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Ullah W, Khan A, Niaz S, Al-Garadi MA, Nasreen N, Swelum AA, Ben Said M. Epidemiological survey, molecular profiling and phylogenetic analysis of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan. Trans R Soc Trop Med Hyg 2024; 118:273-286. [PMID: 38055843 DOI: 10.1093/trstmh/trad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/22/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL), an emerging vector-borne ailment in Khyber Pakhtunkhwa (KPK), Pakistan, exhibits diverse spread patterns and outbreaks. METHODS To comprehend its epidemiology and identify parasite species, we conducted an active survey on suspected CL cases (n=8845) in KPK. RESULTS Microscopy and internal transcribed spacer-1 PCR-restriction fragment length polymorphism (RFLP) molecular techniques detected Leishmania spp. in blood samples. Phylogenetic analysis gauged genetic affinities with other areas. District Bannu displayed the highest CL impact (14.58%), while Swat had the lowest impact (4.33%) among cases. Annual blood examination rate, parasite incidence and slide positivity rate were 4.96 per 1000 people, 0.0233 and 0.047%, respectively. CL infections were prevalent in 1- to 20-y-olds, with males (57.17%) more vulnerable than females (42.82%). Single lesions occurred in 43.73% of patients, while 31.2% people had two lesions, 17.31% had three lesions and 7.74% had more than three lesions. Most had sand-fly exposure but lacked preventive measures like repellents and bed nets. Leishmania tropica was confirmed via RFLP analysis in amplified samples. Phylogenetic analysis unveiled genetic parallels between L. tropica of KPK and isolates from China, Iran, Afghanistan, India, Syria and Morocco. CONCLUSIONS Urgent comprehensive control measures are imperative. Early detection, targeted interventions and raising awareness of CL and sand-fly vectors are vital for reducing the disease's impact. International collaboration and monitoring are crucial to tackle Leishmania spp.'s genetic diversity and curtail its cross-border spread.
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Affiliation(s)
- Wasia Ullah
- Depart ment of Zoology, Abdul Wali Khan University, Khyber Pakhtunkhwa, Pakistan
| | - Adil Khan
- Department of Botany/Zoology, Bacha Khan University Charsadda, Khyber Pakhtunkhwa, Pakistan
- Department of Biology, Mountain Allison university, Sackville, new Brunswick, Canada
| | - Sadaf Niaz
- Depart ment of Zoology, Abdul Wali Khan University, Khyber Pakhtunkhwa, Pakistan
| | - Maged A Al-Garadi
- Department of Animal Production, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Nasreen Nasreen
- Depart ment of Zoology, Abdul Wali Khan University, Khyber Pakhtunkhwa, Pakistan
| | - Ayman A Swelum
- Department of Animal Production, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mourad Ben Said
- Laboratory of Microbiology, National School of Veterinary Medicine of Sidi Thabet, University of Manouba, Manouba 2010, Tunisia
- Department of Basic Sciences, Higher Institute of Biotechnology of Sidi Thabet, University of Manouba, Manouba 2010, Tunisia
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Vandeputte M, van Henten S, van Griensven J, Bottieau E. Which trial do we need? A collaborative platform trial for cutaneous leishmaniasis amongst international travellers. Clin Microbiol Infect 2023; 29:1237-1240. [PMID: 37230249 DOI: 10.1016/j.cmi.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Martin Vandeputte
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Infection Medicine, University of Edinburgh, Edinburgh, UK.
| | - Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Mouri O, Melenotte C, Guéry R, Cotteret C, Schweitzer-Chaput A, Perignon A, Thellier M, Bourrat E, Kaguelidou F, Siriez JY, Malvy D, Gangneux JP, Duvignaud A, Ravel C, Cisternino S, Ransom J, Caumes E, Lortholary O, Grogl M, Buffet P. Self-application of aminoglycoside-based creams to treat cutaneous leishmaniasis in travelers. PLoS Negl Trop Dis 2023; 17:e0011492. [PMID: 37561802 PMCID: PMC10443860 DOI: 10.1371/journal.pntd.0011492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/22/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND In endemic foci, the use of an aquaphilic cream containing paromomycin with/without gentamicin to treat cutaneous leishmaniasis (CL) is safe, painless and cures 78-82% of patients with New and Old World CL. Self-application in travelers requires evaluation. METHODS Travelers with 1-10 lesions of confirmed CL were prospectively treated with the paromomycin-gentamicin formulation (WR279396, 2012-2017, Group 1) and carefully follow up, or treated with a locally produced paromomycin-only cream (2018-2022, Group 2). The cream was applied once under supervision, then self-applied daily for 20-30 days. A cured lesion was defined as 100% re-epithelialization at day 42 without relapse at three months. RESULTS Medical features were similar in Group 1 (17 patients), and Group 2 (23 patients). Patients were infected with either Leishmania major, L. infantum, L. killicki, L. guyanensis, L. braziliensis, or L. naiffi. Intention-to-treat and per-protocol cure rates were 82% (95% confidence interval (CI) [64.23;100.00]) and 87% (95% CI [71,29;100.00]) in Group 1, and 69% (95% CI [50.76; 88.37]) and 76% (95% CI [57.97; 94.41]) in Group 2. In the pooled Group 1&2, 75% (95% CI [61.58;88.42]) (30/40) and 81% (95% CI [68,46;93.6]) (30/37) of patients were cured in intention-to-treat and per-protocol, respectively. There were no significant differences observed in the success rates between Old World and New World CL (83.3% vs. 60%, p = 0.14). Prospective observations in Group 1 showed that adverse events were mainly pruritus (24%) and pain (18%) on lesions (all mild or moderate). No mucosal involvement was observed in either group. DISCUSSION In this representative population of travelers who acquired CL either in the Old or New World, the 81% per-protocol cure rate of a self-applied aminoglycoside cream was similar to that observed in clinical trials.
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Affiliation(s)
- Oussama Mouri
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie, Paris, France
| | - Cléa Melenotte
- Hôpital Necker Enfants Malades, Services de Maladies Infectieuses et Tropicales, Assistance-Publique des Hôpitaux de Paris, Paris, France
| | - Romain Guéry
- Department of Internal Medicine and Infectious Diseases, Hôpital du Confluent, Nantes, Paris, France
| | - Camille Cotteret
- Pharmacie, Hôpital Universitaire Necker-Enfants Malades Assistance-Publique des Hôpitaux de Paris, Paris, France
| | - Arnaud Schweitzer-Chaput
- Pharmacie, Hôpital Universitaire Necker-Enfants Malades Assistance-Publique des Hôpitaux de Paris, Paris, France
| | - Alice Perignon
- Service des maladies infectieuses et tropicales, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Marc Thellier
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie, Paris, France
| | - Emmanuelle Bourrat
- Service de dermatologie Hôpital Saint Louis APHP Paris, Paris, France
- Service de pédiatre générale Hôpital Robert Debré APHP Paris, Paris, France
- Centre d’Investigations Cliniques, INSERM CIC1426, Hôpital Robert Debré, APHP.Nord, Université Paris Cité, Paris, France
| | - Florentia Kaguelidou
- Centre d’Investigations Cliniques, INSERM CIC1426, Hôpital Robert Debré, APHP. Nord, Université Paris Cité, Paris, France
| | - Jean Yves Siriez
- Hôpital Robert-Debré, Service d’Accueil des Urgences pédiatriques, Assistance Publique-Hôpitaux de Paris, 48 boulevard Sérurier, Paris, France
| | - Denis Malvy
- Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de recherche en santé, environnement et travail)–UMR_S 1085, Rennes, France
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Christophe Ravel
- Université de Montpellier, CNRS, IRD, Centre Hospitalo-Universitaire de Montpellier, MiVEGEC, Laboratoire de Parasitologie-Mycologie, CNR Leishmanioses, Montpellier, France
| | - Salvatore Cisternino
- Université de Paris, Necker-Enfants Malades University Hospital, Department of pharmacy, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Université de Paris, Inserm, UMRS-1144, Faculté de Pharmacie, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Janet Ransom
- Fast-Track Drugs and Biologics, North Potomac, Maryland, United States of America
| | - Eric Caumes
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Centre de diagnostic, Hôpital de l’Hôtel-Dieu,-Paris, France
| | - Olivier Lortholary
- Hôpital Necker Enfants Malades, Services de Maladies Infectieuses et Tropicales, Assistance-Publique des Hôpitaux de Paris, Paris, France
- Paris University, Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, AP-HP, IHU Imagine, Paris, France
| | - Max Grogl
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12). CIBERINFEC, ISCIII. Department of Medicine, Universidad Complutense, Madrid, Spain
- US Naval Medical Research Unit No. 6, Lima, Peru
| | - Pierre Buffet
- Centre d’Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
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Gaspari V, Gritti T, Ortalli M, Santi A, Galletti G, Rossi A, Rugna G, Mattivi A, Matteo G, Belloli GL, Mattei G, Varani S. Tegumentary Leishmaniasis in Northeastern Italy from 2017 to 2020: A Neglected Public Health Issue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16047. [PMID: 36498130 PMCID: PMC9740434 DOI: 10.3390/ijerph192316047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Tegumentary leishmaniasis (TL) includes cutaneous (CL) and mucosal (ML) leishmaniasis; despite being endemic in southern Europe, it is often underdiagnosed and underreported. This study aimed to retrospectively examine data collected from patients with TL in a selected area of northeastern Italy (Emilia-Romagna region, RER). A network of 10 diagnostic units within RER was established, and TL cases diagnosed in RER from 2017 to 2020 were evaluated. A total of 135 TL cases were collected (62% male, 38% female); patients ranged from 1 to 84 years, with a median age of 57. Among these cases, 113 (84%) were notified to the public health authorities. The average annual incidence of TL was 0.76 cases per 100,000 inhabitants. Infections were acquired within the RER in 84% of cases; the 113 autochthonous cases were distributed in the foothills areas of the region. We provide evidence of a defined spatial distribution of TL cases in a selected area of northeastern Italy, as well as a relevant number of ML cases. Our observations suggest the need to raise awareness about TL among clinicians and pathologists, promote the molecular confirmation of cases by reference laboratories, and encourage the establishment of surveillance networks for this neglected disease.
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Affiliation(s)
- Valeria Gaspari
- Unit of Dermatology, Head and Neck Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Tommaso Gritti
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Margherita Ortalli
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Annalisa Santi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, 25124 Brescia, Italy
| | - Giorgio Galletti
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, 25124 Brescia, Italy
| | - Arianna Rossi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, 25124 Brescia, Italy
| | - Gianluca Rugna
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, 25124 Brescia, Italy
| | - Andrea Mattivi
- Regional Health Authority, Emilia-Romagna Region, 40127 Bologna, Italy
| | - Giulio Matteo
- Regional Health Authority, Emilia-Romagna Region, 40127 Bologna, Italy
| | - Gian L. Belloli
- Regional Health Authority, Emilia-Romagna Region, 40127 Bologna, Italy
| | - Giovanna Mattei
- Regional Health Authority, Emilia-Romagna Region, 40127 Bologna, Italy
| | - Stefania Varani
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
- Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Horev A, Sagi O, Zur E, Ben-Shimol S. Topical liposomal amphotericin B gel treatment for cutaneous leishmaniasis caused by Leishmania major: a double-blind, randomized, placebo-controlled, pilot study. Int J Dermatol 2022; 62:40-47. [PMID: 36040071 DOI: 10.1111/ijd.16407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) topical treatments may have low efficacy, while systemic treatments have adverse effects (AEs) and high cost. Since treatment options for CL nowadays have numerous disadvantages, an alternative topical treatment is vastly needed. We assessed liposomal amphotericin B gel (LAmB gel) treatment efficacy and safety. METHODS A randomized, double-blind, placebo-controlled trial. Adults with CL (PCR proven, ≤5 lesions) were randomized for 28 days with LAmB gel (cases) versus placebo gel (controls), followed by LAmB gel for 28 days (both groups). Lesion size, ulceration, induration, scarring, swelling, and AEs (pain, itch, erythema, discharge, fever, and urticaria) were assessed at days 1, 28, and 56. PCR was repeated at day 56. RESULTS Thirteen patients (four cases, nine controls) with 39 lesions (11 cases, 28 controls) caused by Leishmania major (L. major) were randomized. Ulcer, induration, scarring, and swelling were noted in 18%, 91%, 0%, and 27% of cases, respectively, versus 86%, 89%, 7%, and 54% of controls, respectively. At day 28, improvement rates were low in both groups. Induration improved comparing LAmB gel treatment for 56 days versus 28 days. Ulceration, induration, and swelling improved comparing all patients at 56 days versus 28 days. PCR turned negative in three of four cases and eight of nine controls. Mild, only local, AEs were reported in <30% of the patients. CONCLUSIONS LAmB gel is safe and may be considered as an alternative topical treatment for CL caused by L. major. Further, larger-scale studies are warranted to evaluate the long-term impact of LAmB gel on the management of CL.
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Affiliation(s)
- Amir Horev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Dermatology Service, Soroka University Medical Center, Beer Sheva, Israel
| | - Orli Sagi
- Parasitology Laboratory, Soroka University Medical Center, Beer Sheva, Israel
| | - Eyal Zur
- Compounding Solutions, Tel-Mond, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
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Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review. Pathogens 2022; 11:pathogens11080921. [PMID: 36015042 PMCID: PMC9415673 DOI: 10.3390/pathogens11080921] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Leishmaniases are human and animal parasitic diseases transmitted by phlebotomine sand flies. Globalization is an important driver of the burden and in the current dynamics of these diseases. A systematic review of articles published between 2000 and 2021 was conducted using the PubMed search engine to identify the epidemiology and clinical management of imported human leishmaniases as a fundamental step to better manage individual cases and traveler and migrant health from a global perspective. A total of 275 articles were selected, representing 10,341 human imported cases. Identified drivers of changing patterns in epidemiology include conflict and war, as well as host factors, such as immunosuppression, natural and iatrogenic. Leishmania species diversity associated with different clinical presentations implies diagnostic and treatment strategies often complex to select and apply, especially in non-endemic settings. Thus, diagnostic and management algorithms for medical clinical decision support are proposed. Increased surveillance of non-endemic cases, whether in vulnerable populations such as refugees/migrants and immunocompromised individuals or travelers, could improve individual health and mitigate the public health risk of introducing Leishmania species into new areas.
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Treatment outcome of imported cutaneous leishmaniasis among travellers and migrants infected with Leishmania major and Leishmania tropica: a retrospective study in European centres 2013 to 2019. Int J Infect Dis 2022; 122:375-381. [PMID: 35728749 DOI: 10.1016/j.ijid.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cutaneous leishmaniasis (CL) in Asia, Northern and Sub-Saharan Africa is mainly caused by Leishmania major and Leishmania tropica. We describe and evaluate the treatment outcome of CL among travellers and migrants in Europe. METHODS A retrospective study of parasitological confirmed CL cases caused by L. major and L. tropica during 2013-2019 in Europe. Data were collected from medical records and databases within the LeishMan network. RESULTS Out of 206 included cases of CL, seventy-five were identified as L. major and 131 as L. tropica. Eighty percent of the patients with L. tropica infection were migrants, whereas 53 % of patients with L. major infection had been visiting friends and relatives. Among patients with L. tropica, 48 %, were younger than 15. Pentavalent antimony cured 73 % (L. major) and 78 % (L. tropica). Intralesional administration had a cure rate, 86 % and systemic, 67%, on L. tropica. Liposomal amphotericin B had a cure rate of 44-63 %. CONCLUSION L. major infections were mostly found in individuals visiting friends and relatives, whereas L. tropica were mainly identified in migrants. No patients with L. major relapsed. Pentavalent antimony, liposomal amphotericin B and cryotherapy had cure rates in accordance with previous studies.
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Clinical diversity and treatment results in Tegumentary Leishmaniasis: A European clinical report in 459 patients. PLoS Negl Trop Dis 2021; 15:e0009863. [PMID: 34644288 PMCID: PMC8544871 DOI: 10.1371/journal.pntd.0009863] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2021] [Accepted: 09/28/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management. METHODOLOGY Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients. PRINCIPAL FINDINGS Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%). CONCLUSION/SIGNIFICANCE CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates.
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Volpedo G, Pacheco-Fernandez T, Holcomb EA, Cipriano N, Cox B, Satoskar AR. Mechanisms of Immunopathogenesis in Cutaneous Leishmaniasis And Post Kala-azar Dermal Leishmaniasis (PKDL). Front Cell Infect Microbiol 2021; 11:685296. [PMID: 34169006 PMCID: PMC8217655 DOI: 10.3389/fcimb.2021.685296] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 12/18/2022] Open
Abstract
Leishmaniasis is a neglected tropical disease that affects 12 million people worldwide. The disease has high morbidity and mortality rates and is prevalent in over 80 countries, leaving more than 300 million people at risk of infection. Of all of the manifestations of this disease, cutaneous leishmaniasis (CL) is the most common form and it presents as ulcerating skin lesions that can self-heal or become chronic, leading to disfiguring scars. This review focuses on the different pathologies and disease manifestations of CL, as well as their varying degrees of severity. In particular, this review will discuss self-healing localized cutaneous leishmaniasis (LCL), leishmaniasis recidivans (LR), mucocutaneous leishmaniasis (MCL), anergic diffuse cutaneous leishmaniasis (ADCL), disseminated leishmaniasis (DL), and Post Kala-azar Dermal Leishmaniasis (PKDL), which is a cutaneous manifestation observed in some visceral leishmaniasis (VL) patients after successful treatment. The different clinical manifestations of CL are determined by a variety of factors including the species of the parasites and the host's immune response. Specifically, the balance between the pro and anti-inflammatory mediators plays a vital role in the clinical presentation and outcome of the disease. Depending upon the immune response, Leishmania infection can also transition from one form of the disease to another. In this review, different forms of cutaneous Leishmania infections and their immunology are described.
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Affiliation(s)
- Greta Volpedo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Microbiology, College of Arts and Sciences, The Ohio State University, Columbus, OH, United States
| | - Thalia Pacheco-Fernandez
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Erin A. Holcomb
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Natalie Cipriano
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Blake Cox
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Abhay R. Satoskar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Microbiology, College of Arts and Sciences, The Ohio State University, Columbus, OH, United States
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Epidemiology, clinical pattern and impact of species-specific molecular diagnosis on management of leishmaniasis in Belgium, 2010-2018: A retrospective study. Travel Med Infect Dis 2020; 38:101885. [PMID: 32977026 DOI: 10.1016/j.tmaid.2020.101885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Species-directed therapy of leishmaniasis has been recommended for travelers since 2014, but little is known about species distribution and treatment practices in non-endemic countries. We aimed to describe leishmaniasis cases in Belgium since species typing became available and evaluate its impact on patient management. METHOD Retrospective analysis of all patients diagnosed by PCR at our national reference laboratory from 2010 to 2018. Species were typed by Hsp-70 sequencing. RESULTS We identified 18 visceral leishmaniasis (VL) and 147 (muco)cutaneous leishmaniasis ((M)CL) cases. VL was exclusively due to L. infantum and consistently treated with liposomal amphotericin B, with four observed failures. (M)CL was caused by ten different species. Of 62 cases diagnosed and species typed after 2014 with timing information, 28 (45.2%) were treated before the species result was available. Therapy was not species-directed in 10/32(28.1%) of those treated after species identification. Patients treated according to the guidelines tended to have a favorable outcome more often than those who were not (36/44, 81.8% versus 8/19, 57.9%; p = 0.045). CONCLUSIONS In contrast to VL, various species caused (M)CL in our setting and species result was often not considered for treatment. Outcome tended to be better however when therapy was species-directed.
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Shaheen N, Qureshi NA, Qureshi MZ, Fatima H, Afzal M, Alhewairini SS. Molecular epidemiological survey of cutaneous leishmaniasis from Azad Jammu and Kashmir, Pakistan. Acta Trop 2020; 206:105434. [PMID: 32126210 DOI: 10.1016/j.actatropica.2020.105434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 12/30/2022]
Abstract
Cutaneous leishmaniasis (CL) is an emerging neglected tropical disease in Azad Jammu and Kashmir which is an underdeveloped area. Prevalence and parasite species identification are the key factors to control disease in a particular population, which were the objectives of the present study. Due to a lack of previous data, we performed a district-based active CL surveillance in 2018. The data of CL, suspected (n = 20,000) cases were analyzed statistically and identified the parasite species in microscopic positive cases by ITS1-PCR RFLP and also obtained accession numbers MN891719-28 from gene Bank. The phylogenetic tree was constructed using MEGA6 software. Out of 20,000 CL, suspected cases the highest rate of 4.02% (135/3360) of CL in Mirpur and the lowest 1.58% (8/505) in Neelum was reported. The slide positivity rate, annual parasite incidence rate and annual blood examination rate were 2.27 per 1000 population, 0.08 and 0.34%. The males were more infected 58.12% (297/511) than females 41.88% (214/511) and the age group of 1-20 years were found highly infected 82.78% (423/511) than 21-40 years 13.89% (71/511) and 41-60 years 3.33% (17/511) in the studied population. The patients 56.36% (288/511) had a single lesion whereas 29.35% (150/511) had two, only 10.76% (31/288) and 8% (12/150) were using bed nets. The patients 14.29% (73/511) had three or more lesions were not using bed nets. Only 27.98% (143/511) patients had received treatment, while 72.02% (368/511) didn't. Microscopically positive cases were found to be 2.56% (511/20,000) and ITS1-PCR positive cases were found to be 91.39% (467/511). The RFLP assay confirmed the presence of Leishmania tropica in 467 samples.
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Affiliation(s)
- Nargis Shaheen
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Naveeda Akhter Qureshi
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan.
| | | | - Huma Fatima
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Muhammad Afzal
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Saleh S Alhewairini
- Department of Plant Production and Protection, College of Agriculture and Veterinary Medicine, Qassim University, Saudi Arabia
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12
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Kosaka A, Sakamoto N, Hikone M, Imai K, Ota M, Washino T, Maeda T, Iwabuchi S. Failure of Liposomal-amphotericin B Treatment for New World Cutaneous Leishmaniasis due to Leishmania braziliensis. Intern Med 2020; 59:1227-1230. [PMID: 32378656 PMCID: PMC7270753 DOI: 10.2169/internalmedicine.4096-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Liposomal-amphotericin B (L-AmB) is used for cutaneous leishmaniasis (CL); however, its treatment failure has not yet been described in detail. A 58-year-old man returned from the Republic of Venezuela with a cutaneous ulcer on his left lower leg. The causative pathogen was Leishmania braziliensis. We started L-AmB 3 mg/kg/day for 6 days; however, the ulcer did not resolve. The patient was successfully retreated with a higher dose L-AmB 4 mg/kg/day 9 times (total, 36 mg/kg). If L-AmB fails to treat CL and other therapeutics cannot be used, increasing the L-AmB dose is a viable option.
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Affiliation(s)
- Atsushi Kosaka
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Naoya Sakamoto
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Mayu Hikone
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Kazuo Imai
- Department of Infectious Diseases and Infection Control, Saitama Medical University, Japan
- Center for Clinical Infectious Diseases and Research, Saitama Medical University, Japan
| | - Masayuki Ota
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Takuya Washino
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Takuya Maeda
- Department of Microbiology, Saitama Medical University, Japan
| | - Sentarou Iwabuchi
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
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13
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Okwara B, Ighorodje E. Cutaneous leishmaniasis: An uncommon finding in South-South Nigeria. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_34_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Route map for the discovery and pre-clinical development of new drugs and treatments for cutaneous leishmaniasis. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2019; 11:106-117. [PMID: 31320296 PMCID: PMC6904839 DOI: 10.1016/j.ijpddr.2019.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022]
Abstract
Although there have been significant advances in the treatment of visceral leishmaniasis (VL) and several novel compounds are currently in pre-clinical and clinical development for this manifestation of leishmaniasis, there have been limited advances in drug research and development (R & D) for cutaneous leishmaniasis (CL). Here we review the need for new treatments for CL, describe in vitro and in vivo assays, models and approaches taken over the past decade to establish a pathway for the discovery, and pre-clinical development of new drugs for CL. These recent advances include novel mouse models of infection using bioluminescent Leishmania, the introduction of PK/PD approaches to skin infection, and defined pre-clinical candidate profiles.
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15
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Abstract
Leishmaniasis is a poverty-related disease with two main clinical forms: visceral leishmaniasis and cutaneous leishmaniasis. An estimated 0·7-1 million new cases of leishmaniasis per year are reported from nearly 100 endemic countries. The number of reported visceral leishmaniasis cases has decreased substantially in the past decade as a result of better access to diagnosis and treatment and more intense vector control within an elimination initiative in Asia, although natural cycles in transmission intensity might play a role. In east Africa however, the case numbers of this fatal disease continue to be sustained. Increased conflict in endemic areas of cutaneous leishmaniasis and forced displacement has resulted in a surge in these endemic areas as well as clinics across the world. WHO lists leishmaniasis as one of the neglected tropical diseases for which the development of new treatments is a priority. Major evidence gaps remain, and new tools are needed before leishmaniasis can be definitively controlled.
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Affiliation(s)
- Sakib Burza
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Médecins Sans Frontières, Delhi, India
| | - Simon L Croft
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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16
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Raja M, Gonzales Zamora JA. Visceral leishmaniasis with cutaneous involvement caused by Leishmania infantum-chagasi. IDCases 2017; 11:16-17. [PMID: 29255674 PMCID: PMC5725215 DOI: 10.1016/j.idcr.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/28/2022] Open
Abstract
Leishmaniainfantum-chagasi is a species of Leishmania associated with visceral involvement. Cutaneous lesions are rarely seen in cases of visceral leishmaniasis. The diagnosis is achieved by skin biopsy and confirmed with molecular techniques such as polymerase chain reaction (PCR). Systemic therapy with amphotericin B is the treatment of choice for visceral leishmaniasis.
We report the case of a 66 year-old woman who presented nodular skin lesions on her back and upper extremities. Biopsy revealed amastigotes that were identified as Leishmania infantum-chagasi by PCR. Evaluation also showed hepatomegaly and pulmonary nodules. Treatment with amphotericin B led to complete resolution of skin lesions.
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Affiliation(s)
- Mohammed Raja
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, Miami 33136, FL, USA
| | - Jose Armando Gonzales Zamora
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, Miami 33136, FL, USA
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17
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Guery R, Henry B, Martin-Blondel G, Rouzaud C, Cordoliani F, Harms G, Gangneux JP, Foulet F, Bourrat E, Baccard M, Morizot G, Consigny PH, Berry A, Blum J, Lortholary O, Buffet P. Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. PLoS Negl Trop Dis 2017; 11:e0006094. [PMID: 29155816 PMCID: PMC5714383 DOI: 10.1371/journal.pntd.0006094] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/04/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Background Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication. Methods We conducted a retrospective analysis of data from a French centralized referral treatment program and from the “LeishMan” European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines. Results From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28–803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3–27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03–32]) while infection with other species had no impact on outcome. Conclusion In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease. Cutaneous and muco-cutaneous leishmaniasis (CL/MCL) are disfiguring diseases caused by a worldwide distributed parasite called Leishmania and its 20 species. Clinical manifestations span a wide continuum from single nodular lesion to disseminated form with mucosal involvement. Though local treatment with cryotherapy and intralesionnal antimony or topical formulations of paromomycin is generally adequate in most of situations, some patients with complex CL/MCL require systemic therapy. No convenient regimen has been proved to be safe and effective for all infecting species, all clinical forms and all patients (e.g. children, pregnant women, adults with comorbidities or immunosuppression). In this study, the authors examined in returning travelers with CL/MCL the effectiveness of an antifungal agent “liposomal amphotericin B” (L-AmB), which is highly effective in visceral leishmaniasis. Surprisingly, rates of healing were lower than in previous reports in this unselected population that reflects clinical practice in non-endemic countries. The observations also suggest that some Leishmania species (namely, L. infantum) may be more susceptible to L-AmB than others. Occurrence of adverse events should raises the question of the benefit-risk balance of L-AmB in CL/MCL. Careful attention to comorbidities and adoption of strict protocols for administration are pre-requisites for the use of L-AmB in patients with CL/MCL.
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Affiliation(s)
- Romain Guery
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- * E-mail: (PB); (RG)
| | - Benoit Henry
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, INSERM U1043—CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Claire Rouzaud
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Florence Cordoliani
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Jean-Pierre Gangneux
- Service de Parasitologie-Mycologie, CHU de Rennes, INSERM U1085, Université Rennes 1, Rennes, France
| | - Françoise Foulet
- Unité de Mycologie, Département de Biologie-Pathologie, CHU Henri Mondor, DHU VIC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Emmanuelle Bourrat
- Service de Pédiatrie Général, Hôpital Robert Debré, Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | - Michel Baccard
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | | | - Paul-Henri Consigny
- Centre Médical de l'Institut Pasteur, Consultation de Maladies Infectieuses, Tropicales et de Médecine des Voyages, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
| | - Antoine Berry
- Service de Parasitologie-Mycologie, CHU de Toulouse, INSERM U1043—CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Buffet
- INTS, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence GR-Ex, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
- * E-mail: (PB); (RG)
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18
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Lachaud L, Fernández-Arévalo A, Normand AC, Lami P, Nabet C, Donnadieu JL, Piarroux M, Djenad F, Cassagne C, Ravel C, Tebar S, Llovet T, Blanchet D, Demar M, Harrat Z, Aoun K, Bastien P, Muñoz C, Gállego M, Piarroux R. Identification of Leishmania by Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) Mass Spectrometry Using a Free Web-Based Application and a Dedicated Mass-Spectral Library. J Clin Microbiol 2017; 55:2924-2933. [PMID: 28724559 PMCID: PMC5625378 DOI: 10.1128/jcm.00845-17] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 01/16/2023] Open
Abstract
Human leishmaniases are widespread diseases with different clinical forms caused by about 20 species within the Leishmania genus. Leishmania species identification is relevant for therapeutic management and prognosis, especially for cutaneous and mucocutaneous forms. Several methods are available to identify Leishmania species from culture, but they have not been standardized for the majority of the currently described species, with the exception of multilocus enzyme electrophoresis. Moreover, these techniques are expensive, time-consuming, and not available in all laboratories. Within the last decade, mass spectrometry (MS) has been adapted for the identification of microorganisms, including Leishmania However, no commercial reference mass-spectral database is available. In this study, a reference mass-spectral library (MSL) for Leishmania isolates, accessible through a free Web-based application (mass-spectral identification [MSI]), was constructed and tested. It includes mass-spectral data for 33 different Leishmania species, including species that infect humans, animals, and phlebotomine vectors. Four laboratories on two continents evaluated the performance of MSI using 268 samples, 231 of which were Leishmania strains. All Leishmania strains, but one, were correctly identified at least to the complex level. A risk of species misidentification within the Leishmania donovani, L. guyanensis, and L. braziliensis complexes was observed, as previously reported for other techniques. The tested application was reliable, with identification results being comparable to those obtained with reference methods but with a more favorable cost-efficiency ratio. This free online identification system relies on a scalable database and can be implemented directly in users' computers.
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Affiliation(s)
- Laurence Lachaud
- Département de Parasitologie-Mycologie, Centre National de Référence des Leishmanioses, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Anna Fernández-Arévalo
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Secció de Parasitologia, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Center of International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Anne-Cécile Normand
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université d'Aix-Marseille, Marseille, France
| | - Patrick Lami
- Département de Parasitologie-Mycologie, Centre National de Référence des Leishmanioses, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Cécile Nabet
- Laboratoire Hospitalo-Universitaire de Parasito-Mycologie, EA 3593, EPaT Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Laboratoire Associé au CNR Leishmania, Cayenne, France
| | | | - Martine Piarroux
- Université Aix-Marseille, INSERM-IRD-AMU UMR 912, Marseille, France
| | - Farid Djenad
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université d'Aix-Marseille, Marseille, France
| | - Carole Cassagne
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université d'Aix-Marseille, Marseille, France
| | - Christophe Ravel
- Département de Parasitologie-Mycologie, Centre National de Référence des Leishmanioses, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Silvia Tebar
- Secció de Parasitologia, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Teresa Llovet
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Denis Blanchet
- Laboratoire Hospitalo-Universitaire de Parasito-Mycologie, EA 3593, EPaT Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Laboratoire Associé au CNR Leishmania, Cayenne, France
| | - Magalie Demar
- Laboratoire Hospitalo-Universitaire de Parasito-Mycologie, EA 3593, EPaT Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Laboratoire Associé au CNR Leishmania, Cayenne, France
| | - Zoubir Harrat
- Laboratoire d'Eco-Épidemiologie Parasitaire et Génétique des Populations, Institut Pasteur d'Algerie, Algiers, Algeria
| | - Karim Aoun
- Laboratoire de Parasitologie Médicale, Biotechnologies et Biomolécules, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Patrick Bastien
- Département de Parasitologie-Mycologie, Centre National de Référence des Leishmanioses, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Montserrat Gállego
- Secció de Parasitologia, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Center of International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Renaud Piarroux
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université d'Aix-Marseille, Marseille, France
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Cutaneous Leishmaniasis Successfully Treated by Liposomal Amphotericin B. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Leishmaniose cutanée à Leishmania infantum : un grand polymorphisme clinique mais un arsenal thérapeutique limité. Ann Dermatol Venereol 2016; 143:587-589. [DOI: 10.1016/j.annder.2016.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Handler MZ, Patel PA, Kapila R, Al-Qubati Y, Schwartz RA. Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management. J Am Acad Dermatol 2016; 73:911-26; 927-8. [PMID: 26568336 DOI: 10.1016/j.jaad.2014.09.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/03/2014] [Accepted: 09/05/2014] [Indexed: 12/25/2022]
Abstract
The diagnosis of leishmaniasis can be challenging because it mimics both infectious and malignant conditions. A misdiagnosis may lead to an unfavorable outcome. Using culture, histologic, and/or polymerase chain reaction study results, a diagnosis of leishmaniasis can be established and treatment initiated. Appropriate management requires an accurate diagnosis, which often includes identification of the specific etiologic species. Different endemic areas have varying sensitivities to the same medication, even within individual species. Species identification may be of practical value, because infections with select species have a substantial risk of visceral involvement. In addition, HIV and otherwise immunocompromised patients with leishmaniasis have a propensity for diffuse cutaneous leishmaniasis. For most New World Leishmania species, parenteral antimonial drugs remain the first line of therapy, while Old World species are easily treated with physical modalities. Historically, live organism vaccination has been used and is effective in preventing leishmaniasis, but results in an inoculation scar and an incubation period that may last for years. A more effective method of vaccination would be welcome.
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Affiliation(s)
- Marc Z Handler
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Parimal A Patel
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Robert A Schwartz
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey; Rutgers School of Public Affairs and Administration, Newark, New Jersey.
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22
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Firdessa R, Good L, Amstalden MC, Chindera K, Kamaruzzaman NF, Schultheis M, Röger B, Hecht N, Oelschlaeger TA, Meinel L, Lühmann T, Moll H. Pathogen- and Host-Directed Antileishmanial Effects Mediated by Polyhexanide (PHMB). PLoS Negl Trop Dis 2015; 9:e0004041. [PMID: 26431058 PMCID: PMC4592236 DOI: 10.1371/journal.pntd.0004041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/06/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by protozoan parasites of the genus Leishmania. CL causes enormous suffering in many countries worldwide. There is no licensed vaccine against CL, and the chemotherapy options show limited efficacy and high toxicity. Localization of the parasites inside host cells is a barrier to most standard chemo- and immune-based interventions. Hence, novel drugs, which are safe, effective and readily accessible to third-world countries and/or drug delivery technologies for effective CL treatments are desperately needed. METHODOLOGY/PRINCIPAL FINDINGS Here we evaluated the antileishmanial properties and delivery potential of polyhexamethylene biguanide (PHMB; polyhexanide), a widely used antimicrobial and wound antiseptic, in the Leishmania model. PHMB showed an inherent antileishmanial activity at submicromolar concentrations. Our data revealed that PHMB kills Leishmania major (L. major) via a dual mechanism involving disruption of membrane integrity and selective chromosome condensation and damage. PHMB's DNA binding and host cell entry properties were further exploited to improve the delivery and immunomodulatory activities of unmethylated cytosine-phosphate-guanine oligodeoxynucleotides (CpG ODN). PHMB spontaneously bound CpG ODN, forming stable nanopolyplexes that enhanced uptake of CpG ODN, potentiated antimicrobial killing and reduced host cell toxicity of PHMB. CONCLUSIONS Given its low cost and long history of safe topical use, PHMB holds promise as a drug for CL therapy and delivery vehicle for nucleic acid immunomodulators.
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Affiliation(s)
- Rebuma Firdessa
- Institute for Molecular Infection Biology, University of Würzburg, Würzburg, Germany
| | - Liam Good
- Royal Veterinary College, University of London, London, United Kingdom
| | | | | | | | - Martina Schultheis
- Institute for Molecular Infection Biology, University of Würzburg, Würzburg, Germany
| | - Bianca Röger
- Institute for Molecular Infection Biology, University of Würzburg, Würzburg, Germany
| | - Nina Hecht
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Würzburg, Germany
| | | | - Lorenz Meinel
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Würzburg, Germany
| | - Tessa Lühmann
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Würzburg, Germany
| | - Heidrun Moll
- Institute for Molecular Infection Biology, University of Würzburg, Würzburg, Germany
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Cutaneous leishmaniasis in travellers: a focus on epidemiology and treatment in 2015. Curr Infect Dis Rep 2015; 17:489. [PMID: 26031962 DOI: 10.1007/s11908-015-0489-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Imported cutaneous leishmaniasis (CL) is a growing problem with increasing global travel to endemic areas. Returned travellers seeking care encounter significant barriers to treatment, including diagnostic delays and difficult access to anti-leishmanial drugs. Treatment recommendations in non-endemic settings are a moving target, reflecting recent developments in Leishmania diagnostics and therapeutics. Accumulating experience with molecular-based species identification has enabled species-directed therapy. Clinicians are reevaluating more toxic traditional regimens in light of newly approved therapeutic agents and emerging data on local cutaneous treatments. Referral centers are implementing treatment decision algorithms designed to maximize efficacy while minimizing adverse events. Although management strategies continue to evolve, treatment of CL in non-endemic settings remains controversial. Persistent reliance on expert opinion reflects lack of research focused on travellers and limited randomized controlled trial evidence. We herein review the current epidemiology of cutaneous leishmaniasis in travellers and species-specific evidence for available therapies.
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Molecular epidemiology of imported cases of leishmaniasis in Australia from 2008 to 2014. PLoS One 2015; 10:e0119212. [PMID: 25734905 PMCID: PMC4348169 DOI: 10.1371/journal.pone.0119212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/28/2015] [Indexed: 02/06/2023] Open
Abstract
Leishmaniasis is a vector borne disease caused by protozoa of the genus Leishmania. Human leishmaniasis is not endemic in Australia though imported cases are regularly encountered. This study aimed to provide an update on the molecular epidemiology of imported leishmaniasis in Australia. Of a total of 206 biopsies and bone marrow specimens submitted to St Vincent’s Hospital Sydney for leishmaniasis diagnosis by PCR, 55 were found to be positive for Leishmania DNA. All PCR products were subjected to restriction fragment length polymorphism analysis for identification of the causative species. Five Leishmania species/species complexes were identified with Leishmania tropica being the most common (30/55). Travel or prior residence in a Leishmania endemic region was the most common route of acquisition with ~47% of patients having lived in or travelled to Afghanistan. Cutaneous leishmaniasis was the most common manifestation (94%) with only 3 cases of visceral leishmaniasis and no cases of mucocutaneous leishmaniasis encountered. This report indicates that imported leishmaniasis is becoming increasingly common in Australia due to an increase in global travel and immigration. As such, Australian clinicians must be made aware of this trend and consider leishmaniasis in patients with suspicious symptoms and a history of travel in endemic areas. This study also discusses the recent identification of a unique Leishmania species found in native kangaroos and a potential vector host which could create the opportunity for the establishment of a local transmission cycle within humans.
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Eiras DP, Kirkman LA, Murray HW. Cutaneous Leishmaniasis: Current Treatment Practices in the USA for Returning Travelers. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015; 7:52-62. [PMID: 25788870 DOI: 10.1007/s40506-015-0038-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Leishmaniasis, a protozoal infection transmitted by sandfly bite, produces a clinical spectrum of disease ranging from asymptomatic infection to ulcerative skin and mucosal lesions to visceral involvement. Leishmaniasis is endemic in regions of Africa, the Middle East, south Asia, southern Europe, northern South America, and Central America. There has been an increase in imported leishmaniasis into developed, non-endemic countries due to increasing global travel. While pentavalent antimonials have been the mainstay of antileishmanial treatment for decades, newer therapeutic options have become available for all forms of infection, including liposomal amphotericin B, miltefosine, fluconazole, and ketoconazole. For the returning traveler with cutaneous leishmaniasis in the USA, treatment approaches are determined based on infecting species, initial presentation, extent and progression of disease, the advantages and drawbacks of available parenteral and oral drugs, and clinician-consultant experience.
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Izri A, Bendjaballah A, Andriantsoanirina V, Durand R. Cutaneous leishmaniasis caused by Leishmania killicki, Algeria. Emerg Infect Dis 2015; 20:502-4. [PMID: 24565368 PMCID: PMC3944836 DOI: 10.3201/eid2003.13-1152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Stahl HC, Ahmadi F, Schleicher U, Sauerborn R, Bermejo JL, Amirih ML, Sakhayee I, Bogdan C, Stahl KW. A randomized controlled phase IIb wound healing trial of cutaneous leishmaniasis ulcers with 0.045% pharmaceutical chlorite (DAC N-055) with and without bipolar high frequency electro-cauterization versus intralesional antimony in Afghanistan. BMC Infect Dis 2014; 14:619. [PMID: 25420793 PMCID: PMC4258014 DOI: 10.1186/s12879-014-0619-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 11/07/2014] [Indexed: 11/21/2022] Open
Abstract
Background A previously published proof of principle phase IIa trial with 113 patients from Kabul showed that bipolar high-frequency (HF) electro-cauterization (EC) of cutaneous leishmaniasis (CL) ulcers and subsequent moist wound treatment (MWT) closed 85% of all Leishmania (L.) tropica lesions within 60 days. Methods A three-armed phase IIb, randomized and controlled clinical trial was performed in Mazar-e-Sharif. L. tropica- or L. major-infected CL patients received intradermal sodium stibogluconate (SSG) (Group I); HF-EC followed by MWT with 0.045% DAC N-055 (Group II); or MWT with 0.045% DAC N-055 in basic crème alone (Group III). The primary outcome was complete epithelialisation before day 75 after treatment start. Results 87 patients enrolled in the trial were randomized into group I (n = 24), II (n = 32) and III (n = 31). The per-protocol analysis of 69 (79%) patients revealed complete epithelialisation before day 75 in 15 (of 23; 65%) patients of Group I, in 23 (of 23; 100%) patients of Group II, and in 20 (of 23; 87%) patients of Group III (p = 0.004, Fisher’s Exact Test). In the per-protocol analysis, wound closure times were significantly different between all regimens in a pair-wise comparison (p = 0.000039, Log-Rank (Mantel-Cox) test). In the intention-to-treat analysis wound survival times in Group II were significantly different from those in Group I (p = 0.000040, Log-Rank (Mantel-Cox) test). Re-ulcerations occurred in four (17%), three (13%) and seven (30%) patients of Group I, II or III, respectively (p = 0.312, Pearson Chi-Square Test). Conclusions Treatment of CL ulcers with bipolar HF-EC followed by MWT with 0.045% DAC N-055 or with DAC N-055 alone showed shorter wound closure times than with the standard SSG therapy. The results merit further exploration in larger trials in the light of our current knowledge of in vitro and in vivo activities of chlorite. Clinicaltrials.gov ID: NCT00996463. Registered: 15th October 2009. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0619-8) contains supplementary material, which is available to authorized users.
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Singh Raghunath R, Yong ASW, Igali L, Tan E, Lockwood D. Cutaneous leishmaniasis in a returning UK traveller. Postgrad Med J 2014; 90:540-1. [PMID: 25053817 DOI: 10.1136/postgradmedj-2014-132620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rakhi Singh Raghunath
- Department of Dermatology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Adrian S W Yong
- Department of Dermatology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Laszlo Igali
- Department of Cellular Pathology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Eunice Tan
- Department of Dermatology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Diana Lockwood
- London School of Hygiene and Tropical Medicine, London, UK
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Mouri O, Morizot G, Van der Auwera G, Ravel C, Passet M, Chartrel N, Joly I, Thellier M, Jauréguiberry S, Caumes E, Mazier D, Marinach-Patrice C, Buffet P. Easy identification of leishmania species by mass spectrometry. PLoS Negl Trop Dis 2014; 8:e2841. [PMID: 24902030 PMCID: PMC4046964 DOI: 10.1371/journal.pntd.0002841] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/23/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis is caused by several Leishmania species that are associated with variable outcomes before and after therapy. Optimal treatment decision is based on an accurate identification of the infecting species but current methods to type Leishmania isolates are relatively complex and/or slow. Therefore, the initial treatment decision is generally presumptive, the infecting species being suspected on epidemiological and clinical grounds. A simple method to type cultured isolates would facilitate disease management. METHODOLOGY We analyzed MALDI-TOF spectra of promastigote pellets from 46 strains cultured in monophasic medium, including 20 short-term cultured isolates from French travelers (19 with CL, 1 with VL). As per routine procedure, clinical isolates were analyzed in parallel with Multilocus Sequence Typing (MLST) at the National Reference Center for Leishmania. PRINCIPAL FINDINGS Automatic dendrogram analysis generated a classification of isolates consistent with reference determination of species based on MLST or hsp70 sequencing. A minute analysis of spectra based on a very simple, database-independent analysis of spectra based on the algorithm showed that the mutually exclusive presence of two pairs of peaks discriminated isolates considered by reference methods to belong either to the Viannia or Leishmania subgenus, and that within each subgenus presence or absence of a few peaks allowed discrimination to species complexes level. CONCLUSIONS/SIGNIFICANCE Analysis of cultured Leishmania isolates using mass spectrometry allows a rapid and simple classification to the species complex level consistent with reference methods, a potentially useful method to guide treatment decision in patients with cutaneous leishmaniasis.
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Affiliation(s)
- Oussama Mouri
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
| | - Gloriat Morizot
- Unité d'Immunologie Moléculaire des Parasites, Institut Pasteur de Paris, Paris, France
| | - Gert Van der Auwera
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christophe Ravel
- Centre National de Référence des Leishmanioses, Montpellier, France
| | - Marie Passet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
| | - Nathalie Chartrel
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
| | - Isabelle Joly
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
| | - Marc Thellier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- Institut National de la Santé et de la Recherche Médicale U945, Paris, France
| | - Stéphane Jauréguiberry
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladie Infectieuse, Paris, France
| | - Eric Caumes
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladie Infectieuse, Paris, France
| | - Dominique Mazier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- Institut National de la Santé et de la Recherche Médicale U945, Paris, France
| | - Carine Marinach-Patrice
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- Institut National de la Santé et de la Recherche Médicale U945, Paris, France
| | - Pierre Buffet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service Parasitologie-Mycologie, Paris, France
- Université Pierre et Marie Curie-Paris6, UMR S945 Paris, France
- Institut National de la Santé et de la Recherche Médicale U945, Paris, France
- * E-mail:
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Salah AB, Zaâtour A, Ben Messaoud N, Kidar A, Smith PL, Kopydlowski KM, Kreishman-Deitrick M, Nielsen CJ, Novitt-Moreno A, Ransom JH, Morizot G, Grogl M, Buffet PA. Parasite load decrease during application of a safe and easily applied antileishmanial aminoglycoside cream. PLoS Negl Trop Dis 2014; 8:e2749. [PMID: 24853096 PMCID: PMC4031053 DOI: 10.1371/journal.pntd.0002749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | | | | | - Philip L. Smith
- United States Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Karen M. Kopydlowski
- United States Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Mara Kreishman-Deitrick
- United States Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Carl J. Nielsen
- United States Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Anne Novitt-Moreno
- Fast-Track Drugs & Biologics, LLC, North Potomac, Maryland, United States of America
| | - Janet H. Ransom
- Fast-Track Drugs & Biologics, LLC, North Potomac, Maryland, United States of America
| | | | - Max Grogl
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- * E-mail:
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Nadler C, Enk CD, Leon GT, Samuni Y, Maly A, Czerninski R. Diagnosis and Management of Oral Leishmaniasis—Case Series and Literature Review. J Oral Maxillofac Surg 2014; 72:927-34. [DOI: 10.1016/j.joms.2013.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 10/31/2013] [Accepted: 10/31/2013] [Indexed: 11/16/2022]
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Kroidl A, Kroidl I, Bretzel G, Löscher T. Non-healing old world cutaneous leishmaniasis caused by L. infantum in a patient from Spain. BMC Infect Dis 2014; 14:206. [PMID: 24739742 PMCID: PMC3991887 DOI: 10.1186/1471-2334-14-206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of Old World Cutaneous Leishmaniasis in the Mediterranean region is increasing and in Southern Europe often caused by Leishmania infantum. Spontaneous healing of cutaneous leishmaniasis is commonly observed, especially if caused by L. major, whereas L. infantum associated lesions have been reported with longer disease duration and decreased tendency for self-limitation, however, available information is sparse. CASE PRESENTATION We report the case of an otherwise healthy woman from Southern Spain who presented with a seven years persistent, non-healing, painless, central ulcerated, nodular cutaneous lesion with a diameter of 2 cm of the forearm. Cutaneous leishmaniasis was diagnosed by smear and histology, showing large amounts of leishmania amastigotes in subepidermal histiocytes and extensive lymphocyte and plasma cell inflammation. L. infantum as the causative pathogen was confirmed by restriction fragment length polymorphism and microsatellite-PCR. Systemic or visceral involvement was excluded by negative leishmania serology and clinical presentation, relevant concomitant diseases or immunosuppression were excluded including quantification of immunoglobulin levels and lymphocyte phenotyping. Topical and systemic anti-infectious treatment options, often limited in terms of efficacy, tolerability and long lasting treatment duration, were considered. Treatment was successfully performed by surgical extraction in local anaesthesia only. CONCLUSION To our knowledge this is the longest reported duration of a L. infantum associated cutaneous leishmaniasis indicating a potential long lasting natural evolution of the disease in an otherwise healthy and immunocompetent patient, however, high parasite density may have reflected a lack of a L. infantum specific immune response. Complete surgical extraction can be successfully performed as treatment.
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Affiliation(s)
- Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Leopoldstr, 5, 80802 Munich, Germany.
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Showler AJ, Wilson ME, Kain KC, Boggild AK. Parasitic diseases in travelers: a focus on therapy. Expert Rev Anti Infect Ther 2014; 12:497-521. [DOI: 10.1586/14787210.2014.892827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Blum J, Buffet P, Visser L, Harms G, Bailey MS, Caumes E, Clerinx J, van Thiel PPAM, Morizot G, Hatz C, Dorlo TPC, Lockwood DNJ. LeishMan recommendations for treatment of cutaneous and mucosal leishmaniasis in travelers, 2014. J Travel Med 2014; 21:116-29. [PMID: 24745041 DOI: 10.1111/jtm.12089] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment of cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML) in travelers is still controversial. Over the last decade, national and international consortia have published recommendations for treating CL in travelers. These guidelines harmonize many issues, but there are some discrepancies. METHODS Leishmania parasites causing CL can now be genotyped by polymerase chain reaction techniques for detecting Leishmania DNA. Therefore, treatment recommendations can now be species based rather than based on geographical exposure. To review the evidence on which the recommendations were based, "LeishMan" (Leishmaniasis Management), a group of experts from 13 institutions in eight European countries, performed a PubMed MEDLINE) literature search and considered unpublished evidence and the experts' own personal experiences. The Oxford evidence grading system was used to evaluate the information. RESULTS AND CONCLUSION In this article, the authors provide practical treatment recommendations for imported CL and ML in Europe, drawn up from the review by the European experts.
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Jebran AF, Schleicher U, Steiner R, Wentker P, Mahfuz F, Stahl HC, Amin FM, Bogdan C, Stahl KW. Rapid healing of cutaneous leishmaniasis by high-frequency electrocauterization and hydrogel wound care with or without DAC N-055: a randomized controlled phase IIa trial in Kabul. PLoS Negl Trop Dis 2014; 8:e2694. [PMID: 24551257 PMCID: PMC3923720 DOI: 10.1371/journal.pntd.0002694] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/29/2013] [Indexed: 12/30/2022] Open
Abstract
Background Anthroponotic cutaneous leishmaniasis (CL) due to Leishmania (L.) tropica infection is a chronic, frequently disfiguring skin disease with limited therapeutic options. In endemic countries healing of ulcerative lesions is often delayed by bacterial and/or fungal infections. Here, we studied a novel therapeutic concept to prevent superinfections, accelerate wound closure, and improve the cosmetic outcome of ACL. Methodology/Principal Findings From 2004 to 2008 we performed a two-armed, randomized, double-blinded, phase IIa trial in Kabul, Afghanistan, with patients suffering from L. tropica CL. The skin lesions were treated with bipolar high-frequency electrocauterization (EC) followed by daily moist-wound-treatment (MWT) with polyacrylate hydrogel with (group I) or without (group II) pharmaceutical sodium chlorite (DAC N-055). Patients below age 5, with facial lesions, pregnancy, or serious comorbidities were excluded. The primary, photodocumented outcome was the time needed for complete lesion epithelialization. Biopsies for parasitological and (immuno)histopathological analyses were taken prior to EC (1st), after wound closure (2nd) and after 6 months (3rd). The mean duration for complete wound closure was short and indifferent in group I (59 patients, 43.1 d) and II (54 patients, 42 d; p = 0.83). In patients with Leishmania-positive 2nd biopsies DAC N-055 caused a more rapid wound epithelialization (37.2 d vs. 58.3 d; p = 0.08). Superinfections occurred in both groups at the same rate (8.8%). Except for one patient, reulcerations (10.2% in group I, 18.5% in group II; p = 0.158) were confined to cases with persistent high parasite loads after healing. In vitro, DAC N-055 showed a leishmanicidal effect on pro- and amastigotes. Conclusions/Significance Compared to previous results with intralesional antimony injections, the EC plus MWT protocol led to more rapid wound closure. The tentatively lower rate of relapses and the acceleration of wound closure in a subgroup of patients with parasite persistence warrant future studies on the activity of DAC N-055. Trial Registration ClinicalTrails.gov NCT00947362 In many countries of the Middle East such as Afghanistan, cutaneous leishmaniasis is a highly prevalent, chronic and stigmatizing skin disease. Poor hygiene conditions frequently aggravate the lesions due to bacterial and fungal superinfections. Classical treatments with injections of pentavalent antimony are hampered by costs, side effects, resistance development, supply and manufactural quality problems. In the present study on Afghan patients with Leishmania tropica-induced skin lesions we evaluated the clinical effect of an initial removal of lesion tissue by electrocoagulation using a bipolar high-frequency electrosurgery instrument, followed by daily moist wound treatment with or without a preparation of pharmaceutical sodium chlorite (DAC N-055). DAC N-055 is a compound with anti-infective, immunomodulatory and tissue repair-promoting effects. Our analysis revealed that the carefully performed moist wound treatment led to a rapid healing of the wounds within an average period of 6 weeks, even in the absence of the sodium chlorite preparation. This is considerably faster than the time spans previously reported for local or systemic antimony treatment. We believe that the current standard for local care of chronic wounds should also be applied to Leishmania skin lesions. If combined with an initial single high-frequency electrocoagulation, it is a highly effective, inexpensive and well-tolerated treatment option for cutaneous leishmaniasis.
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Affiliation(s)
- Ahmad Fawad Jebran
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ulrike Schleicher
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Reto Steiner
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Pia Wentker
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Farouq Mahfuz
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Hans-Christian Stahl
- Waisenmedizin e.V. Promoting Access to Care with Essential Medicine, Non-Profit Organization, Freiburg, Germany
| | - Faquir Mohammad Amin
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Christian Bogdan
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- * E-mail: (CB); (KWS)
| | - Kurt-Wilhelm Stahl
- Waisenmedizin e.V. Promoting Access to Care with Essential Medicine, Non-Profit Organization, Freiburg, Germany
- * E-mail: (CB); (KWS)
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Lavergne RA, Iriart X, Martin-Blondel G, Chauvin P, Menard S, Fillaux J, Cassaing S, Roques-Malecaze C, Arnaud S, Valentin A, Magnaval JF, Marchou B, Berry A. Contribution of molecular diagnosis to the management of cutaneous leishmaniasis in travellers. Clin Microbiol Infect 2014; 20:O528-30. [PMID: 24279601 DOI: 10.1111/1469-0691.12487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 11/29/2022]
Abstract
Cutaneous leishmaniasis is one of the most frequent skin diseases occurring after travelling in endemic areas. Optimal management requires identification of the species of Leishmania involved. In this study we aimed to evaluate the use of molecular diagnosis as routine, in comparison with direct examination and culture. Thirty positive diagnoses were carried out between 2007 and 2013. Classical PCR enabled 11 positive cases to be identified that were found to be negative by conventional methods. Sequencing led to the identification of eight different species. Routine use of PCR and sequencing appears very efficient in the management of cutaneous leishmaniasis.
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Affiliation(s)
- R A Lavergne
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM, U1043, Toulouse, France; CNRS, U5282, Toulouse, France; Université de Toulouse, UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France
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