós Graduação em Nutrição e Saúde, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda Calvo-Fortes
- Programa de Pós Graduação em Nutrição e Saúde, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gabriela Silveira-Nunes
- Departamento de Medicina, Universidade Federal de Juiz de Fora, Governador Valadares, Brazil
| | - Giovanna Caliman Camatta
- Programa de Pós Graduação em Nutrição e Saúde, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Elaine Speziali
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Silvia Turroni
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | | | | | - Nicola Neretti
- Departament of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI, United States
| | - Tatiani Uceli Maioli
- Programa de Pós Graduação em Nutrição e Saúde, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo Ribeiro Santos
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Patrizia Brigidi
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Claudio Franceschi
- Center for Biophysics, Bioinformatics, Biocomplexity, University of Bologna, Bologna, Italy.,Laboratory of Systems Biology of Healthy Aging, Department of Applied Mathematics, Lobachevsky University, Nizhny Novgorod, Russia
| | - Ana Maria Caetano Faria
- Programa de Pós Graduação em Nutrição e Saúde, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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10
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Silva-Freitas ML, Corrêa-Castro G, Cota GF, Giacoia-Gripp C, Rabello A, Teixeira Dutra J, de Vasconcelos ZFM, Savino W, Da-Cruz AM, Santos-Oliveira JR. Impaired Thymic Output Can Be Related to the Low Immune Reconstitution and T Cell Repertoire Disturbances in Relapsing Visceral Leishmaniasis Associated HIV/AIDS Patients. Front Immunol 2020; 11:953. [PMID: 32508833 PMCID: PMC7251171 DOI: 10.3389/fimmu.2020.00953] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Visceral leishmaniasis/HIV-co-infected patients (VL/HIV) accounts for around 8% of VL reported cases in Brazil. Relapses of Leishmania infection after anti-leishmanial treatment constitute a great challenge in the clinical practice because of the disease severity and drug resistance. We have shown that non-relapsing-VL/HIV (NR-) evolved with increase of CD4+ T-cell counts and reduction of activated CD4+ and CD8+ T cells after anti-leishmanial treatment. This immune profile was not observed in relapsing-VL/HIV patients (R-), indicating a more severe immunological compromising degree. Elevated activation status may be related to a deficient immune reconstitution and could help to explain the frequent relapses in VL/HIV co-infection. Our aim was to evaluate if this gain of T cells was related to changes in the peripheral TCRVβ repertoire and inflammatory status, as well as the possible thymus involvement in the replenishment of these newly formed T lymphocytes. Methods: VL/HIV patients, grouped into non-relapsing (NR- = 6) and relapsing (R- = 12) were evaluated from the active phase up to 12 months post-treatment (mpt). HIV-infected patients (non-VL) and healthy subjects (HS) were included. The TCRVβ repertoire was evaluated ex vivo by flow cytometry, whereas the plasmatic cytokine levels were assessed by Luminex assay. To evaluate the thymic output, DNA was extracted from PBMCs for TCR rearrangement excision circles (TREC) quantification by qPCR. Results: VL/HIV cases presented an altered mobilization profile (expansions or retractions) of the TCRVβ families when compared to HS independent of the follow-up phase (p < 0.05). TCRVβ repertoire on CD4+ T-cells was more homogeneous in the NR-VL/HIV cases, but heterogeneous on CD8+ T-cells, since different Vβ-families were mobilized. NR-VL/HIV had the inflammatory pattern reduced after 6 mpt. Importantly, VL/HIV patients showed number of TREC copies lower than controls during all follow-up. An increase of recent thymic emigrants was observed in NR-VL/HIV individuals at 10 mpt compared to R- patients (p < 0.01), who maintained lower TREC contents than the HIV controls. Conclusions: VL/HIV patients that maintain the thymic function, thus generating new T-cells, seem able to replenish the T lymphocyte compartment with effector cells, then enabling parasite control.
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Affiliation(s)
- Maria Luciana Silva-Freitas
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Gabriela Corrêa-Castro
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia Do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Glaucia Fernandes Cota
- Centro de Referência em Leishmanioses, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brazil
| | - Carmem Giacoia-Gripp
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ana Rabello
- Centro de Referência em Leishmanioses, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brazil
| | - Juliana Teixeira Dutra
- Laboratório de Alta Complexidade, Instituto Nacional de Saúde da Mulher, da Criança e Do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Zilton Farias Meira de Vasconcelos
- Laboratório de Alta Complexidade, Instituto Nacional de Saúde da Mulher, da Criança e Do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Wilson Savino
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Rede de Pesquisas em Saúde Do Estado Do Rio de Janeiro/FAPERJ, Rio de Janeiro, Brazil
| | - Alda Maria Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Rede de Pesquisas em Saúde Do Estado Do Rio de Janeiro/FAPERJ, Rio de Janeiro, Brazil.,Disciplina de Parasitologia/DMIP, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Joanna Reis Santos-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia Do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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11
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Bezerra JAB, Oliveira IVPDM, Yamakawa AC, Nilsson MG, Tomaz KLR, Oliveira KDSD, Rocha CSD, Calabuig CIP, Fornazari F, Langoni H, Antunes JMADP. Serological and molecular investigation of Leishmania spp. infection in cats from an area endemic for canine and human leishmaniasis in Northeast Brazil. ACTA ACUST UNITED AC 2020; 28:790-796. [PMID: 31691733 DOI: 10.1590/s1984-29612019082] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
Abstract
The aim of this study was to investigate the occurrence of Leishmania spp. antibodies, and its association with feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV), in domestic cats from an area endemic for canine and human leishmaniasis in Rio Grande do Norte State, Brazil. Ninety-one cats were subjected to a complete clinical exam, and blood samples were collected. An epidemiological questionnaire was used to investigate the risk factors. IgG anti-Leishmania spp. antibodies were detected by immunofluorescence antibody test (IFAT), with a cut-off value of 1:40. Polymerase chain reaction (PCR) was performed to detect genetic material of Leishmania spp. in the blood samples. The presence of antibodies against FIV and antigens of FeLV was evaluated using an immunochromatographic test. Seropositivity for Leishmania spp., FIV, and FeLV was observed in 14/91 (15.38%), 26/91 (28.57%), and 3/91 (3.29%) cats, respectively. All samples gave negative results on PCR analysis. Based on these data, no significant statistical association was observed between seropositivity for Leishmania spp., and sex, age, presence of clinical signs, evaluated risk factors, and positivity for retroviruses. These findings demonstrated for the first time that cats from Mossoró, Rio Grande do Norte, are being exposed to this zoonosis and might be part of the epidemiological chain of transmission of visceral leishmaniasis.
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Affiliation(s)
- José Artur Brilhante Bezerra
- Hospital Veterinário Jerônimo Dix-Huit Rosado Maia, Universidade Federal Rural do Semi-Árido - UFERSA, Mossoró, RN, Brasil
| | | | - Ana Carolina Yamakawa
- Núcleo de Pesquisas em Zoonoses - NUPEZO, Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista - UNESP, Botucatu, SP, Brasil
| | - Mariana Guimarães Nilsson
- Núcleo de Pesquisas em Zoonoses - NUPEZO, Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista - UNESP, Botucatu, SP, Brasil
| | - Klívio Loreno Raulino Tomaz
- Hospital Veterinário Jerônimo Dix-Huit Rosado Maia, Universidade Federal Rural do Semi-Árido - UFERSA, Mossoró, RN, Brasil
| | | | - Célio Souza da Rocha
- Hospital Veterinário Jerônimo Dix-Huit Rosado Maia, Universidade Federal Rural do Semi-Árido - UFERSA, Mossoró, RN, Brasil
| | - Cecília Irene Perez Calabuig
- Hospital Veterinário Jerônimo Dix-Huit Rosado Maia, Universidade Federal Rural do Semi-Árido - UFERSA, Mossoró, RN, Brasil
| | - Felipe Fornazari
- Núcleo de Pesquisas em Zoonoses - NUPEZO, Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista - UNESP, Botucatu, SP, Brasil
| | - Helio Langoni
- Núcleo de Pesquisas em Zoonoses - NUPEZO, Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista - UNESP, Botucatu, SP, Brasil
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12
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Elliott T, Simpson J, Naresh KN, Lockwood D, Bailey AC. An unusual case of post-kala-azar dermal leishmaniasis in a patient with HIV and visceral leishmaniasis co-infection. Int J STD AIDS 2019; 30:1221-1223. [PMID: 31558131 DOI: 10.1177/0956462419868617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Visceral leishmaniasis (VL) is a vector-borne disease caused by Leishmania donovani complex. Post-kala-azar dermal leishmaniasis (PKDL) is a rash that can occur following treatment for VL due to L. donovani species. We describe an unusual case of PKDL occurring during treatment for Leishmania infantum VL in a patient with human immunodeficiency virus-co infection.
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Affiliation(s)
- Tamara Elliott
- HIV and Sexual Health Medicine, Imperial College Healthcare NHS Trust, London, UK
| | | | - Kikkeri N Naresh
- Histopathology, Imperial College Healthcare NHS Trust, London, UK
| | - Diana Lockwood
- Infectious Diseases and Tropical Medicine, Hospital for Tropical Diseases, London, UK
| | - Angela C Bailey
- HIV and Sexual Health Medicine, Imperial College Healthcare NHS Trust, London, UK
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13
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Bosch-Nicolau P, Ubals M, Salvador F, Sánchez-Montalvá A, Aparicio G, Erra A, Martinez de Salazar P, Sulleiro E, Molina I. Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression. PLoS Negl Trop Dis 2019; 13:e0007708. [PMID: 31469834 PMCID: PMC6742442 DOI: 10.1371/journal.pntd.0007708] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/12/2019] [Accepted: 08/15/2019] [Indexed: 02/02/2023] Open
Abstract
Background Tumor necrosis factor alpha (TNF-α) blockers are recognized as a risk factor for reactivation of granulomatous infections. Leishmaniasis has been associated with the use of these drugs, although few cases have been reported. Methodology We performed a retrospective observational study including patients with confirmed leishmaniasis acquired in the Mediterranean basin that were under TNF-α blockers therapy at the moment of the diagnosis. Patients diagnosed in our hospital from 2008 to 2018 were included. Moreover, a systematic review of the literature was performed and cases fulfilling the inclusion criteria were also included. Principal findings Forty-nine patients were analyzed including nine cases from our series. Twenty-seven (55.1%) cases were male and median age was 55 years. Twenty-five (51%) patients were under infliximab treatment, 20 (40.8%) were receiving adalimumab, 2 (4.1%) etanercept, one (2%) golimumab and one (2%) a non-specified TNF-α blocker. Regarding clinical presentation, 28 (57.1%) presented as cutaneous leishmaniasis (CL), 16 (32.6%) as visceral leishmaniasis (VL) and 5 (10.2%) as mucocutaneous leishmaniasis (MCL). All VL and MCL patients were treated with systemic therapies. Among CL patients, 13 (46.4%) were treated with a systemic drug (11 received L-AmB, one intramuscular antimonials and one miltefosine) while 14 (50%) patients were given local treatment (13 received intralesional pentavalent antimonials, and one excisional surgery). TNF-α blockers were interrupted in 32 patients (65.3%). After treatment 5 patients (10.2%) relapsed. Four patients with a CL (3 initially treated with local therapy maintaining TNF-α blockers and one treated with miltefosine) and one patient with VL treated with L-AmB maintaining TNF-α blockers. Conclusions This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis in endemic population modulating the expression of the disease leading to atypical presentations. According to the cases reported, the best treatment strategy would be a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution. Tumor necrosis factor alpha (TNF-α) blockers are widely used in numerous inflammatory diseases such rheumatoid arthritis, psoriasis or inflammatory bowel diseases. They have been recognized as a risk factor for reactivation of granulomatous infections. Although few cases have been reported, Leishmaniasis has been associated with the use of these drugs. Leishmania infantum is the main causative agent of leishmaniasis in Southern Europe and is prone to produce the visceral form. However, TNF-α has been implicated in the initial events of the infection mediating the disease expression. In our series, we have observed a surprisingly high proportion of cutaneous form (32.6%) and muco-cutaneous form (10.2%). Clinical outcome observed in this series is also unusual. Four cases (14.3%) with cutaneous leishmaniasis who received local therapy relapsed. Among patients with visceral leishmaniasis, one patient who maintained TNF-α blockers therapy relapsed despite etiological treatment. This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis leading to atypical presentations. According to the cases reported we proposed as best treatment strategy a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution.
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Affiliation(s)
- Pau Bosch-Nicolau
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Maria Ubals
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Gloria Aparicio
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alba Erra
- Department of Rheumatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Pablo Martinez de Salazar
- Department of Clinical Microbiology, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Elena Sulleiro
- Department of Clinical Microbiology, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
- * E-mail:
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14
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Capelli-Peixoto J, Mule SN, Tano FT, Palmisano G, Stolf BS. Proteomics and Leishmaniasis: Potential Clinical Applications. Proteomics Clin Appl 2019; 13:e1800136. [PMID: 31347770 DOI: 10.1002/prca.201800136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 07/02/2019] [Indexed: 02/06/2023]
Abstract
Leishmaniases are diseases caused by protozoan parasites of the genus Leishmania. They are endemic in 98 countries, affect around 12 million people worldwide and may present several distinct clinical forms. Unfortunately, there are only a few drugs available for treatment of leishmaniasis, which are toxic and not always effective. Different parasite species and different clinical forms require optimization of the treatment or more specific therapies, which are not available. The emergence of resistance is also a matter of concern. Besides, diagnosis can sometimes be complicated due to atypical manifestations and associations with other pathologies. In this review, proteomic data are presented and discussed in terms of their application in important issues in leishmaniasis such as parasite resistance to chemotherapy, diagnosis of active disease in patients and dogs, markers for different clinical forms, identification of virulence factors, and their potential use in vaccination. It is shown that proteomics has contributed to the discovery of potential biomarkers for prognosis, diagnosis, therapeutics, monitoring of disease progression, treatment follow-up and identification of vaccine candidates for specific diseases. However, the authors believe its capabilities have not yet been fully explored for routine clinical analysis for several reasons, which will be presented in this review.
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Affiliation(s)
- Janaína Capelli-Peixoto
- Leishmaniasis laboratory, Institute of Biomedical Sciences, Department of Parasitology, University of São Paulo, São Paulo, Brazil
| | - Simon Ngao Mule
- GlycoProteomics laboratory, Institute of Biomedical Sciences, Department of Parasitology, University of São Paulo, São Paulo, Brazil
| | - Fabia Tomie Tano
- Leishmaniasis laboratory, Institute of Biomedical Sciences, Department of Parasitology, University of São Paulo, São Paulo, Brazil
| | - Giuseppe Palmisano
- GlycoProteomics laboratory, Institute of Biomedical Sciences, Department of Parasitology, University of São Paulo, São Paulo, Brazil
| | - Beatriz Simonsen Stolf
- Leishmaniasis laboratory, Institute of Biomedical Sciences, Department of Parasitology, University of São Paulo, São Paulo, Brazil
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15
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Lupia T, Corcione S, Boglione L, Cariti G, De Rosa FG. Visceral leishmaniasis in a patient with active HBV/HDV co-infection. J Infect Public Health 2019; 13:306-308. [PMID: 31416795 DOI: 10.1016/j.jiph.2019.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/09/2019] [Accepted: 07/28/2019] [Indexed: 12/22/2022] Open
Abstract
Visceral leishmaniasis (VL) is an endemic infection in different regions of Italy and Europe caused by protozoan parasites of the genus Leishmania, transmitted to humans through sandflies bites. Reactivation after Solid Organ Transplantation was reported and could be a risk of organ rejection. A 48 years old woman was admitted to our hospital, complaining about low-grade fever, loss of weight and new onset pancytopenia in a known cirrhosis due to active HBV/HDV co-infection. Clinical, microbiological and anatomo-pathological elements were pivotal to define the diagnosis of VL and started an appropriate anti-infective treatment. After that she underwent liver transplantation and a therapy for VL was set. No signs of reactivation were reported in the 14 months of follow-up.
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Affiliation(s)
- Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy.
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Lucio Boglione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Giuseppe Cariti
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
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16
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Colomba C, Saporito L, Di Carlo P, Tolomeo M, Cervo A, Firenze A, Trizzino M, Cascio A. Direct-acting antivirals and visceral leishmaniasis: a case report. BMC Infect Dis 2019; 19:328. [PMID: 30999874 PMCID: PMC6471807 DOI: 10.1186/s12879-019-3947-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 04/03/2019] [Indexed: 11/15/2022] Open
Abstract
Background Visceral leishmaniasis is a vector-borne parasitic disease caused by protozoa belonging to the genus Leishmania. The clinical presentation of visceral leishmaniasis strictly depends on the host immunocompetency, whereas depressive conditions of the immune system impair the capability to resolve the infection and allow reactivation from sites of latency of the parasite. Case presentation We describe a case of visceral leishmaniasis (VL) that occurred in a patient with chronic hepatitis C treated with direct-acting antiviral drugs (DAA). The hypothesized mechanism is the alteration of protective inflammation mechanisms secondary to DAA therapy. Downregulation of type II and III IFNs, their receptors, which accompany HCV clearance achieved during treatment with sofosbuvir and ribavirin might have a negative impact on a risk for reactivation of a previous Leishmania infection. We know indeed that IFN-γ is important to enhance killing mechanisms in macrophages, which are the primary target cells of Leishmania. Conclusion Since VL is endemic in Sicily as well as in other countries of the Mediterranean basin, physicians should be aware of the possible unmasking of cryptic Leishmania infection by DAAs.
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Affiliation(s)
- Claudia Colomba
- Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy.
| | - Laura Saporito
- Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy
| | - Paola Di Carlo
- Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy
| | - Manlio Tolomeo
- Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy
| | - Adriana Cervo
- Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy
| | - Alberto Firenze
- Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy
| | - Marcello Trizzino
- Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy
| | - Antonio Cascio
- Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy
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17
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Noronha TRD, Fock RA. Visceral leishmaniasis: amastigotes in the bone marrow. Hematol Transfus Cell Ther 2019; 41:99-100. [PMID: 30793113 PMCID: PMC6371228 DOI: 10.1016/j.htct.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/20/2018] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Ricardo Ambrósio Fock
- Hospital Universitário da Universidade de São Paulo (HU USP), São Paulo, SP, Brazil.
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18
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Claudio U, Alessandro O, Luca C, Jacopo V, Katia F. Visceral leishmaniasis in a patient with lung tumour: a case report. Trop Doct 2019; 49:147-149. [PMID: 30727854 DOI: 10.1177/0049475519825781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An increasing use of immunosuppressant medication mandates clinicians to look for leishmaniasis even in non-HIV febrile patients. We report this case to highlight leishmaniasis as a cause of fever in patients undergoing chemotherapy in an endemic area.
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Affiliation(s)
- Ucciferri Claudio
- Professor, Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d'Annunzio," Chieti, Pescara, Italy
| | - Occhionero Alessandro
- Professor, Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d'Annunzio," Chieti, Pescara, Italy
| | - Caiazzo Luca
- Professor, Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d'Annunzio," Chieti, Pescara, Italy
| | - Vecchiet Jacopo
- Professor, Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d'Annunzio," Chieti, Pescara, Italy
| | - Falasca Katia
- Professor, Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d'Annunzio," Chieti, Pescara, Italy
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19
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Al Balushi A, Khamis F, Klaassen CHW, Gangneux JP, Van Hellemond JJ, Petersen E. Double Infection With Leishmania tropica and L. major in an HIV Patient Controlled With High Doses of Amphotericin B. Open Forum Infect Dis 2018; 5:ofy323. [PMID: 30619911 PMCID: PMC6306567 DOI: 10.1093/ofid/ofy323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022] Open
Abstract
We present a unique case of disseminated Leishmaniasis in an HIV patient. Two different Leishmania species were identified by genomic sequencing in both bone marrow and skin. The Leishmania infection could be suppressed but not cured, despite a high dose of amphotericin B of nearly 65 g over more than 6 years.
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Affiliation(s)
- Asma Al Balushi
- Department of Infectious Diseases, The Royal Hospital, Muscat, Sultanate of Oman
| | - Faryal Khamis
- Department of Infectious Diseases, The Royal Hospital, Muscat, Sultanate of Oman
| | - Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Jaap J Van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Eskild Petersen
- Department of Infectious Diseases, The Royal Hospital, Muscat, Sultanate of Oman
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20
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Clemente WT, Mourão PHO, Aguado JM. Current approaches to visceral leishmaniasis treatment in solid organ transplant recipients. Expert Rev Anti Infect Ther 2018; 16:391-397. [PMID: 29737887 DOI: 10.1080/14787210.2018.1473763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The increasing number of transplants performed worldwide and the growing global mobility with migration and travel to and from developing countries and tropical areas are bringing new challenges for the management of transplant infectious diseases, previously less commonly seen, such as Leishmaniasis. However, in this scenario there is a lack of information and the current knowledge is based on a few studies. The selection of the most appropriate treatment depends on various factors, such as patient profile, Leishmania species, disease extent, drug availability, concomitant infections and previous treatments. Therapeutic options may include different formulations of amphotericin B, pentavalent antimonials, miltefosine and paromomycin, among others. These drugs can be used alone or in combination. Areas covered: This review is a practical guide for Visceral Leishmaniasis (VL) specific treatment in solid organ transplant recipients (SOT), including therapeutic options and assessment of therapy response. Expert commentary: The main challenges for treatment of leishmaniasis in SOT recipients are related to the duration of therapy, curative criteria and secondary prophylaxis. Immunosuppression dose reduction is often recommended, but such decisions must be made on an individual basis. At present, Liposomal Amphotericin B is the best choice for treatment and prophylaxis.
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Affiliation(s)
- Wanessa Trindade Clemente
- a Faculty of Medicine, Departamento de Propedêutica Complementar , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | | | - Jose María Aguado
- c Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid , Madrid , Comunidad de Madrid , Spain
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21
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Ceccarelli M, Rullo EV, Condorelli F, Vitale F, Marco VD, Nunnari G, Pellicanò GF. Unusual Signs and Symptoms in HIV-Positive Patients Coinfected with Leishmania spp: The Importance of Neglected Tropical Disease in Differential Diagnosis. Open Access Maced J Med Sci 2018; 6:843-847. [PMID: 29875857 PMCID: PMC5985878 DOI: 10.3889/oamjms.2018.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 02/25/2018] [Accepted: 03/27/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND: Leishmaniasis is a parasitic disease affecting both animals and humans, acquired with the bite of sand flies or, in Injection Drug Users (IDUs), with contaminated needles, still hypoendemic in Sicily and the Mediterranean basin. Even though it is responsible for 20,000 to 40,000 deaths per year, this parasitic infection is still considered a neglected tropical disease. People Living with HIV (PLWH) are considered at high-risk of developing Leishmaniasis and, despite the introduction of Highly Active Anti-Retroviral Therapy (HAART), mortality rate and relapses prevalence are still high in coinfected people. CASE REPORT: We present a case of HIV-Leishmania coinfection, posing the attention on the atypical signs and symptoms and the importance of thinking about other causes than the HIV infection progression when the patient presents with a worsening of his immune status during HAART. CONCLUSION: This parasitic disease has a high mortality rate, so it is mandatory to think about it in all the patients having a low CD4+ T-cell count and an inverted CD4/CD8 ratio under HAART.
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Affiliation(s)
- Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Italy
| | - Emmanuele Venanzi Rullo
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Italy
| | - Fabrizio Condorelli
- Department of Pharmacological Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Fabrizio Vitale
- Zoo-prophylactic Experimental Institute of Sicily, Palermo (PA), Italy
| | - Vincenzo Di Marco
- Zoo-prophylactic Experimental Institute of Sicily, Barcellona Pozzo di Gotto (ME), Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Italy
| | - Giovanni Francesco Pellicanò
- Department of Human Pathology of the Adult and the Developmental Age "G. Barresi", Unit of Infectious Diseases, University of Messina, Italy
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22
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Echchakery M, Nieto J, Boussaa S, El Fajali N, Ortega S, Souhail K, Aajly H, Chicharro C, Carrillo E, Moreno J, Boumezzough A. Asymptomatic carriers of Leishmania infantum in patients infected with human immunodeficiency virus (HIV) in Morocco. Parasitol Res 2018; 117:1237-1244. [PMID: 29478175 DOI: 10.1007/s00436-018-5805-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/08/2018] [Indexed: 02/02/2023]
Abstract
In Morocco, visceral leishmaniasis (VL) is a parasitic disease caused by the flagellated protozoan parasite Leishmania infantum. L. infantum is transmitted by the bite of female phlebotomine sandflies, and its main reservoir hosts are domestic dogs. Asymptomatic infection with L. infantum is more frequent than clinically apparent disease. In HIV-infected patients, the risk of clinical VL is increased due to immunosuppression that may reactivate latent infections. However, coinfected subjects do not necessarily develop VL and may remain as asymptomatic carriers depending on their immune status. The present study investigates the asymptomatic carriers of L. infantum in HIV-infected patients in central Morocco, where human cases of visceral leishmaniasis by L. infantum have been reported. A total of 200 HIV-infected patients attending the Infectious Diseases Unit of the Ibn Zohar Hospital of Marrakech participated in the study. Parasitological and serological blood analyses included a direct microscopic examination (DME), culture in Novy-McNeal-Nicolle (NNN) medium, and serology by indirect immunofluorescence (IFI). We found prevalence rates of 5% (10/200) by IFI, 3% (6/200) by DME, and 2.5% (5/200) by culture. The parasite was identified as L. infantum by PCR from positive cultures.
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Affiliation(s)
- M Echchakery
- Laboratory of Medical Analysis, Ibn Zohr Regional Hospital Center, Marrakech, Morocco.,Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - J Nieto
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - S Boussaa
- Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco. .,ISPITS-Higher Institute of Nursing and Health Technology, Marrakech, Morocco.
| | - N El Fajali
- Department of Infectious Diseases, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - S Ortega
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - K Souhail
- Laboratory of Medical Analysis, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - H Aajly
- Department of Infectious Diseases, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - C Chicharro
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - E Carrillo
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - J Moreno
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - A Boumezzough
- Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
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