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de Oliveira ME, Scussel R, Borghezan LA, Feuser PE, Ramos FF, Cardoso MDM, De Pieri E, Luiz GP, Galvani NC, Dal-Bó AG, Coelho EAF, Machado-de-Ávila RA. Accuracy improvement enzyme-linked immunosorbent assay using superparamagnetic/polyethylene glycol) nanoparticles for leishmaniasis diagnostic. Diagn Microbiol Infect Dis 2024; 109:116326. [PMID: 38692205 DOI: 10.1016/j.diagmicrobio.2024.116326] [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: 10/25/2023] [Revised: 03/11/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
Serodiagnosis methods have been used as platforms for diagnostic tests for many diseases. Due to magnetic nanoparticles' properties to quickly detach from an external magnetic field and particle size effects, these nanomaterials' functionalization allows the specific isolation of target analytes, enhancing accuracy parameters and reducing serodiagnosis time. Superparamagnetic iron oxide nanoparticles (MNPs) were synthesized and functionalized with polyethylene glycol (PEG) and then associated with the synthetic Leishmaniosis epitope. This nano-peptide antigen showed promising results. Regarding Tegumentary leishmaniasis diagnostic accuracy, the AUC was 0.8398 with sensibility 75% (95CI% 50.50 - 89.82) and specificity 87.50% (95CI% 71.93 - 95.03), and Visceral leishmaniasis accuracy study also present high performance, the AUC was 0.9258 with sensibility 87.50% (95CI% 63.98 - 97.78) and specificity 87.50% (95CI% 71.93 - 95.03). Our results demonstrate that the association of the antigen with MNPs accelerates and improves the diagnosis process. MNPs could be an important tool for enhancing serodiagnosis.
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Affiliation(s)
- Maria Eduarda de Oliveira
- Programa de Pós-Graduação em Microbiologia, Parasitologia e Patologia, Universidade Federal do Paraná, 81531-990, Curitiba, Paraná, Brazil
| | - Rahisa Scussel
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Universitário, 88806-000, Criciúma, Santa Catarina, Brazil
| | - Letícia Alves Borghezan
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Universitário, 88806-000, Criciúma, Santa Catarina, Brazil
| | - Paulo Emilio Feuser
- Programa de Pós-Graduação em Engenharia Química, Department of Engenharia Química, Universidade Federal de Santa Catarina, Cidade Universitária Trindade, 88010-970, Florianópolis, Santa Catarina, Brazil
| | - Fernanda Fonseca Ramos
- Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana de Melo Cardoso
- Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Ellen De Pieri
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Universitário, 88806-000, Criciúma, Santa Catarina, Brazil
| | - Gabriel Paulino Luiz
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Universitário, 88806-000, Criciúma, Santa Catarina, Brazil
| | - Nathalia Coral Galvani
- Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Alexandre Gonçalves Dal-Bó
- Programa de Pós-Graduação em Ciência e Engenharia de Materiais, Universidade do Extremo Sul Catarinense Sangão, 88806-000, Criciúma, Santa Catarina, Brazil
| | - Eduardo Antônio Ferraz Coelho
- Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Andrez Machado-de-Ávila
- Programa de Pós-Graduação em Microbiologia, Parasitologia e Patologia, Universidade Federal do Paraná, 81531-990, Curitiba, Paraná, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Universitário, 88806-000, Criciúma, Santa Catarina, Brazil.
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Aderie EM, Diro E, Zachariah R, da Fonseca MS, Abongomera C, Dolamo BL, Ritmeijer K. Does timing of antiretroviral treatment influence treatment outcomes of visceral leishmaniasis in Northwest Ethiopia? Trans R Soc Trop Med Hyg 2018. [PMID: 28633331 PMCID: PMC5914408 DOI: 10.1093/trstmh/trx023] [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] [Indexed: 12/17/2022] Open
Abstract
Background Visceral leishmaniasis (VL) patients with HIV co-infection should receive antiretroviral treatment (ART). However, the best timing for initiation of ART is not known. Among such individuals, we assessed the influence of ART timing on VL outcomes. Methods A retrospective cohort study was conducted in Northwest Ethiopia among VL patients starting ART between 2008 and 2015. VL outcomes were assessed by the twelfth month of starting ART, within 4 weeks of VL diagnosis or thereafter. Results Of 213 VL-HIV co-infected patients with ART initiation, 96 (45.1%) had moderate to severe malnutrition, 53 (24.9%) had active TB and 128 (60.1%) had hemoglobin levels under 9 g/dL. Eighty-nine (41.8%) were already on ART before VL diagnosis, 46 (21.6%) started ART within 4 weeks, and 78 (36.6%) thereafter. Definitive cure in those starting ART within 4 weeks 59% (95% CI 43–75%) and those starting thereafter 56% (95% CI 44–68%) was not significantly different. Those starting ART before primary VL had higher 12-months mortality compared to those starting later (RR 0.6; 95% CI 0.4–0.9; p=0.012). Conclusions VL-HIV patients are severely ill and with serious additional comorbidities. Outcomes of HIV-VL management are unsatisfactory and early ART initiation was associated with higher mortality. Further research on the optimal timing of ART initiation, and ensuring earlier diagnosis of VL patients, with improved management of comorbidities are needed.
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Affiliation(s)
| | | | - Rony Zachariah
- Médecins sans Frontières, Operational Center Brussels (LuxOR), Luxembourg City, Luxembourg
| | | | - Charles Abongomera
- Médecins Sans Frontières, Addis Ababa, Ethiopia.,Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Koert Ritmeijer
- Médecins sans Frontières, Operational Center Amsterdam, The Netherlands
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Castro A, Carrillo E, San Martín JV, Botana L, Molina L, Matía B, Fernandez L, Horrillo L, Ibarra-Meneses A, Sanchez C, Ruiz-Giardin JM, Moreno J. Lymphoproliferative response after stimulation with soluble leishmania antigen (SLA) as a predictor of visceral leishmaniasis (VL) relapse in HIV+ patients. Acta Trop 2016; 164:345-351. [PMID: 27693332 DOI: 10.1016/j.actatropica.2016.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/22/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022]
Abstract
The introduction of HAART resulted in the decrease of Leishmania/HIV co-infection cases; nevertheless, the number of relapses remains high and secondary prophylaxis is recommended. However, secondary prophylaxis is not necessary in all patients, and presents a high risk of toxicity and an elevated cost. Our aim was to study whether specific cellular response to Leishmania infantum (measured by cell proliferation response after stimulation with soluble Leishmania antigen (SLA)), could be a useful tool to attempt a secondary prophylaxis withdrawal. In June 2009 an outbreak of leishmaniasis by Leishmania infantum was declared in the southeast of Madrid, and since January 2013, we recruited 10 HIV+ patients that had been treated for visceral leishmaniasis. 6 patients had positive SLA-cell proliferation test. The mean CD4 cell counts of those patients with positive SLA were 140 cel/mm3 and 40 cel/mm3 in those with negative SLA test. 3 patients with positive SLA-cell proliferation test (CD4 count: 336, 307, 625) were not on prophylaxis, and the other 3 patients (CD4 count: 152, 189, 359) were on secondary prophylaxis that was withdrawn after the positive SLA-cell proliferation test with no posterior relapses (mean follow up 60 weeks). From the 4 patients, which had negative SLA-cell proliferation test and continued on prophylaxis, 3 had positive PCR for Leishmania at the end of the follow-up and 2 presented clinical relapses. The performance of SLA-cell proliferation test can be a useful tool that can permit us to try withdrawal of the prophylaxis in Leishmania/HIV co-infected patients with low CD4+ counts under clinical supervision, diminishing risk of toxicity and cost.
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Alemayehu M, Wubshet M, Mesfin N. Magnitude of visceral leishmaniasis and poor treatment outcome among HIV patients: meta-analysis and systematic review. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2016; 8:75-81. [PMID: 27042142 PMCID: PMC4809333 DOI: 10.2147/hiv.s96883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Visceral leishmaniasis (VL) coinfection with HIV/AIDS most often results in unfavorable responses to treatment, frequent relapses, and premature deaths. Scarce data are available, regarding the magnitude and poor treatment outcomes of VL-HIV coinfection. Objective The main objective of this systematic review was to describe the pooled prevalence of VL and poor treatment outcome among HIV patients. Review methods Electronic databases mainly PubMed were searched. Databases, such as Google and Google scholar, were searched for gray literature. Articles were selected based on their inclusion criterion, whether they included HIV-positive individuals with VL diagnosis. STATA 11 software was used to conduct a meta-analysis of pooled prevalence of VL-HIV coinfection. Results Fifteen of the 150 articles fulfilled the inclusion criteria. A majority of the study participants were males between 25 years and 41 years of age. The pooled prevalence of VL-HIV coinfection is 5.2% with 95% confidence interval of (2.45–10.99). Two studies demonstrated the impact of antiretroviral treatment on reduction in relapse rate compared with patients who did not start antiretroviral treatment. One study showed that the higher the baseline CD4+ cell count (>100 cells/mL) the lower the relapse rate. Former VL episodes were identified as risk factors for relapse in two articles. In one of the articles, an earlier bout of VL remains significant in the model adjusted to other variables. Conclusion The pooled prevalence of VL in HIV-infected patients is low and an earlier bout of VL and CD4+ count <100 cells/mL at the time of primary VL diagnosis are factors that predict poor treatment outcome.
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Affiliation(s)
- Mekuriaw Alemayehu
- Environmental and Occupational Health and Safety Department, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mamo Wubshet
- Environmental and Occupational Health and Safety Department, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Mesfin
- Internal Medicine Department, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Silva EDD, Andrade LDD, Araújo PSRD, Silveira VM, Padilha CE, Silva MALD, Medeiros ZMD. Case study of a patient with HIV-AIDS and visceral leishmaniasis co-infection in multiple episodes. Rev Inst Med Trop Sao Paulo 2014; 55:425-8. [PMID: 24213197 PMCID: PMC4105092 DOI: 10.1590/s0036-46652013000600010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/15/2013] [Indexed: 11/22/2022] Open
Abstract
Report of a 45-year-old male farmer, a resident in the forest zone of Pernambuco, who was diagnosed with human immunodeficiency virus (HIV) in 1999 and treated using antiretroviral (ARV) drugs. In 2005, the first episode of visceral leishmaniasis (VL), as assessed by parasitological diagnosis of bone marrow aspirate, was recorded. When admitted to the hospital, the patient presented fever, hepatosplenomegaly, weight loss, and diarrhea. Since then, six additional episodes of VL occurred, with a frequency rate of one per year (2005-2012, except in 2008). In 2011, the patient presented a disseminated skin lesion caused by the amastigotes of Leishmania, as identified by histopathological assessment of skin biopsy samples. In 2005, he was treated with N-methyl-glucamine-antimony and amphotericin B deoxycholate. However, since 2006 because of a reported toxicity, the drug of choice was liposomal amphotericin B. As recommended by the Ministry of Health, this report emphasizes the need for HIV patients living in VL endemic areas to include this parasitosis in their follow-up protocol, particularly after the first infection of VL.
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Affiliation(s)
- Elis Dionísio da Silva
- Postgraduate Course of Biology applied to Health, Federal University of Pernambuco, PE, Brazil, ,
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Murray HW. Progress in the treatment of a neglected infectious disease: visceral leishmaniasis. Expert Rev Anti Infect Ther 2014; 2:279-92. [PMID: 15482193 DOI: 10.1586/14787210.2.2.279] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Visceral leishmaniasis (kala-azar) is a disseminated intracellular protozoal infection. Most cases (90%) occur in the rural regions of five countries: India, Sudan, Nepal, Bangladesh and Brazil. As with other infectious diseases embedded in high-level poverty, developing and/or delivering new treatments for visceral leishmaniasis had been painfully slow or nonexistent. However, despite persistent unresolved obstacles (e.g., drug affordability), renewed interest in visceral leishmaniasis and numerous successful treatment trials have combined to turn a therapeutic corner in the past 5 years, yielding new alternatives to conventional pentavalent antimony. Advances include the use of low-cost generic pentavalent antimony, rediscovery of amphotericin B, short-course regimens via lipid formulations of amphotericin B, retesting injectible paromyomycin and, of clear-cut importance, identifying miltefosine (Impavido, Zentaris) as the first effective oral therapy for this neglected disease.
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Affiliation(s)
- Henry W Murray
- Department of Medicine, Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA.
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Molina I, Fisa R, Riera C, Falcó V, Elizalde A, Salvador F, Crespo M, Curran A, López-Chejade P, Tebar S, Pérez-Hoyos S, Ribera E, Pahissa A. Ultrasensitive real-time PCR for the clinical management of visceral leishmaniasis in HIV-Infected patients. Am J Trop Med Hyg 2013; 89:105-10. [PMID: 23629932 DOI: 10.4269/ajtmh.12-0527] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Molecular methods have been proposed as an alternative tool for the diagnosis of visceral leishmaniasis (VL), but no data are available regarding use for monitoring clinical outcome. A prospective cohort study of human immunodeficiency virus-(HIV) and VL-coinfected patients was conducted in a university-affiliated hospital in Barcelona, Spain. Leishmania parasite load was monitored using a real-time polymerase chain reaction (PCR) at baseline and every 3 months. Cutoff values for PCR were determined using receiver operating characteristic (ROC) curves. Overall, 37 episodes were analyzed, and 25 of these episodes were considered as relapsing episodes. A significant decrease of parasite load measured 3 months after treatment could predict the clinical evolution of VL. A parasite load over 0.9 parasites/mL measured 12 months after treatment could predicts relapse with a sensitivity of 100% and a specificity of 90.9%. Monitoring parasite load by an ultrasensitive quantitative Leishmania PCR is useful to predict the risk of relapse after a VL episode in HIV-infected patients.
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Affiliation(s)
- Israel Molina
- Infectious Disease Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Colasanti J, Altamirano J, Espinoza L. An unwelcome synergy: leishmaniasis and HIV. Am J Med 2013; 126:114-6. [PMID: 23331437 DOI: 10.1016/j.amjmed.2012.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Jonathan Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Ritmeijer K, ter Horst R, Chane S, Aderie EM, Piening T, Collin SM, Davidson RN. Limited Effectiveness of High-Dose Liposomal Amphotericin B (AmBisome) for Treatment of Visceral Leishmaniasis in an Ethiopian Population With High HIV Prevalence. Clin Infect Dis 2011; 53:e152-8. [DOI: 10.1093/cid/cir674] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cota GF, de Sousa MR, Rabello A. Predictors of visceral leishmaniasis relapse in HIV-infected patients: a systematic review. PLoS Negl Trop Dis 2011; 5:e1153. [PMID: 21666786 PMCID: PMC3110161 DOI: 10.1371/journal.pntd.0001153] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 03/07/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Visceral leishmaniasis (VL) is a common complication in AIDS patients living in Leishmania-endemic areas. Although antiretroviral therapy has changed the clinical course of HIV infection and its associated illnesses, the prevention of VL relapses remains a challenge for the care of HIV and Leishmania co-infected patients. This work is a systematic review of previous studies that have described predictors of VL relapse in HIV-infected patients. REVIEW METHODS We searched the electronic databases of MEDLINE, LILACS, and the Cochrane Central Register of Controlled Trials. Studies were selected if they included HIV-infected individuals with a VL diagnosis and patient follow-up after the leishmaniasis treatment with an analysis of the clearly defined outcome of prediction of relapse. RESULTS Eighteen out 178 studies satisfied the specified inclusion criteria. Most patients were males between 30 and 40 years of age, and HIV transmission was primarily via intravenous drug use. Previous VL episodes were identified as risk factors for relapse in 3 studies. Two studies found that baseline CD4+ T cell count above 100 cells/mL was associated with a decreased relapse rate. The observation of an increase in CD4+ T cells at patient follow-up was associated with protection from relapse in 5 of 7 studies. Meta-analysis of all studies assessing secondary prophylaxis showed significant reduction of VL relapse rate following prophylaxis. None of the five observational studies evaluating the impact of highly active antiretroviral therapy use found a reduction in the risk of VL relapse upon patient follow-up. CONCLUSION SOME PREDICTORS OF VL RELAPSE COULD BE IDENTIFIED: a) the absence of an increase in CD4+ cells at follow-up; b) lack of secondary prophylaxis; and c) previous history of VL relapse. CD4+ counts below 100 cells/mL at the time of primary VL diagnosis may also be a predictive factor for VL relapse.
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Affiliation(s)
- Gláucia F Cota
- Post-Graduate Program in Health Sciences, René Rachou Institute, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.
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Effects of HIV aspartyl-proteinase inhibitors on Leishmania sp. Exp Parasitol 2010; 126:557-63. [DOI: 10.1016/j.exppara.2010.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 05/06/2010] [Accepted: 06/01/2010] [Indexed: 11/21/2022]
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Mondal S, Bhattacharya P, Ali N. Current diagnosis and treatment of visceral leishmaniasis. Expert Rev Anti Infect Ther 2010; 8:919-44. [PMID: 20695748 DOI: 10.1586/eri.10.78] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Human visceral leishmaniasis (VL), a potentially fatal disease, is most prevalent in the Indian subcontinent, East Africa and South America. Definite diagnosis and effective treatment are the primary needs for the control of VL. Diagnosis of VL has typically relied on microscopic examination of bone marrow/splenic aspirate, but serology and molecular methods are now better alternatives. The conventional drugs for treatment of VL have limitations including unresponsiveness, relapse, specific toxicities and parenteral administration lasting for long durations. Moreover, they are less effective in HIV-VL-coinfected patients. Registration of miltefosine and paromomycin, and preferential pricing of AmBisome has offered more choices for monotherapy and combination therapy for VL. Combination therapy will increase treatment efficacy and prevent the development of resistance. In addition, active case finding and vector control strategies will also have a positive impact in the control of VL. This article critically addresses the currently available diagnostic and treatment regimens for the control of VL.
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Affiliation(s)
- Smriti Mondal
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, Kolkata, India
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Abstract
The Leishmaniases are a group of diseases transmitted to humans by the bite of a sandfly, caused by protozoan parasites of the genus Leishmania. Various Leishmania species infect humans, producing a spectrum of clinical manifestations. It is estimated that 350 million people are at risk, with a global yearly incidence of 1-1.5 million for cutaneous and 500,000 for visceral Leishmaniasis (VL). VL is a major cause of morbidity and mortality in East Africa, Brazil and the Indian subcontinent. Co-infection with human immunodeficiency virus (HIV) alters the immune response to the disease. Here we review the immune response to Leishmania in the setting of HIV co-infection. Improved understanding of the immunology involved in co-infections may help in designing prophylactic and therapeutic strategies against Leishmaniasis.
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Affiliation(s)
- Navid Ezra
- Department of Medicine, Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, USA
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Abellán-Martínez J, Guerra-Vales JM, Fernández-Cotarelo MJ, González-Alegre MT. Evolution of the incidence and aetiology of fever of unknown origin (FUO), and survival in HIV-infected patients after HAART (Highly Active Antiretroviral Therapy). Eur J Intern Med 2009; 20:474-7. [PMID: 19712847 DOI: 10.1016/j.ejim.2009.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 12/17/2008] [Accepted: 01/04/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fever of unknown origin (FUO) is common among HIV-infected patients with a CD4+ T-lymphocyte cell count below 200 cells/ml. The use of HAART has transformed the evolution of AIDS and related diseases. DESIGN AND METHOD Case-control study, nested on a historical cohort of 3777 HIV-infected patients who were attended at "12 de Octubre" University Hospital in Madrid, Spain, between 1994 and 2000. RESULTS 276 FUO episodes were recorded, 58 of which occurred in patients receiving HAART. The significant decrease on the accumulated FUO incidence along the study period of 7.3 episodes per 100 HIV-infected patients after 1997 corresponded with the introduction of HAART. FUO was more frequent in patients who did not receive HAART. The aetiological spectrum of FUO was transformed by the introduction of HAART: the incidence of tuberculosis decreased while that of leishmaniasis increased. The four year survival in the non-FUO group increased when compared to that of patients who had had FUO. Similarly, this four year survival increased in patients who received HAART at the time of FUO versus those not receiving it. CONCLUSIONS Our results confirm that the incidence of FUO has significantly decreased with the introduction of HAART. HAART has also transformed the aetiological spectrum related to FUO considerably. The most frequent cause of FUO in non-HAART patients on this study was the disseminated infection by Mycobacterium avium intracellulare (MAI), followed by tuberculosis, while leishmaniasis was its most common cause in patients receiving HAART. Survival decreased in patients who developed FUO; however, patients who received HAART at the time of FUO had longer survival than patients who did not.
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Le Pape P. Development of new antileishmanial drugs – current knowledge and future prospects. J Enzyme Inhib Med Chem 2008; 23:708-18. [DOI: 10.1080/14756360802208137] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Patrice Le Pape
- Département de Parasitologie et de Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, IICiMed UPRES EA 1155, UFR de Sciences Pharmaceutiques, 1 rue Gaston VeilNantes cedex 01F-44035, France
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The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 2008; 21:334-59, table of contents. [PMID: 18400800 DOI: 10.1128/cmr.00061-07] [Citation(s) in RCA: 574] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To date, most Leishmania and human immunodeficiency virus (HIV) coinfection cases reported to WHO come from Southern Europe. Up to the year 2001, nearly 2,000 cases of coinfection were identified, of which 90% were from Spain, Italy, France, and Portugal. However, these figures are misleading because they do not account for the large proportion of cases in many African and Asian countries that are missed due to a lack of diagnostic facilities and poor reporting systems. Most cases of coinfection in the Americas are reported in Brazil, where the incidence of leishmaniasis has spread in recent years due to overlap with major areas of HIV transmission. In some areas of Africa, the number of coinfection cases has increased dramatically due to social phenomena such as mass migration and wars. In northwest Ethiopia, up to 30% of all visceral leishmaniasis patients are also infected with HIV. In Asia, coinfections are increasingly being reported in India, which also has the highest global burden of leishmaniasis and a high rate of resistance to antimonial drugs. Based on the previous experience of 20 years of coinfection in Europe, this review focuses on the management of Leishmania-HIV-coinfected patients in low-income countries where leishmaniasis is endemic.
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ter Horst R, Collin S, Ritmeijer K, Bogale A, Davidson R. Concordant HIV Infection and Visceral Leishmaniasis in Ethiopia: The Influence of Antiretroviral Treatment and Other Factors on Outcome. Clin Infect Dis 2008; 46:1702-9. [DOI: 10.1086/587899] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Wilson ME. Clinical trials report. Curr Infect Dis Rep 2008. [DOI: 10.1007/s11908-008-0008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol 2007; 5:873-82. [PMID: 17938629 DOI: 10.1038/nrmicro1748] [Citation(s) in RCA: 995] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Governed by parasite and host factors and immunoinflammatory responses, the clinical spectrum of leishmaniasis encompasses subclinical (inapparent), localised (skin lesions), and disseminated infection (cutaneous, mucosal, or visceral). Symptomatic disease is subacute or chronic and diverse in presentation and outcome. Clinical characteristics vary further by endemic region. Despite T-cell-dependent immune responses, which produce asymptomatic and self-healing infection, or appropriate treatment, intracellular infection is probably life-long since targeted cells (tissue macrophages) allow residual parasites to persist. There is an epidemic of cutaneous leishmaniasis in Afghanistan and Pakistan and of visceral infection in India and Sudan. Diagnosis relies on visualising parasites in tissue or serology; culture and detection of parasite DNA are useful in the laboratory. Pentavalent antimony is the conventional treatment; however, resistance of visceral infection in India has spawned new treatment approaches--amphotericin B and its lipid formulations, injectable paromomycin, and oral miltefosine. Despite tangible advances in diagnosis, treatment, and basic scientific research, leishmaniasis is embedded in poverty and neglected. Current obstacles to realistic prevention and proper management include inadequate vector (sandfly) control, no vaccine, and insufficient access to or impetus for developing affordable new drugs.
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Affiliation(s)
- Henry W Murray
- Department of Medicine, Weill Medical College of Cornell University, New York, USA.
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Abstract
Opportunistic parasitic infections are an important cause of morbidity and mortality in people infected with HIV. Since the introduction of highly active antiretroviral therapy (HAART), there has been a marked reduction in the occurrence and clinical course of these parasitic infections. Although these changes have been attributed to the restoration of cell-mediated immunity induced by either non-nucleoside reverse transcriptase inhibitors or HIV protease inhibitors, in combination with at least two nucleoside reverse transcriptase inhibitors included in HAART, there is evidence that HIV protease inhibitors have a direct inhibitory effect on the proteases of parasites. The results of studies on opportunistic parasitic infections conducted both before and during the HAART era indicate the need to develop clinical trials on the efficacy of HIV protease inhibitors in controlling parasitic infections in individuals with HIV or other immunocompromised individuals and laboratory investigations on aspartyl proteases of parasites as an important target for the development of new drugs.
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Roberts MTM. Current understandings on the immunology of leishmaniasis and recent developments in prevention and treatment. Br Med Bull 2005; 75-76:115-30. [PMID: 16847165 DOI: 10.1093/bmb/ldl003] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Leishmaniasis is a major tropical disease with a wide clinical spectrum of cutaneous, mucocutaneous and visceral involvement. Presentation is often varied and diagnosis can be challenging. The outcome of infection is determined by the parasite species and the host's immunological response. The CD4+ T helper cell is critical with animal models demonstrating that cure is associated with strong IFN-gamma, interleukin (IL)-2 and IL-12 responses in the absence of classical Th2 cytokines or IL-10. Prevention has focussed on vector control, control of animal reservoirs and efforts to develop a protective vaccine. Treatment options historically have relied on antimonials though agents with better tolerability and efficacy have been developed including amphotericin and the oral agent miltefosine. Drug resistance, human immunodeficiency virus and changes in vector epidemiology threaten recent advances. Renewed impetus led by the WHO is required to co-ordinate future international effort to develop new drugs and ultimately a vaccine.
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Affiliation(s)
- M T M Roberts
- Department of Medicine and Infectious Diseases, Worcester Royal Hospital, Charles Hastings Way, Worcester, Worcs WR5 1JG, UK.
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