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Oliveira D, Lopes KF, de Avelar DM, Cota G, Oliveira E. Accuracy of serological tests in diagnosing mucosal leishmaniasis. Parasitol Res 2023; 122:2001-2010. [PMID: 37391643 DOI: 10.1007/s00436-023-07900-9] [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: 01/25/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
In this serum panel-based study, we evaluated the accuracy of serological tests originally developed for visceral leishmaniasis (VL), for diagnosis of mucosal leishmaniasis (ML). A total of five tests were evaluated, four of which are registered at the National Agency of Sanitary Surveillance (Agência Nacional de Vigilância Sanitária-ANVISA) (RIDASCREEN® Leishmania Ab from R-Biopharm AG., Leishmania ELISA IgG + IgM from Vircell S.L., IFI Leishmaniose Humana-BioManguinhos, and IT-LEISH® from Bio-Rad Laboratories, Inc.), and the other a direct agglutination test (DAT-LPC) prototype kit developed at Fiocruz. The panel was composed of 40 serum samples from patients with confirmed ML and 20 from patients with mucosal involvement and negative parasitological/molecular tests for leishmaniasis and confirmation of another etiology. All cases were treated from 2009 to 2016 in a referral center for leishmaniasis in Belo Horizonte, Minas Gerais, Brazil (Instituto René Rachou, Fiocruz). Diagnostic accuracy, based on the cut-off point for VL diagnosis, was 86.2% with RIDASCREEN® Leishmania Ab, 73.3% with Leishmania ELISA IgG + IgM, and 66.7% with IFI Leishmaniose Humana, while IT-LEISH® and DAT-LPC had the lowest accuracy (38.3%), despite high specificity (100% and 95%, respectively). New cut-off points defined with sera from ML patients improved accuracy from 86.2 to 89% (p = 0.64) and 73.3 to 88% (p = 0.04) for RIDASCREEN® Leishmania Ab and Leishmania ELISA IgG + IgM, respectively. Moreover, these tests presented greater sensitivity and immunoreactivity in patients with moderate/severe clinical ML forms. The data of this study suggest that ELISA assays can contribute to laboratory diagnosis, especially for patients with moderate or severe mucosal involvement.
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Affiliation(s)
- Diana Oliveira
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Karine Ferreira Lopes
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Moreira de Avelar
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil.
| | - Edward Oliveira
- Clinical Research and Public Politics in Infectious and Parasitic Diseases, Instituto René Rachou, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil.
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Lopes KF, Lanna T, Oliveira E. Characterization of agglutinating antibodies detected by the direct agglutination test for visceral leishmaniasis diagnosis. Parasitol Res 2022; 121:3025-3030. [PMID: 35972546 DOI: 10.1007/s00436-022-07624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/05/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to characterize agglutinating antibodies detected by the direct agglutination test (DAT-LPC) for the diagnosis of visceral leishmaniasis (VL). The DAT-LPC antigen/antibodies complex was recovered, washed, and used as antigenic substrate in a modified enzyme-linked immunosorbent assay (modified ELISA), revealed with anti-human IgM, IgG, and IgG subtype conjugates, and in the immunofluorescent antibodies test (IFAT), revealed with anti-human IgG and IgG1 conjugates. IgM antibodies were detected in 50%, IgG and IgG1 in 100%, and IgG3 in 52.8% of the 36 samples from VL patients. IFAT showed that agglutinating IgG and IgG1 antibodies recognized more intensely antigens located in the membrane and kinetoplast of the parasite. No antibodies were detected in the 15 samples from healthy individuals. This study shows for the first time that the antibodies responsible for agglutination in DAT-LPC are mostly of the IgG1 subtype.
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Affiliation(s)
- Karine Ferreira Lopes
- Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Clinical Research and Public Politics in Infectious and Parasitic Diseases, Av. Augusto de Lima, Belo Horizonte, MG, 1715, 30190-001, Brazil.,Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Functional Genomic of Parasites, Av. Augusto de Lima, Belo Horizonte, MG, 1715, 30190-001, Brazil
| | - Thana Lanna
- Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Clinical Research and Public Politics in Infectious and Parasitic Diseases, Av. Augusto de Lima, Belo Horizonte, MG, 1715, 30190-001, Brazil.,Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Functional Genomic of Parasites, Av. Augusto de Lima, Belo Horizonte, MG, 1715, 30190-001, Brazil
| | - Edward Oliveira
- Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Clinical Research and Public Politics in Infectious and Parasitic Diseases, Av. Augusto de Lima, Belo Horizonte, MG, 1715, 30190-001, Brazil. .,Instituto René Rachou, Oswaldo Cruz Foundation (IRR/FIOCRUZ), Functional Genomic of Parasites, Av. Augusto de Lima, Belo Horizonte, MG, 1715, 30190-001, Brazil.
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Moulik S, Sengupta S, Chatterjee M. Molecular Tracking of the Leishmania Parasite. Front Cell Infect Microbiol 2021; 11:623437. [PMID: 33692966 PMCID: PMC7937807 DOI: 10.3389/fcimb.2021.623437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
With the Visceral Leishmaniasis/Kala-azar Elimination Program in South Asia in its consolidation phase, the focus is mainly on case detection, vector control, and identifying potential sources of infection. Accordingly, emphasis is presently on curbing transmission, which is potentially achievable by identification and elimination of potential reservoirs. The strongest contenders for being the disease reservoir are cases of Post Kala-azar Dermal Leishmaniasis (PKDL) which occurs in a minor proportion of individuals apparently cured of Visceral Leishmaniasis (VL). The demonstration of parasites in tissue aspirates despite being a risky and invasive process is the gold standard for diagnosis of VL, but is now being replaced by serological tests e.g., rK39 strip test and direct agglutination test. However, these antibody based tests are limited in their ability to diagnose relapses, detect cases of PKDL, and monitor effectiveness of treatment. Accordingly, detection of antigen or nucleic acids by polymerase chain reaction has been successfully applied for monitoring of parasite kinetics. This review article provides updated information on recent developments regarding the available antibody or antigen/nucleic acid based biomarkers for longitudinal monitoring of patients with VL or PKDL and emphasizes the need for availability of studies pertaining to quantification of treatment response or relapse.
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Affiliation(s)
- Srija Moulik
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Shilpa Sengupta
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Mitali Chatterjee
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
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4
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Freire ML, de Souza A, Cota G, Rabello A, Machado de Assis T. Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario. PLoS Negl Trop Dis 2020; 14:e0008741. [PMID: 33031382 PMCID: PMC7544087 DOI: 10.1371/journal.pntd.0008741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
Human visceral leishmaniasis (VL) is a severe and potentially fatal parasitic disease if not correctly diagnosed and treated. Brazil is one of the three countries most endemic for VL and, like most countries affected by this disease, has a large budget constraint for the incorporation of new health technologies. Although different diagnostic tests for VL are currently available in the country, economic studies evaluating diagnostic kits are scarce. The objective of this study was to conduct a cost-effectiveness analysis of the nine available diagnostic tests for human VL in HIV-infected and uninfected patients in Brazil. The perspective of analysis was the Brazilian public health system, and the outcome of interest was "cases diagnosed correctly". The costs of the tests were estimated using the microcosting technique, and comparisons were performed with decision trees. Sensitivity analyses were explored applying variations in cost and effectiveness values. For VL diagnosis among HIV-uninfected patients, using blood samples for the rapid tests (RDTs), the noncommercial direct agglutination test (DAT-LPC) and IT-LEISH were cost-effective tests compared with the baseline OnSite test, but they presented different incremental cost-effectiveness ratios (ICER) of US$7.04 and US$ 205.40, respectively. Among HIV-infected patients, DAT-LPC was the most cost-effective diagnostic test. Comparisons among the tests with the same methodology, based on the low ICER values, revealed that IT-LEISH was the most cost-effective test among the RDTs and the Ridascreen Leishmania Ab among the ELISA tests. These results confirm that cost-effectiveness analyses can provide useful information to support the incorporation of new health technologies within a known scenario and willingness to pay threshold. It was observed that tests based on the same methodologies presented different cost-effectiveness ratios for the same group of patients and that different tests should be recommended for different patient groups. DAT-LPC was an important cost-effective strategy for all patients, requiring minimum laboratorial infrastructure, and IT-LEISH was the cost-effective test for VL screening in HIV-uninfected patients. IT-LEISH and DAT-LPC have complementary profiles and should both be provided by the Brazilian health system.
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Affiliation(s)
- Mariana Lourenço Freire
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
| | - Aline de Souza
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
| | - Gláucia Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
| | - Ana Rabello
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
| | - Tália Machado de Assis
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
- Centro Federal de Educação Tecnológica de Minas Gerais, Campus Contagem, Alameda das Perdizes, Cabral, Contagem, Minas Gerais, Brasil
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5
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Machado AS, Ramos FF, Santos TTO, Costa LE, Ludolf F, Lage DP, Bandeira RS, Tavares GSV, Oliveira-da-Silva JA, Steiner BT, Chaves AT, Oliveira JS, Chávez-Fumagalli MA, de Magalhães-Soares DF, Silveira JAG, Duarte MC, Machado-de-Ávila RA, Lyon S, Gonçalves DU, Caligiorne RB, Coelho EAF. A new Leishmania hypothetical protein can be used for accurate serodiagnosis of canine and human visceral leishmaniasis and as a potential prognostic marker for human disease. Exp Parasitol 2020; 216:107941. [PMID: 32622940 DOI: 10.1016/j.exppara.2020.107941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 11/26/2022]
Abstract
Distinct antigens have been evaluated with diagnostic purpose for canine and human visceral leishmaniasis (VL), and variable sensitivity and specificity values have been obtained in the assays. In the present study, a Leishmania infantum hypothetical protein called LiHyG, which was identified in an immunoproteomics study in Leishmania infantum amastigote extracts by antibodies in VL dogs sera; was cloned, expressed, purified and evaluated as a recombinant protein (rLiHyG) for the diagnosis of canine and human disease. The recombinant amastigote-specific A2 protein (rA2) and a soluble L. infantum protein extract (SLA) were used as controls. For canine VL, the sensitivity values were of 100%, 57.29% and 48.57%, when rLiHyG, rA2 and SLA were used, respectively, while the specificity values were of 100%, 81.43% and 88.57%, respectively. In addition, AUC values were of 1.00, 0.72 and 0.65, when rLiHyG, rA2 and SLA were used, respectively, while accuracy was of 100%, 72.38% and 75.24%, respectively. For human VL, the sensitivity values were of 100%, 84.00% and 88.00%, when rLiHyG, rA2 and SLA were used, respectively, while the specificity values were of 100%, 58.75% and 73.75%, respectively. In addition, AUC values were of 1.00, 0.76 and 0.83, when rLiHyG, rA2 and SLA were used, respectively, while accuracy was of 100%, 64.8% and 66.6%, respectively. The prognostic role of rLiHyG in the human VL was also evaluated, by means of post-therapeutic serological follow-up with sera samples collected before and six months after treatment. Results showed that treated patients presented significant reductions in the anti-rLiHyG IgG, IgG1, and IgG2 antibody levels, with results being similar to those found in healthy subjects. Testing the rA2 protein and SLA as antigens, lower IgG, IgG1, and IgG2 levels were also found, although they were higher after treatment than those obtained for rLiHyG. In conclusion, results suggested that rLiHyG could be considered for future studies as a diagnostic and/or prognostic marker for canine and human VL.
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Affiliation(s)
- Amanda S Machado
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, 30150-240, Belo Horizonte, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Fernanda F Ramos
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Thaís T O Santos
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Lourena E Costa
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Fernanda Ludolf
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Daniela P Lage
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Raquel S Bandeira
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Grasiele S V Tavares
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - João A Oliveira-da-Silva
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Bethina T Steiner
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, 88806-000, Santa Catarina, Brazil
| | - Ana T Chaves
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Jamil S Oliveira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Miguel A Chávez-Fumagalli
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Danielle F de Magalhães-Soares
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Julia A G Silveira
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Mariana C Duarte
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Ricardo A Machado-de-Ávila
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, 88806-000, Santa Catarina, Brazil
| | - Sandra Lyon
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, 30622-020, Minas Gerais, Brazil
| | - Denise U Gonçalves
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Rachel B Caligiorne
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, 30150-240, Belo Horizonte, Minas Gerais, Brazil
| | - Eduardo A F Coelho
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil.
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do Vale INPC, Saliba JW, Fonseca GSF, Peruhype-Magalhães V, de Araújo FF, Pascoal-Xavier MA, Teixeira-Carvalho A, Campos FMF, Andrade MC, Lula JF, Reis AB, Lemos EM, de Carvalho SFG, Oliveira E, Martins-Filho OA. Laboratorial algorithm for serological diagnosis of visceral leishmaniasis using rK39-ICT, DAT-LPC and FC-Simplex IgG1. J Immunol Methods 2020; 480:112765. [PMID: 32119888 DOI: 10.1016/j.jim.2020.112765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/04/2019] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
The performance of distinct serological tests (rK39-ICT, IFAT, DAT-LPC, FC-Simplex IgG1) was assessed and a laboratorial algorithm was proposed for accurate diagnosis of VL. DAT-LPC and FC-Simplex IgG1 showed outstanding accuracy (AUC = 0.93) to identify VL patients. The use of a sequential serological algorithm (rK39-ICT screening followed by DAT-LPC or FC-Simplex IgG1) improved the global accuracy for VL (97.2%) diagnosis. An alternative approach for diagnosis of VL has been also assessed for interchangeable use of serum/whole blood lysate samples in DAT-LPC and FC-Simplex IgG1. Our data showed an outstanding agreement for the results obtained with whole blood lysate samples as compared to serum samples (DAT-LPC =100%; FC-Simplex IgG1 = 99%). Together, these findings provide insights to improve the current overall accuracy of VL diagnosis and present innovative laboratorial tests and alternative samples from use in public health services.
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Affiliation(s)
| | - Juliana Wilke Saliba
- Instituto René Rachou - Fundação Oswaldo Cruz - FIOCRUZ-Minas, Belo Horizonte, MG, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Edward Oliveira
- Instituto René Rachou - Fundação Oswaldo Cruz - FIOCRUZ-Minas, Belo Horizonte, MG, Brazil
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Lévêque MF, Lachaud L, Simon L, Battery E, Marty P, Pomares C. Place of Serology in the Diagnosis of Zoonotic Leishmaniases With a Focus on Visceral Leishmaniasis Due to Leishmania infantum. Front Cell Infect Microbiol 2020; 10:67. [PMID: 32158704 PMCID: PMC7052174 DOI: 10.3389/fcimb.2020.00067] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Abstract
Leishmaniases are a group of parasitic diseases transmitted through the bite of female phlebotomine sandflies. Depending on the Leishmania species, the reservoirs can be humans (anthroponosis) or different animals (zoonosis). Zoonotic leishmaniasis present several clinical forms in function of the species involved: visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and muco-cutaneous leishmaniasis (MCL). The biological diagnosis is of utmost importance because the clinical features are not specific. In addition to parasitological and molecular biology (polymerase chain reaction, PCR) assays, serology is routinely used for the diagnosis of leishmaniasis. Indeed, although PCR is more sensitive than serological assays, its implementation is limited to referral laboratories and research centers. Therefore, serology is still a key element for their diagnosis. Here, we discuss the different serological assays available for the diagnosis of zoonotic leishmaniasis. We will review the enzyme-linked immunosorbent assay, immunofluorescence antibody test, immunochromatography test (ICT), direct agglutination test, and western blot as well as the different diagnostic strategies in function of the clinical form (VL, CL, and MCL). We will also discuss the place of serology for detecting asymptomatic carriers and for the follow-up of VL. Depending on the laboratory, different assays can be used, from ICT, which is appropriate for field testing, to a combination of serological tests to improve the sensitivity.
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Affiliation(s)
- Maude F Lévêque
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire et Université de Montpellier, UMR MIVEGEC, Centre National de Référence des Leishmanioses, Montpellier, France
| | - Laurence Lachaud
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire et Université de Montpellier, UMR MIVEGEC, Centre National de Référence des Leishmanioses, Montpellier, France
| | - Loïc Simon
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire l'Archet, INSERM, U1065, C3M, Virulence microbienne et signalisation inflammatoire - Université de la Côte d'Azur, Faculté de Médecine, Laboratoire associé au Centre National de Référence des Leishmanioses, Nice, France
| | - Emilie Battery
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire et Université de Montpellier, UMR MIVEGEC, Centre National de Référence des Leishmanioses, Montpellier, France
| | - Pierre Marty
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire l'Archet, INSERM, U1065, C3M, Virulence microbienne et signalisation inflammatoire - Université de la Côte d'Azur, Faculté de Médecine, Laboratoire associé au Centre National de Référence des Leishmanioses, Nice, France
| | - Christelle Pomares
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire l'Archet, INSERM, U1065, C3M, Virulence microbienne et signalisation inflammatoire - Université de la Côte d'Azur, Faculté de Médecine, Laboratoire associé au Centre National de Référence des Leishmanioses, Nice, France
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8
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Assis TSMD, Azeredo-da-Silva ALFD, Oliveira D, Cota G, Werneck GL, Rabello A. Budgetary impact of diagnostic tests for visceral leishmaniasis in Brazil. CAD SAUDE PUBLICA 2017; 33:e00142416. [PMID: 29267689 DOI: 10.1590/0102-311x00142416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 04/03/2017] [Indexed: 11/21/2022] Open
Abstract
The aim of the present study was to estimate the financial costs of the incorporation and/or replacement of diagnostic tests for human visceral leishmaniasis (VL) in Brazil. The analysis was conducted from the perspective of the Brazilian Unified National Health System (SUS) over a period of three years. Six diagnostic tests were evaluated: the indirect immunofluorescence antibody test (IFAT), the IT LEISH rapid test, the parasitological examination of bone marrow aspirate, the direct agglutination test (DAT-LPC) standardized in the Clinical Research Laboratory, René Rachou Institute of the Oswaldo Cruz Foundation, the Kalazar Detect rapid test, and polymerase chain reaction (PCR). The assumptions used were the number of suspected cases of VL reported to the Brazilian Ministry of Health in 2014 and the direct cost of diagnostic tests. The costs to diagnose suspected cases of VL over three years using the IFAT and the DAT-LPC were estimated at USD 280,979.91 and USD 121,371.48, respectively. The analysis indicated that compared with the use of the IFAT, the incorporation of the DAT-LPC into the SUS would result in savings of USD 159,608.43. With regard to the budgetary impact of rapid tests, the use of IT LEISH resulted in savings of USD 21.708,72 over three years. Compared with a parasitological examination, diagnosis using PCR resulted in savings of USD 3,125,068.92 over three years. In this study, the replacement of the IFAT with the DAT-LPC proved financially advantageous. In addition, the replacement of the Kalazar Detect rapid test with the IT LEISH in 2015 was economically valuable, and the replacement of parasitological examination with PCR was indicated.
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Affiliation(s)
- Tália Santana Machado de Assis
- Centro Federal de Educação Tecnológica de Minas Gerais, Contagem, Brasil.,Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
| | | | - Diana Oliveira
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
| | - Gláucia Cota
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
| | | | - Ana Rabello
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
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Assis TMD, Guimarães PN, Oliveira E, Peruhype-Magalhães V, Gomes LI, Rabello A. Acceptance and potential barriers to effective use of diagnostic tests for visceral leishmaniasis in an urban area in Brazil. Rev Soc Bras Med Trop 2016; 49:241-4. [PMID: 27192596 DOI: 10.1590/0037-8682-0247-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/03/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Acceptance of the IT LEISH(r) and direct agglutination test- made in the Laboratório de Pesquisas Clínicas (DAT-LPC) by healthcare professionals and patients suspected of visceral leishmaniasis (VL) in Ribeirão das Neves was evaluated. METHODS Ninety-two patients and 47 professionals completed three questionnaires. RESULTS Eighty-eight (96%) patients considered fingertip blood collection a positive test feature, and 86% (37) and 91% of professionals considered the IT LEISH(r) easy to perform and interpret, respectively. All professionals classified the DAT-LPC as simple and easy. CONCLUSIONS Patients and healthcare professionals in Ribeirão das Neves demonstrated a high degree of acceptance of the IT LEISH(r) and DAT-LPC.
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Affiliation(s)
- Tália Machado de Assis
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Paloma Nogueira Guimarães
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Edward Oliveira
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Vanessa Peruhype-Magalhães
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Luciana Inácia Gomes
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
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Machado de Assis TS, Azeredo-da-Silva ALF, Werneck GL, Rabello A. Cost-effectiveness analysis of diagnostic tests for human visceral leishmaniasis in Brazil. Trans R Soc Trop Med Hyg 2016; 110:464-71. [PMID: 27618920 DOI: 10.1093/trstmh/trw050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/01/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of study was to estimate the incremental cost-effectiveness ratio (ICER) of diagnostic options for visceral leishmaniasis (VL) in Brazil. METHODS Six diagnostic tests were considered: IT LEISH, Kalazar Detect, DAT-LPC (DAT made in the Laboratório de Pesquisas Clínicas), IFAT, PCR and direct examination of bone marrow aspirate performed in either an ambulatory or a hospital setting. A database was built using the cost and effectiveness. The perspective of this study was the Brazilian public healthcare system and the results were expressed in costs per correctly diagnosed cases. RESULTS In a favorable hypothetical scenario, DAT-LPC presented the lowest cost (US$4.92) and highest effectiveness (99%). Paired analyses showed that IT LEISH was dominant compared to IFAT, microscopy and Kalazar Detect and that Kalazar Detect was dominant over IFAT and microscopy. PCR was dominant over the bone marrow aspirate in the hospital and showed an ICER of 57.76 compared with aspirate in an ambulatory setting. CONCLUSIONS These results highlight the need for the revision of algorithm for VL diagnostic in Brazil. Replacements of IFAT with DAT-LPC, Kalazar Detect with IT LEISH and bone marrow aspirate performed in a hospital setting with PCR are cost-effective public health measures.
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Affiliation(s)
- Tália S Machado de Assis
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou/Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil Centro Federal de Educação Tecnológica de Minas Gerais, Contagem, Minas Gerais, Brazil
| | - André Luis Ferreira Azeredo-da-Silva
- Instituto para Avaliação de Tecnologias em Saúde, Porto Alegre, Rio Grande do Sul, Brazil Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Loureiro Werneck
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Rabello
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou/Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
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Assis TSMD, Guimarães PN, Oliveira E, Peruhype-Magalhães V, Gomes LI, Rabello A. Study of implementation and direct cost estimates for diagnostic tests for human visceral leishmaniasis in an urban area in Brazil. CAD SAUDE PUBLICA 2016; 31:2127-36. [PMID: 26735380 DOI: 10.1590/0102-311x00158614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/04/2015] [Indexed: 11/22/2022] Open
Abstract
This work reports the process and costs of comprehensively implementing two tests to decentralize the diagnosis of visceral leishmaniasis (VL) in an endemic city in Brazil: a rapid test (IT LEISH) and a direct agglutination test (DAT-LPC). The implementation began by training health professionals to perform the tests. Estimation of the training costs considered the proportional remuneration of all professionals involved and the direct costs of the tests used for training. The study was conducted between November 2011 and November 2013. During that time, 17 training sessions were held, and 175 professionals were trained. The training cost for each professional was US$ 7.13 for the IT LEISH and US$ 9.93 for the DAT-LPC. The direct costs of the IT LEISH and DAT-LPC were estimated to be US$ 6.62 and US$ 5.44, respectively. This first evaluation of the implementation of these diagnostic tests indicates the feasibility of decentralizing both methods to extend access to VL diagnosis in Brazil.
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Affiliation(s)
| | | | - Edward Oliveira
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
| | | | | | - Ana Rabello
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
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Oliveira E, Saliba JW, Oliveira D, Dias ES, Paz GF. A prototype of the direct agglutination test kit (DAT-Canis) for the serological diagnosis of canine visceral leishmaniasis. Vet Parasitol 2016; 221:9-13. [DOI: 10.1016/j.vetpar.2016.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
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13
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Bhattacharyya T, Bowes DE, El-Safi S, Sundar S, Falconar AK, Singh OP, Kumar R, Ahmed O, Boelaert M, Miles MA. Significantly lower anti-Leishmania IgG responses in Sudanese versus Indian visceral leishmaniasis. PLoS Negl Trop Dis 2014; 8:e2675. [PMID: 24587456 PMCID: PMC3930516 DOI: 10.1371/journal.pntd.0002675] [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: 08/28/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL), a widely distributed systemic disease caused by infection with the Leishmania donovani complex (L. donovani and L. infantum), is almost always fatal if symptomatic and untreated. A rapid point-of-care diagnostic test for anti-Leishmania antibodies, the rK39-immunochromatographic test (rK39-ICT), has high sensitivity and specificity in South Asia but is less sensitive in East Africa. One of the underlying reasons may be continent-specific molecular diversity in the rK39 antigen within the L. donovani complex. However, a second reason may be differences in specific IgG anti-Leishmania levels in patients from different geographical regions, either due to variable antigenicity or immunological response. METHODOLOGY/PRINCIPAL FINDINGS We determined IgG titres of Indian and Sudanese VL patients against whole cell lysates of Indian and Sudanese L. donovani strains. Indian VL patients had significantly higher IgG titres against both L. donovani strains compared to Sudanese VL patients (p<0.0001). Mean reciprocal log10 50% end-point titres (1/log10t50) were i) 3.80 and 3.88 for Indian plasma and ii) 2.13 and 2.09 for Sudanese plasma against Indian and Sudanese antigen respectively (p<0.0001). Overall, the Indian VL patients therefore showed a 46.8-61.7 -fold higher mean ELISA titre than the Sudanese VL patients. The higher IgG titres occurred in children (<16 years old) and adults of either sex from India (mean 1/log10t50: 3.60-4.15) versus Sudan (mean 1/log10t50: 1.88-2.54). The greatest difference in IgG responses was between male Indian and Sudanese VL patients of ≥ 16 years old (mean 1/log10t50: 4.15 versus 1.99 = 144-fold (p<0.0001). CONCLUSIONS/SIGNIFICANCE Anti-Leishmania IgG responses among VL patients in Sudan were significantly lower than in India; this may be due to chronic malnutrition with Zn(2+) deficiency, or variable antigenicity and capacity to generate IgG responses to Leishmania antigens. Such differential anti-Leishmania IgG levels may contribute to lower sensitivity of the rK39-ICT in East Africa.
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Affiliation(s)
- Tapan Bhattacharyya
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Duncan E. Bowes
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sayda El-Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | - Om Prakash Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rajiv Kumar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- Immunology and Infection Laboratory, Queensland Institute of Medical Research, Herston, Queensland, Australia
| | - Osman Ahmed
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Department of Laboratory Medicine, Karolinska Insitutet, Stockholm, Sweden
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Michael A. Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Louzir H, Aoun K, Späth GF, Laouini D, Prina E, Victoir K, Bouratbine A. [Leishmania epidemiology, diagnosis, chemotherapy and vaccination approaches in the international network of Pasteur Institutes]. Med Sci (Paris) 2013; 29:1151-60. [PMID: 24356147 DOI: 10.1051/medsci/20132912020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Protozoan parasites of the genus Leishmania generate severe human diseases termed leishmaniases. Due to their frequency and the severity of certain clinical forms, these diseases represent a major public health problem and limit the economic growth in various developing countries. The presence of Pasteur Institutes in countries with endemic leishmaniasis has provided important incentives to develop a strong public health agenda in the Pasteur scientific community with respect to this important disease. A concerted effort is now coordinated through the recently created LeishRIIP platform (www.leishriip.org), which aims to identify synergies and complementary expertise between the eleven members of the international network of Pasteur Institutes working on various aspects of the disease including epidemiology, diagnosis, chemotherapy and vaccination.
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Affiliation(s)
- Hechmi Louzir
- Laboratoire transmission, contrôle et immunobiologie des infections, LR 11-IPT-02, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisie
| | - Karim Aoun
- Laboratoire de parasitologie-mycologie, LR 11-IPT-06 parasitoses médicales, biotechnologie et biomolécules, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisie
| | - Gerald F Späth
- Unité de parasitologie moléculaire et signalisation, CNRS, URA 2581, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France
| | - Dhafer Laouini
- Laboratoire transmission, contrôle et immunobiologie des infections, LR 11-IPT-02, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisie
| | - Eric Prina
- Unité de parasitologie moléculaire et signalisation, CNRS, URA 2581, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France
| | - Kathleen Victoir
- Direction internationale, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France
| | - Aïda Bouratbine
- Laboratoire de parasitologie-mycologie, LR 11-IPT-06 parasitoses médicales, biotechnologie et biomolécules, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisie
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Cota GF, de Sousa MR, de Freitas Nogueira BM, Gomes LI, Oliveira E, Assis TSM, de Mendonça ALP, Pinto BF, Saliba JW, Rabello A. Comparison of parasitological, serological, and molecular tests for visceral leishmaniasis in HIV-infected patients: a cross-sectional delayed-type study. Am J Trop Med Hyg 2013; 89:570-7. [PMID: 23836568 DOI: 10.4269/ajtmh.13-0239] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to evaluate the accuracy of invasive and non-invasive tests for diagnosis of visceral leishmaniasis (VL) in a large series of human immunodeficiency virus (HIV)-infected patients. In this delayed-type cross-sectional study, 113 HIV-infected symptomatic patients were evaluated by an adjudication committee after clinical follow-up to establish the presence or absence of VL as the target condition (reference test). The index tests were recombinant K39 antigen-based immunochromatographic test (rK39), indirect fluorescent antibody test (IFAT), prototype kit of direct agglutination test (DAT-LPC), and real-time polymerase chain reaction (qPCR) in peripheral blood. Compared with parasitological test and adjudication committee diagnosis or latent class model analyses, IFAT and rk39 dipstick test presented the lowest sensitivity. DAT-LPC exhibited good overall performance, and there was no statistical difference between DAT-LPC and qPCR diagnosis accuracy. Real-time PCR emerges as a less invasive alternative to parasitological examination for confirmation of cases not identified by DAT.
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Affiliation(s)
- Gláucia Fernandes Cota
- Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil.
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