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Jamal F, Altaf I, Ahmed G, Asad S, Ahmad H, Zia Q, Azhar A, Farheen S, Shafi T, Karim S, Zubair S, Owais M. Amphotericin B Nano-Assemblies Circumvent Intrinsic Toxicity and Ensure Superior Protection in Experimental Visceral Leishmaniasis with Feeble Toxic Manifestation. Vaccines (Basel) 2023; 11:vaccines11010100. [PMID: 36679946 PMCID: PMC9866558 DOI: 10.3390/vaccines11010100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
In spite of its high effectiveness in the treatment of both leishmaniasis as well as a range of fungal infections, the free form of the polyene antibiotic amphotericin B (AmB) does not entertain the status of the most preferred drug of choice in clinical settings. The high intrinsic toxicity of the principal drug could be considered the main impedance in the frequent medicinal use of this otherwise very effective antimicrobial agent. Taking into consideration this fact, the pharma industry has introduced many novel dosage forms of AmB to alleviate its toxicity issues. However, the limited production, high cost, requirement for a strict cold chain, and need for parenteral administration are some of the limitations that explicitly compel professionals to look for the development of an alternate dosage form of this important drug. Considering the fact that the nano-size dimensions of drug formulation play an important role in increasing the efficacy of the core drug, we employed a green method for the development of nano-assemblies of AmB (AmB-NA). The as-synthesized AmB-NA manifests desirable pharmacokinetics in the treated animals. The possible mechanistic insight suggested that as-synthesized AmB-NA induces necrosis-mediated cell death and severe mitochondrial dysfunction in L. donovani promastigotes by triggering depolarization of mitochondrial membrane potential. In vivo studies demonstrate a noticeable decline in parasite burden in the spleen, liver, and bone marrow of the experimental BALB/c mice host. In addition to successfully suppressing the Leishmania donovani, the as-formed AmB-NA formulation also modulates the host immune system with predominant Th1 polarization, a key immune defender that facilitates the killing of the intracellular parasite.
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Affiliation(s)
- Fauzia Jamal
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Ishrat Altaf
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Ghufran Ahmed
- Department of Microbiology, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Sheikh Asad
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Hira Ahmad
- Department of Zoology, Aligarh Muslim University, Aligarh 202002, India
| | - Qamar Zia
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Asim Azhar
- Neat Meatt Biotech Private Limited, Bio-NEST-UDSC, University of Delhi (South Campus), New Delhi 110021, India
| | - Saba Farheen
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Taj Shafi
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Shabana Karim
- Department of Botany, Anugrah Narayan College, Patliputra University, Patna 800013, India
| | - Swaleha Zubair
- Department of Computer Science, Aligarh Muslim University, Aligarh 202002, India
| | - Mohammad Owais
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
- Correspondence:
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Araújo CF, Oliveira IBN, Silva MVT, Pereira LIDA, Pinto SA, Silveira MB, Dorta ML, Fonseca SG, Gomes RS, Ribeiro-Dias F. New world Leishmania spp. infection in people living with HIV: Concerns about relapses and secondary prophylaxis. Acta Trop 2021; 224:106146. [PMID: 34562423 DOI: 10.1016/j.actatropica.2021.106146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Coinfection with the human immunodeficiency virus (HIV) and Leishmania impairs immune responses, increases treatment failure and relapse rates in patients with American tegumentary leishmaniasis (ATL), as well as visceral leishmaniasis (VL). There is insufficient data on the treatment, relapse, and secondary prophylaxis in patients coinfected with HIV/Leishmania in Brazil. This study investigated patients with HIV/ATL and HIV/VL to describe the outcome of leishmaniasis in patients assisted at a referral hospital of Brazilian midwestern region. Patients with HIV/ATL (n = 21) mainly presented cutaneous diseases (76.2%) with an overall relapse rate of 28.57% after treatment, whereas HIV/VL (n = 28) patients accounted for 17.5% of the cases. The counts of CD4+ T cells and CD8+ T cells and the CD4+/CD8+ cell ratios at diagnosis or relapses were not significantly different between relapsing and non-relapsing patients. Patients with HIV/ATL or HIV/VL showed high levels of activation markers in CD4+ and CD8+ T cells. The regular use of highly active antiretroviral therapy (HAART) and viral load at the time of diagnosis did not influence the relapse rates. Relapses occurred in 36.4% (4/11) of the patients with HIV/VL receiving secondary prophylaxis and in 5.9% (1/17) of the patients who did not receive secondary prophylaxis (p = 0.06). These data are relevant for the therapeutic management of the patients coinfected with HIV/Leishmania.
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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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Aquino SR, Diniz LFB, Queiroz IT, Cunha MA, Justo AM, Silva ED, Pereira VRA, Medeiros ZM, Carmo RF. Case Report: Severe Visceral Leishmaniasis in a Patient with HIV Coinfection Undergoing Treatment for Erythema Nodosum Leprosum. Am J Trop Med Hyg 2020; 103:2253-2256. [PMID: 32901606 DOI: 10.4269/ajtmh.20-0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report a case of visceral leishmaniasis (VL)/HIV coinfection in a patient undergoing regular antiretroviral therapy and treatment with thalidomide for erythema nodosum leprosum. He presented at a health service with high fever, chills, asthenia, pale skin, lower limb edema, hepatomegaly, and splenomegaly. Visceral leishmaniasis was confirmed by direct examination, and serological and molecular tests. Serum levels of Th1/Th2 cytokines were measured. The patient began treatment with liposomal amphotericin B, with good clinical response; however, VL recurred 6 months later. Treatment was reinitiated, maintaining secondary prophylaxis with liposomal amphotericin B. The patient showed clinical improvement with important recovery of CD4+ T-lymphocyte count.
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Affiliation(s)
- Samuel R Aquino
- Hospital Universitário da Universidade Federal do Vale do São Francisco, Petrolina, Brazil.,Programa de Pós-Graduação em Ciências da Saúde e Biológicas, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Lucyo F B Diniz
- Hospital Universitário da Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | | | | | - Alda M Justo
- Colegiado de Enfermagem, Universidade de Pernambuco Campus Petrolina, Petrolina, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
| | | | | | - Zulma M Medeiros
- Instituto Aggeu Magalhães, Recife, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
| | - Rodrigo F Carmo
- Programa de Pós-Graduação em Biociências, Universidade Federal do Vale do São Francisco, Petrolina, Brazil.,Programa de Pós-Graduação em Ciências da Saúde e Biológicas, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
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Mohammed R, Fikre H, Schuster A, Mekonnen T, van Griensven J, Diro E. Multiple Relapses of Visceral Leishmaniasis in HIV Co-Infected Patients: A Case Series from Ethiopia. Curr Ther Res Clin Exp 2020; 92:100583. [PMID: 32382359 PMCID: PMC7198908 DOI: 10.1016/j.curtheres.2020.100583] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/10/2020] [Indexed: 12/21/2022] Open
Abstract
There is a high rate of visceral leishmaniasis (VL) relapse/recurrence among patients with concomitant HIV co-infection. Fever, the most common symptom of VL is less frequent with relapse of VL. In contrast, there is high tissue parasite load. Most of these patients need longer duration of treatment and combination regimens to achieve cure. There is an urgent need to look for alternative better treatment options.
Background Human visceral leishmaniasis (VL) is a life-threatening protozoan disease caused by parasites belonging to the Leishmania donovani complex. Ethiopia has the highest VL-HIV co-infection rate in the world, with several of these patients presenting with repeated episodes of VL disease (ie, relapse). However, we lack data on how HIV patients with multiple VL relapse present clinically, and whether they continue to respond to currently available medicines. Methods The medical records of VL-HIV co-infected patients with multiple VL relapses at the Leishmaniasis Treatment and Research Center in Gondar, Ethiopia, between June 2012 and June 2016 were retrieved. Variables on their clinical and laboratory profiles were collected. Descriptive analysis was done to show the characteristics of the VL episodes. Result A total of 48 VL episodes in 12 patients were identified, the median number of episodes per patient was 5 (interquartile range, 4–8 episodes). The median time to relapse was 5 months (interquartile range, 3–5.5 months). Splenomegaly was present in 47 of the episodes (98%), fever or other accompanying symptoms were present in only 66% (32 out of 48). The median tissue parasite grade at VL diagnosis was 6+ (interquartile range, 5+– 6+). All patients were on antiretroviral therapy. The median duration of treatment per episode was 2 months (interquartile range, 2–2 months). All patients achieved parasitological cure at discharge at each episode. Conclusions Multiple recurrences of VL diseases were observed in HIV co-infected patients. With recurrent episodes, splenomegaly was found to be the main manifestation, whereas fever was less common. These patients came with recurrence of diseases in <6 months and required prolonged treatment to achieve cure. Further research on prediction, prevention, and better management options for recurrent VL is needed. ORCID ID: https://orcid.org/0000-0002-1410-0454. (Curr Ther Res Clin Exp. 2020; 81:XXX–XXX)
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Affiliation(s)
- Rezika Mohammed
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia.,Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Angela Schuster
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tigist Mekonnen
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
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Visceral leishmaniasis in Northeast Brazil: What is the impact of HIV on this protozoan infection? PLoS One 2019; 14:e0225875. [PMID: 31805100 PMCID: PMC6894860 DOI: 10.1371/journal.pone.0225875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this study was to compare cases of Visceral Leishmaniasis (VL) with and without HIV in a state in northeastern Brazil. Methodology We performed a comparative study in the state’s referral hospital for infectious/parasitic diseases located in Northeast Brazil between January 2007 and July 2017. The data obtained using this protocol were analyzed with SPSS. Principal findings In total, 252 patients were evaluated, including 126 with coincident VL/HIV and 126 with VL alone. Both groups primarily consisted of male patients. The most commonly affected ages were 30–39 years in the coinfected group and 19–29 years in the VL group (p < 0.001). Fever and anorexia (p = 0.001), which were more common in those with VL alone, were frequently observed, while diarrhea, vomiting, bleeding and dyspnea were more common in patients with VL/HIV coinfection (p<0.005). According to the hemogram results, leukocyte levels were lower in the VL group (p < 0.0001). Additionally, AST (aspartate aminotransferase) and ALT (alanine aminotransferase) levels differed between the groups, with higher levels in patients with VL (p < 0.001). On average, HIV was diagnosed 2.6 years before VL (p < 0.001), and VL relapse was observed only in the coinfection group (36.5% of cases). Fever (β = +0.17; p = 0.032) in the first VL/HIV episode was identified as a risk factor for relapse (R2 = 0.18). More deaths occurred in the VL/HIV group (11.1%) than in the VL group (2.4%). Conclusion/Significance VL/HIV was found to be prevalent among young adults, although the median patient age was higher in the VL/HIV group. The classic symptomatology of VL was more common in patients not coinfected with HIV; therefore, attention is needed in patients with HIV who present with any symptoms that suggest the presence of VL, especially in endemic areas. No cases of VL relapse occurred in patients without HIV, and death was more common in the VL/HIV co-infected group.
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7
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Ferreira GR, Castelo Branco Ribeiro JC, Meneses Filho A, de Jesus Cardoso Farias Pereira T, Parente DM, Pereira HF, Carlos da Silva J, Zacarias DA, Vieira da Silva L, Medeiros Faustino SK, Almeida Neto WS, Costa DL, Lopes de Mendonça I, Nery Costa CH. Human Competence to Transmit Leishmania infantum to Lutzomyia longipalpis and the Influence of Human Immunodeficiency Virus Infection. Am J Trop Med Hyg 2018; 98:126-133. [PMID: 29141704 DOI: 10.4269/ajtmh.16-0883] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Visceral leishmaniasis (VL) caused by Leishmania infantum is a lethal disease transmitted by sand flies. Although, considered a zoonosis with dogs held as the main reservoirs, humans are also sources of infection. Therefore, control policies currently focused on dog culling may need to consider that VL and human immunodeficiency virus (HIV)/VL patients may also be infectious, contributing to transmission. Reservoir competence of patients with VL without and with HIV infection and of persons asymptomatically infected with Leishmania was assessed by xenodiagnosis with the vector Lutzomyia longipalpis. Parasites in sand fly's guts were identified by using optical microscopy and by conventional polymerase chain reaction (PCR). Leishmania infantum blood parasite burden was determined by quantitative PCR. Among the 61 participants, 27 (44%) infected sand flies as seen by microscopy or PCR. When infectiousness was assessed by microscopy, xenodiagnosis was positive in five (25%) patients not infected with HIV, whereas nine (45%) of those harboring HIV were positive. Among the 19 asymptomatic patients four (21%) infected sand flies only demonstrated by PCR. One (50%) asymptomatic patient with HIV had a positive xenodiagnosis by microscopy. 9/372 (2.4%) and 37/398 (9.2%) sand flies were infected when feeding in patients without and with HIV, respectively. Infectiousness was poorly correlated with quantitative PCR. The study shows that asymptomatic humans are capable of transmitting L. infantum, that ill persons with HIV infection are more infectious to sand flies, and that humans are more important reservoirs than previously thought. This fact may be considered when designing control policies for zoonotic VL.
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Affiliation(s)
- Gabriel Reis Ferreira
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil.,Graduation Program in Sciences and Health, Federal University of Piauí, Teresina, Brazil
| | - José Carlos Castelo Branco Ribeiro
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil.,Graduation Program in Sciences and Health, Federal University of Piauí, Teresina, Brazil
| | - Antônio Meneses Filho
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil
| | | | - Daniela Moura Parente
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil
| | - Humberto Feitosa Pereira
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil
| | - Jailthon Carlos da Silva
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil.,Graduation Program in Sciences and Health, Federal University of Piauí, Teresina, Brazil
| | - Danielle Alves Zacarias
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil
| | | | | | | | - Dorcas Lamounier Costa
- Graduation Program in Sciences and Health, Federal University of Piauí, Teresina, Brazil.,Maternal and Child Department, Federal University of Piauí, Teresina, Brazil.,Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil
| | | | - Carlos Henrique Nery Costa
- Graduation Program in Sciences and Health, Federal University of Piauí, Teresina, Brazil.,Department of Community Medicine, Federal University of Piauí, Teresina, Brazil.,Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil
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Epidemiological, clinical and laboratory aspects of human visceral leishmaniasis (HVL) associated with human immunodeficiency virus (HIV) coinfection: a systematic review. Parasitology 2018; 145:1801-1818. [PMID: 29806575 DOI: 10.1017/s003118201800080x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Coinfection with human visceral leishmaniasis (HVL) and human immunodeficiency virus (HIV) has become an emerging public health problem in several parts of the world, with high morbidity and mortality rates. A systematic review was carried out in the literature available in PubMed, Scielo and Lilacs related to HVL associated with HIV coinfection, seeking to analyze epidemiological, clinical and laboratory aspects. Of the 265 articles found, 15 articles were included in the qualitative analysis, which referred to the results of HVL treatment in patients coinfected with HIV. In the published articles between 2007 and 2015, 1171 cases of HVL/HIV coinfection were identified, 86% males, average age 34 years, liposomal amphotericin B was the most commonly used drug, cure rates 68 and 20% relapses and 19% deaths, five different countries, bone marrow was used in 10/15 manuscripts. HVL/HIV coinfection is a major challenge for public health, mainly due to the difficulty in establishing an accurate diagnosis, low response to treatment with high relapse rates and evolution to death. In addition, these two pathogens act concomitantly for the depletion of the immune system, contributing to worsening the clinical picture of these diseases, which requires effective surveillance and epidemiological control measures.
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van Griensven J, Mengesha B, Mekonnen T, Fikre H, Takele Y, Adem E, Mohammed R, Ritmeijer K, Vogt F, Adriaensen W, Diro E. Leishmania Antigenuria to Predict Initial Treatment Failure and Relapse in Visceral Leishmaniasis/HIV Coinfected Patients: An Exploratory Study Nested Within a Clinical Trial in Ethiopia. Front Cell Infect Microbiol 2018; 8:94. [PMID: 29651411 PMCID: PMC5884955 DOI: 10.3389/fcimb.2018.00094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Biomarkers predicting the risk of VL treatment failure and relapse in VL/HIV coinfected patients are needed. Nested within a two-site clinical trial in Ethiopia (2011–2015), we conducted an exploratory study to assess whether (1) levels of Leishmania antigenuria measured at VL diagnosis were associated with initial treatment failure and (2) levels of Leishmania antigenuria at the end of treatment (parasitologically-confirmed cure) were associated with subsequent relapse. Methods:Leishmania antigenuria at VL diagnosis and cure was determined using KAtex urine antigen test and graded as negative (0), weak/moderate (grade 1+/2+) or strongly-positive (3+). Logistic regression and Kaplan-Meier methods were used to assess the association between antigenuria and (1) initial treatment failure, and (2) relapse over the 12 months after cure, respectively. Results: The analysis to predict initial treatment failure included sixty-three coinfected adults [median age: 30 years interquartile range (IQR) 27–35], median CD4 count: 56 cells/μL (IQR 38–113). KAtex results at VL diagnosis were negative in 11 (17%), weak/moderate in 17 (27%) and strongly-positive in 35 (36%). Twenty (32%) patients had parasitologically-confirmed treatment failure, with a risk of failure of 9% (1/11) with KAtex-negative results, 0% (0/17) for KAtex 1+/2+ and 54% (19/35) for KAtex 3+ results. Compared to KAtex-negative patients, KAtex 3+ patients were at increased risk of treatment failure [odds ratio 11.9 (95% CI 1.4–103.0); P: 0.025]. Forty-four patients were included in the analysis to predict relapse [median age: 31 years (IQR 28–35), median CD4 count: 116 cells/μL (IQR 95–181)]. When achieving VL cure, KAtex results were negative in 19 (43%), weak/moderate (1+/2+) in 10 (23%), and strongly positive (3+) in 15 patients (34%). Over the subsequent 12 months, eight out of 44 patients (18%) relapsed. The predicted 1-year relapse risk was 6% for KAtex-negative results, 14% for KAtex 1+/2+ and 42% for KAtex 3+ results [hazard ratio of 2.2 (95% CI 0.1–34.9) for KAtex 1+/2+ and 9.8 (95% CI 1.8–82.1) for KAtex 3+, compared to KAtex negative patients; P: 0.03]. Conclusion: A simple field-deployable Leishmania urine antigen test can be used for risk stratification of initial treatment failure and VL relapse in HIV-patients. A dipstick-format would facilitate field implementation.
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Affiliation(s)
- Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bewketu Mengesha
- Department of Clinical Sciences, University of Gondar, Gondar, Ethiopia
| | - Tigist Mekonnen
- Department of Clinical Sciences, University of Gondar, Gondar, Ethiopia
| | - Helina Fikre
- Department of Clinical Sciences, University of Gondar, Gondar, Ethiopia
| | - Yegnasew Takele
- Department of Clinical Sciences, University of Gondar, Gondar, Ethiopia
| | - Emebet Adem
- Department of Clinical Sciences, University of Gondar, Gondar, Ethiopia
| | - Rezika Mohammed
- Department of Clinical Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Wim Adriaensen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ermias Diro
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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10
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Performance of two immunochromatographic tests for diagnosis of visceral leishmaniasis in patients coinfected with HIV. Parasitol Res 2017; 117:419-427. [PMID: 29270768 DOI: 10.1007/s00436-017-5716-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/11/2017] [Indexed: 01/11/2023]
Abstract
Because of visceral leishmaniasis (VL) urbanization and spreading of the human immunodeficiency virus (HIV) infection to rural areas, coinfection has become more common. Here, we compared the accuracy of Kalazar Detect® (KD), an rK39-based immunochromatographic (IC) test, and OrangeLife® (OL), an rK39 + rK28 IC test, for diagnosing VL in patients coinfected with HIV in an endemic area in Brazil. Seventy-six VL patients and 40 patients with other diseases, of which 31 and 21 patients, respectively, were infected with HIV, were examined. The sensitivity of OL and KD tests was 88.89 and 95.45%, respectively, in patients without HIV. The sensitivity dropped to 67.74 and 61.29%, respectively, in coinfected patients. The decrease in sensitivity was not related to a decrease in the production of Leishmania-specific IgG. Because of the low sensitivity of rk39 test in HIV-infected patients, we suggest that patients with negative rK39 results should undergo further investigation with additional serological tests that are not based only on the rK39 antigen and examination of bone marrow aspirates.
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Cota GF, de Sousa MR, de Assis TSM, Pinto BF, Rabello A. Exploring prognosis in chronic relapsing visceral leishmaniasis among HIV-infected patients: Circulating Leishmania DNA. Acta Trop 2017; 172:186-191. [PMID: 28501450 DOI: 10.1016/j.actatropica.2017.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Visceral leishmaniasis (VL) affecting HIV-infected patients is considered a challenging condition because of its high mortality and relapse rates. The approach of this condition is still surrounded by many uncertainties, especially regarding the criteria to institute and discontinue secondary prophylaxis for VL. The aim of this study was to evaluate the Leishmania parasitism kinetic assessed by polymerase chain reaction (PCR) as a possible tool in the prognostic assessment in a context in which patients are receiving highly active antiretroviral therapy and secondary prophylaxis. METHODS A prospective observation of Leishmania-HIV-co infected patients was performed and two groups with distinct clinical prognosis unpredicted by their CD4 count at the moment of VL diagnosis and not related to their HIV load control were confirmed. RESULTS Relapsing (R) and non-relapsing (NR) patients had similar antiviral therapy use rates, CD4 lymphocyte count medians and HIV load levels at VL-diagnosis. At the 12-month follow-up, R-patients presented a significantly lower CD4 lymphocyte count than NR-patients, without difference in HIV load control. The time between HIV and VL diagnoses was longer in the R than NR-group. Comparison between Kaplan-Meier relapse-free survival curves (time to relapse) using a log rank test showed that patients presenting circulating Leishmania DNA had a significantly higher risk of clinical VL relapse within 4 months after a positive test (p=0.001). CONCLUSIONS These results reinforce that a negative PCR could be a useful tool to support prophylaxis interruption among patients with CD4 counts above 200cells/mm3 and that a positive PCR suggests imminent VL relapse.
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Castro A, Carrillo E, San Martín JV, Botana L, Molina L, Matía B, Fernandez L, Horrillo L, Ibarra-Meneses A, Sanchez C, Ruiz-Giardin JM, Moreno J. Lymphoproliferative response after stimulation with soluble leishmania antigen (SLA) as a predictor of visceral leishmaniasis (VL) relapse in HIV+ patients. Acta Trop 2016; 164:345-351. [PMID: 27693332 DOI: 10.1016/j.actatropica.2016.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/22/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022]
Abstract
The introduction of HAART resulted in the decrease of Leishmania/HIV co-infection cases; nevertheless, the number of relapses remains high and secondary prophylaxis is recommended. However, secondary prophylaxis is not necessary in all patients, and presents a high risk of toxicity and an elevated cost. Our aim was to study whether specific cellular response to Leishmania infantum (measured by cell proliferation response after stimulation with soluble Leishmania antigen (SLA)), could be a useful tool to attempt a secondary prophylaxis withdrawal. In June 2009 an outbreak of leishmaniasis by Leishmania infantum was declared in the southeast of Madrid, and since January 2013, we recruited 10 HIV+ patients that had been treated for visceral leishmaniasis. 6 patients had positive SLA-cell proliferation test. The mean CD4 cell counts of those patients with positive SLA were 140 cel/mm3 and 40 cel/mm3 in those with negative SLA test. 3 patients with positive SLA-cell proliferation test (CD4 count: 336, 307, 625) were not on prophylaxis, and the other 3 patients (CD4 count: 152, 189, 359) were on secondary prophylaxis that was withdrawn after the positive SLA-cell proliferation test with no posterior relapses (mean follow up 60 weeks). From the 4 patients, which had negative SLA-cell proliferation test and continued on prophylaxis, 3 had positive PCR for Leishmania at the end of the follow-up and 2 presented clinical relapses. The performance of SLA-cell proliferation test can be a useful tool that can permit us to try withdrawal of the prophylaxis in Leishmania/HIV co-infected patients with low CD4+ counts under clinical supervision, diminishing risk of toxicity and cost.
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Eberhardt E, Mondelaers A, Hendrickx S, Van den Kerkhof M, Maes L, Caljon G. Molecular detection of infection homogeneity and impact of miltefosine treatment in a Syrian golden hamster model of Leishmania donovani and L. infantum visceral leishmaniasis. Parasitol Res 2016; 115:4061-70. [PMID: 27412759 DOI: 10.1007/s00436-016-5179-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/20/2016] [Indexed: 02/07/2023]
Abstract
Control of visceral leishmaniasis caused by Leishmania infantum and Leishmania donovani primarily relies on chemotherapy using an increasingly compromised repertoire of antileishmanial compounds. For evaluation of novel drugs, the Syrian golden hamster is considered as a clinically relevant laboratory model. In this study, two molecular parasite detection assays were developed targeting cathepsin-like cysteine protease B (CPB) DNA and 18S rRNA to achieve absolute amastigote quantification in the major target organs liver and spleen. Both quantitative PCR (qPCR) techniques showed excellent agreement with a strong correlation with the conventional microscopic reading of Giemsa-stained tissue smears. Using multiple single tissue pieces and all three detection methods, we confirmed homogeneity of infection in liver and spleen and the robustness of extrapolating whole organ burdens from a small single tissue piece. Comparison of pre- and post-treatment burdens in infected hamsters using the three detection methods consistently revealed a stronger parasite reduction in the spleen compared to the liver, indicating an organ-dependent clearance efficacy for miltefosine. In conclusion, this study in the hamster demonstrated high homogeneity of infection in liver and spleen and advocates the use of molecular detection methods for assessment of low (post-treatment) tissue burdens.
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Affiliation(s)
- Eline Eberhardt
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Room S7.24, Campus Drie Eiken, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Annelies Mondelaers
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Room S7.24, Campus Drie Eiken, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Sarah Hendrickx
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Room S7.24, Campus Drie Eiken, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Magali Van den Kerkhof
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Room S7.24, Campus Drie Eiken, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Louis Maes
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Room S7.24, Campus Drie Eiken, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Guy Caljon
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Room S7.24, Campus Drie Eiken, Universiteitsplein 1, B-2610, Wilrijk, Belgium.
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14
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Faucher JF, Morquin D, Reynes J, Chirouze C, Hoen B, Le Moing V. Serial use of pentamidine and miltefosine for treating Leishmania infantum-HIV coinfection. Parasitol Int 2016; 65:444-6. [PMID: 27353022 DOI: 10.1016/j.parint.2016.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022]
Abstract
Liposomal amphotericin B (LAmb) may fail to heal Leishmania infantum visceral leishmaniasis (VL) in the immunodeficient host. There are currently no guidelines on how to treat such patients and efficacy of miltefosine monotherapy seems limited in this indication. We present 2 cases of patients with VL and AIDS for which LAmb had to be interrupted (one because of toxicity, one because of treatment failure) and who were treated effectively with pentamidine followed by miltefosine.
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Affiliation(s)
- Jean-François Faucher
- Service des maladies infectieuses et Tropicales, CHRU de Besançon, 25030 Besançon cedex, France.
| | - David Morquin
- Service des maladies infectieuses et Tropicales, CHU de Montpellier, 34295 Montpellier cedex 5, France.
| | - Jacques Reynes
- Service des maladies infectieuses et Tropicales, CHU de Montpellier, 34295 Montpellier cedex 5, France.
| | - Catherine Chirouze
- Service des maladies infectieuses et Tropicales, CHRU de Besançon, 25030 Besançon cedex, France.
| | - Bruno Hoen
- Service des maladies infectieuses et Tropicales, CHRU de Besançon, 25030 Besançon cedex, France.
| | - Vincent Le Moing
- Service des maladies infectieuses et Tropicales, CHU de Montpellier, 34295 Montpellier cedex 5, France.
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15
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Mondelaers A, Sanchez-Cañete MP, Hendrickx S, Eberhardt E, Garcia-Hernandez R, Lachaud L, Cotton J, Sanders M, Cuypers B, Imamura H, Dujardin JC, Delputte P, Cos P, Caljon G, Gamarro F, Castanys S, Maes L. Genomic and Molecular Characterization of Miltefosine Resistance in Leishmania infantum Strains with Either Natural or Acquired Resistance through Experimental Selection of Intracellular Amastigotes. PLoS One 2016; 11:e0154101. [PMID: 27123924 PMCID: PMC4849676 DOI: 10.1371/journal.pone.0154101] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/08/2016] [Indexed: 02/06/2023] Open
Abstract
During the last decade miltefosine (MIL) has been used as first-line treatment for visceral leishmaniasis in endemic areas with antimonial resistance, but a decline in clinical effectiveness is now being reported. While only two MIL-resistant Leishmania infantum strains from HIV co-infected patients have been documented, phenotypic MIL-resistance for L. donovani has not yet been identified in the laboratory. Hence, a better understanding of the factors contributing to increased MIL-treatment failure is necessary. Given the paucity of defined MIL-resistant L. donovani clinical isolates, this study used an experimental amastigote-selected MIL-resistant L. infantum isolate (LEM3323). In-depth exploration of the MIL-resistant phenotype was performed by coupling genomic with phenotypic data to gain insight into gene function and the mutant phenotype. A naturally MIL-resistant L. infantum clinical isolate (LEM5159) was included to compare both datasets. Phenotypically, resistance was evaluated by determining intracellular amastigote susceptibility in vitro and actual MIL-uptake. Genomic analysis provided supportive evidence that the resistance selection model on intracellular amastigotes can be a good proxy for the in vivo field situation since both resistant strains showed mutations in the same inward transporter system responsible for the acquired MIL-resistant phenotype. In line with previous literature findings in promastigotes, our data confirm a defective import machinery through inactivation of the LiMT/LiRos3 protein complex as the main mechanism for MIL-resistance also in intracellular amastigotes. Whole genome sequencing analysis of LEM3323 revealed a 2 base pair deletion in the LiMT gene that led to the formation an early stop codon and a truncation of the LiMT protein. Interestingly, LEM5159 revealed mutations in both the LiMT and LiRos3 genes, resulting in an aberrant expression of the LiMT protein. To verify that these mutations were indeed accountable for the acquired resistance, transfection experiments were performed to re-establish MIL-susceptibility. In LEM3323, susceptibility was restored upon expression of a LiMT wild-type gene, whereas the MIL-susceptibility of LEM5159 could be reversed after expression of the LiRos3 wild-type gene. The aberrant expression profile of the LiMT protein could be restored upon rescue of the LiRos3 gene both in the LEM5159 clinical isolate and a ΔLiRos3 strain, showing that expression of LdMT is dependent on LdRos3 expression. The present findings clearly corroborate the pivotal role of the LiMT/LiRos3 complex in resistance towards MIL.
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Affiliation(s)
- Annelies Mondelaers
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Maria P. Sanchez-Cañete
- Instituto de Parasitologia y Biomedicina "Lopez-Neyra", Avda. Conocimiento S/N Parque Tecnológico Ciencias de la Salud, 18016, Granada, Spain
| | - Sarah Hendrickx
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Eline Eberhardt
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Raquel Garcia-Hernandez
- Instituto de Parasitologia y Biomedicina "Lopez-Neyra", Avda. Conocimiento S/N Parque Tecnológico Ciencias de la Salud, 18016, Granada, Spain
| | - Laurence Lachaud
- Laboratoire de Parasitologie-Mycologie et Centre National de Référence des Leishmanioses, Centre Hospitalier Universitaire et Université de Montpellier 39, Avenue Charles Flahault, 34295, Montpellier, France
| | - James Cotton
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, Cambridge, United Kingdom
| | - Mandy Sanders
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, Cambridge, United Kingdom
| | - Bart Cuypers
- Molecular Parasitology Unit (MPU), Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
- Advanced Database Research and Modeling (ADReM) research group, University of Antwerp, Middelheimlaan 1,2020, Antwerpen, Belgium
| | - Hideo Imamura
- Molecular Parasitology Unit (MPU), Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Jean-Claude Dujardin
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
- Molecular Parasitology Unit (MPU), Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Guy Caljon
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Francisco Gamarro
- Instituto de Parasitologia y Biomedicina "Lopez-Neyra", Avda. Conocimiento S/N Parque Tecnológico Ciencias de la Salud, 18016, Granada, Spain
| | - Santiago Castanys
- Instituto de Parasitologia y Biomedicina "Lopez-Neyra", Avda. Conocimiento S/N Parque Tecnológico Ciencias de la Salud, 18016, Granada, Spain
- * E-mail:
| | - Louis Maes
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
- * E-mail:
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Morizot G, Jouffroy R, Faye A, Chabert P, Belhouari K, Calin R, Charlier C, Miailhes P, Siriez JY, Mouri O, Yera H, Gilquin J, Tubiana R, Lanternier F, Mamzer MF, Legendre C, Peyramond D, Caumes E, Lortholary O, Buffet P. Antimony to Cure Visceral Leishmaniasis Unresponsive to Liposomal Amphotericin B. PLoS Negl Trop Dis 2016; 10:e0004304. [PMID: 26735920 PMCID: PMC4703342 DOI: 10.1371/journal.pntd.0004304] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/24/2015] [Indexed: 02/07/2023] Open
Abstract
We report on 4 patients (1 immunocompetent, 3 immunosuppressed) in whom visceral leishmaniasis had become unresponsive to (or had relapsed after) treatment with appropriate doses of liposomal amphotericin B. Under close follow-up, full courses of pentavalent antimony were administered without life-threatening adverse events and resulted in rapid and sustained clinical and parasitological cure. Visceral leishmaniasis causes fever, enlargement of internal organs like the liver and the spleen, and leads to death if no treatment is given. It is caused by a microbe called Leishmania and affects children and adults in warm and temperate regions of the world. Antimony in different forms has been used to treat Visceral Leishmaniasis for almost one century and is still in use in several countries despite the fact that it sometimes displays toxic effects, especially in patients with underlying health problems. Because it is better tolerated and at least as effective as antimony, liposomal amphotericin B is now used as the first treatment for Visceral Leishmaniasis in Southern Europe. We observed that a small proportion of patients—especially those with an impaired immune system—do not cure even after several courses of liposomal amphotericin B. In 4 such patients with “unresponsiveness” to liposomal amphotericin B, antimony provided a sustained cure without major side effects. We conclude that when multiple failures or relapses occur after treatment with liposomal amphotericin B, antimony is a reasonable, potentially life-saving treatment option. These observations also suggest that “unresponsiveness” to amphotericin B results from unusual resistance mechanisms.
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Affiliation(s)
| | - Romain Jouffroy
- Service d’anesthésie-réanimation, Hôpital Necker, Paris, France
| | - Albert Faye
- Service de Pédiatrie générale, Hôpital Robert Debré, Paris, France
| | - Paul Chabert
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Lyon, France
| | - Katia Belhouari
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Ruxandra Calin
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Caroline Charlier
- Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants malades, IHU Imagine, Paris, France
| | - Patrick Miailhes
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Lyon, France
| | - Jean-Yves Siriez
- Service d'Accueil des Urgences pédiatriques, Hôpital Robert Debré, Paris, France
| | - Oussama Mouri
- Service de Parasitologie-Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Hélène Yera
- Service de Parasitologie-Mycologie. Hôpital Cochin, Faculté de Médecine, Paris Descartes, Paris, France
| | - Jacques Gilquin
- Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants malades, IHU Imagine, Paris, France
| | - Roland Tubiana
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Fanny Lanternier
- Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants malades, IHU Imagine, Paris, France
| | | | | | - Dominique Peyramond
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Lyon, France
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants malades, IHU Imagine, Paris, France
| | - Pierre Buffet
- Service de Parasitologie-Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
- 945 INSERM, Université Paris 6, Paris, France
- * E-mail:
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17
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Crowe A, Slavin J, Stark D, Aboltins C. A case of imported Leishmania infantum cutaneous leishmaniasis; an unusual presentation occurring 19 years after travel. BMC Infect Dis 2014; 14:597. [PMID: 25428722 PMCID: PMC4262283 DOI: 10.1186/s12879-014-0597-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 10/29/2014] [Indexed: 11/21/2022] Open
Abstract
Background Leishmania infantum is a flagellated protozoan parasite that is able to parasitize blood and tissue. Leishmania species cause a spectrum of clinical disease with cutaneous, visceral or mucosal involvement. L. infantum is recognised as a cause of visceral leishmaniasis (VL) and is less commonly reported as a cause of cutaneous leishmaniasis (CL) from countries around the Mediterranean basin. This is the first report of imported L. infantum CL to Australia and is remarkable for a 19 year period between the patient's exposure to an endemic region, and the manifestation of symptoms. Case presentation A 76 year old Italian-born man presented to our institution with a non-healing lesion over his upper lip, abutting his nasal mucosa. The patient had travelled to Italy, an endemic area for L. infantum 19 years earlier but had resided in Australia, a non-endemic area since. Histopathology performed on a biopsy of the lesion demonstrated findings consistent with CL. A species specific polymerase chain reaction (PCR) performed on the tissue detected L. infantum. The patient had complete clinical recovery following treatment with Liposomal amphotericin B at a dose of 3 mg/kg for five days followed by a subsequent 3 mg/kg dose at day ten. Conclusions L. infantum should be recognised as a cause of imported CL in returned travellers from the Mediterranean. In this case, the incubation period for L. infantum CL was at least 19 years. This case adds to the described spectrum of clinical presentations of leishmaniasis and supports the theory of parasite persistence underlying natural immunity and recurrence of disease. Clinicians should consider L. infantum CL in the differential diagnosis of a non-healing skin lesion in any patient who reports travel to the Mediterranean, even when travel occurred several years before clinical presentation. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0597-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy Crowe
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia.
| | - John Slavin
- Department of Pathology, St Vincent's Hospital, Melbourne, Australia.
| | - Damien Stark
- Department of Microbiology, SydPath, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
| | - Craig Aboltins
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia. .,Department of Infectious Diseases, Northwest Academic Centre, The University of Melbourne, Epping, Victoria, Australia.
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18
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Vassallo M, Moranne O, Ambrosetti D, Jeandel PY, Pomares C, Cassuto E, Boscagli A, Giraud G, Montagne N, Dentone C, Demacina I, Villaggio B, Secondo G, Ferrea G, Passeron C, Saudes L, Kaphan R, Marty P, Rosenthal E. Visceral leishmaniasis due to Leishmania infantum with renal involvement in HIV-infected patients. BMC Infect Dis 2014; 14:561. [PMID: 25358548 PMCID: PMC4216653 DOI: 10.1186/s12879-014-0561-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/14/2014] [Indexed: 11/12/2022] Open
Abstract
Background We describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings. Cases presentation Four HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete recovery of renal function after anti-parasitic treatment. Main clinical presentations were nephrotic or nephritic syndrome and/or acute renal failure secondary to membranoproliferative type III glomerulonephritis or acute interstitial nephritis. Clinical outcome was poor, probably as a consequence of insufficient immuno-virological control of the HIV infection. Conclusions Our findings suggest that the main histological findings in case of renal involvement due to Leishmania infantum infection in HIV-infected patients are type III MPGN and acute interstitial nephritis, with a histological specificity similar to that observed in canine leishmaniasis. Poor immune status in HIV-infected patients, altering the capacity for parasite clearance, and prolonged course of chronic active VL in this population may lead to the development of specific renal lesions. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0561-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matteo Vassallo
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Olivier Moranne
- Department of Nephrology, Dialysis and Transplantation, Nice University Hospital, Nice, France. .,Department of Public Health, Nice University Hospital, Nice, France. .,Laboratory of Human Motricity, Education and Health (LAMHESS), University of Nice Sophia-Antipolis, Nice, France.
| | - Damien Ambrosetti
- Department of Histopathology, Nice University Hospital, Nice, France.
| | | | - Christelle Pomares
- Parasitology and Mycology, Nice University Hospital and Inserm U 1065, Nice-Sophia Antipolis University, Equipe 6, Centre Méditerranéen de Médicine Moléculaire, Nice, France.
| | - Elisabeth Cassuto
- Department of Nephrology, Dialysis and Transplantation, Nice University Hospital, Nice, France.
| | - Annick Boscagli
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Guillaume Giraud
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Nathalie Montagne
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Chiara Dentone
- Department of Infectious Diseases, Sanremo General Hospital, Sanremo, Italy.
| | - Ilaria Demacina
- Department of Infectious Diseases, Sanremo General Hospital, Sanremo, Italy.
| | - Barbara Villaggio
- Department of Histopathology, Genoa University Hospital, Genoa, Italy.
| | - Giovanni Secondo
- Department of Infectious Diseases, Sanremo General Hospital, Sanremo, Italy.
| | - Giuseppe Ferrea
- Department of Infectious Diseases, Sanremo General Hospital, Sanremo, Italy.
| | - Corinne Passeron
- Department of Nephrology, Cannes General Hospital, Cannes, France.
| | - Laurence Saudes
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Regis Kaphan
- Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - Pierre Marty
- Parasitology and Mycology, Nice University Hospital and Inserm U 1065, Nice-Sophia Antipolis University, Equipe 6, Centre Méditerranéen de Médicine Moléculaire, Nice, France.
| | - Eric Rosenthal
- Department of Internal Medicine, Nice University Hospital, Nice, France.
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19
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Monge-Maillo B, Norman FF, Cruz I, Alvar J, López-Vélez R. Visceral leishmaniasis and HIV coinfection in the Mediterranean region. PLoS Negl Trop Dis 2014; 8:e3021. [PMID: 25144380 PMCID: PMC4140663 DOI: 10.1371/journal.pntd.0003021] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Visceral leishmaniasis is hypoendemic in Mediterranean countries, where it is caused by the flagellate protozoan Leishmania infantum. VL cases in this area account for 5%–6% of the global burden. Cases of Leishmania/HIV coinfection have been reported in the Mediterranean region, mainly in France, Italy, Portugal, and Spain. Since highly active antiretroviral therapy was introduced in 1997, a marked decrease in the number of coinfected cases in this region has been reported. The development of new diagnostic methods to accurately identify level of parasitemia and the risk of relapse is one of the main challenges in improving the treatment of coinfected patients. Clinical trials in the Mediterranean region are needed to determine the most adequate therapeutic options for Leishmania/HIV patients as well as the indications and regimes for secondary prophylaxis. This article reviews the epidemiological, diagnostic, clinical, and therapeutic aspects of Leishmania/HIV coinfection in the Mediterranean region.
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Affiliation(s)
- Begoña Monge-Maillo
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Francesca F. Norman
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Israel Cruz
- WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Jorge Alvar
- Visceral Leishmaniasis Program, Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Rogelio López-Vélez
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
- * E-mail:
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20
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Wong SSY, Fung KSC, Chau S, Poon RWS, Wong SCY, Yuen KY. Molecular diagnosis in clinical parasitology: When and why? Exp Biol Med (Maywood) 2014; 239:1443-60. [DOI: 10.1177/1535370214523880] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Microscopic detection and morphological identification of parasites from clinical specimens are the gold standards for the laboratory diagnosis of parasitic infections. The limitations of such diagnostic assays include insufficient sensitivity and operator dependence. Immunoassays for parasitic antigens are not available for most parasitic infections and have not significantly improved the sensitivity of laboratory detection. Advances in molecular detection by nucleic acid amplification may improve the detection in asymptomatic infections with low parasitic burden. Rapidly accumulating genomic data on parasites allow the design of polymerase chain reaction (PCR) primers directed towards multi-copy gene targets, such as the ribosomal and mitochondrial genes, which further improve the sensitivity. Parasitic cell or its free circulating parasitic DNA can be shed from parasites into blood and excreta which may allow its detection without the whole parasite being present within the portion of clinical sample used for DNA extraction. Multiplex nucleic acid amplification technology allows the simultaneous detection of many parasitic species within a single clinical specimen. In addition to improved sensitivity, nucleic acid amplification with sequencing can help to differentiate different parasitic species at different stages with similar morphology, detect and speciate parasites from fixed histopathological sections and identify anti-parasitic drug resistance. The use of consensus primer and PCR sequencing may even help to identify novel parasitic species. The key limitation of molecular detection is the technological expertise and expense which are usually lacking in the field setting at highly endemic areas. However, such tests can be useful for screening important parasitic infections in asymptomatic patients, donors or recipients coming from endemic areas in the settings of transfusion service or tertiary institutions with transplantation service. Such tests can also be used for monitoring these recipients or highly immunosuppressed patients, so that early preemptive treatment can be given for reactivated parasitic infections while the parasitic burden is still low.
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Affiliation(s)
- Samson SY Wong
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Kitty SC Fung
- Department of Pathology, United Christian Hospital, Kwun Tong of New Kowloon, Hong Kong
| | - Sandy Chau
- Department of Pathology, United Christian Hospital, Kwun Tong of New Kowloon, Hong Kong
| | - Rosana WS Poon
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Sally CY Wong
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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Silva JM, Zacarias DA, de Figueirêdo LC, Soares MRA, Ishikawa EAY, Costa DL, Costa CHN. Bone marrow parasite burden among patients with New World kala-azar is associated with disease severity. Am J Trop Med Hyg 2014; 90:621-6. [PMID: 24615127 DOI: 10.4269/ajtmh.13-0376] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Kala-azar or visceral leishmaniasis, found mostly throughout the Indian Subcontinent, East Africa, and Brazil, kills 20,000-40,000 persons annually. The agents, Leishmania donovani and Leishmania infantum, are obligatory intracellular protozoa of mononuclear phagocytes found principally in the spleen and bone marrow. Protracted fever, anemia, wasting, hepatosplenomegaly, hemorrhages, and bacterial co-infections are typical features. One hundred and twenty-two (122) in-hospital patients were studied to verify if higher bone marrow parasite load estimated by quantitative polymerase chain reaction is associated with severe disease. The estimated median parasite load was 5.0 parasites/10(6) human nucleated cells. It is much higher in deceased than among survivors (median 75.0 versus 4.2). Patients who lost more weight had a higher parasite burden, as well as patients with epistaxis, abdominal pain, edema, and jaundice. This study suggests that higher parasite load is influenced by wasting, which may lead to more severe disease.
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Affiliation(s)
- Joyce M Silva
- Laboratory of Leishmaniasis, Institute of Tropical Diseases "Natan Portella", Federal University of Piauí, Teresina, PI, Brazil; Department of Biology, Federal University of Piauí, Floriano at Floriano, PI, Brazil; Maternal and Childhood Department, Federal University of Piauí, Teresina, PI, Brazil; Laboratory of Molecular Biology, Nucleus of Tropical Medicine, Federal University of Pará, Belém, PA, Brazil; Department of Community Medicine, Federal University of Piauí, Teresina, PI, Brazil
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22
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Silva EDD, Andrade LDD, Araújo PSRD, Silveira VM, Padilha CE, Silva MALD, Medeiros ZMD. Case study of a patient with HIV-AIDS and visceral leishmaniasis co-infection in multiple episodes. Rev Inst Med Trop Sao Paulo 2014; 55:425-8. [PMID: 24213197 PMCID: PMC4105092 DOI: 10.1590/s0036-46652013000600010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/15/2013] [Indexed: 11/22/2022] Open
Abstract
Report of a 45-year-old male farmer, a resident in the forest zone of Pernambuco, who was diagnosed with human immunodeficiency virus (HIV) in 1999 and treated using antiretroviral (ARV) drugs. In 2005, the first episode of visceral leishmaniasis (VL), as assessed by parasitological diagnosis of bone marrow aspirate, was recorded. When admitted to the hospital, the patient presented fever, hepatosplenomegaly, weight loss, and diarrhea. Since then, six additional episodes of VL occurred, with a frequency rate of one per year (2005-2012, except in 2008). In 2011, the patient presented a disseminated skin lesion caused by the amastigotes of Leishmania, as identified by histopathological assessment of skin biopsy samples. In 2005, he was treated with N-methyl-glucamine-antimony and amphotericin B deoxycholate. However, since 2006 because of a reported toxicity, the drug of choice was liposomal amphotericin B. As recommended by the Ministry of Health, this report emphasizes the need for HIV patients living in VL endemic areas to include this parasitosis in their follow-up protocol, particularly after the first infection of VL.
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Affiliation(s)
- Elis Dionísio da Silva
- Postgraduate Course of Biology applied to Health, Federal University of Pernambuco, PE, Brazil, ,
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Albuquerque LCPD, Mendonça IR, Cardoso PN, Baldaçara LR, Borges MRMM, Borges JDC, Pranchevicius MCDS. HIV/AIDS-related visceral leishmaniasis: a clinical and epidemiological description of visceral leishmaniasis in northern Brazil. Rev Soc Bras Med Trop 2014; 47:38-46. [DOI: 10.1590/0037-8682-0180-2013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/23/2014] [Indexed: 11/22/2022] Open
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Lachaud L, Dedet JP, Marty P, Faraut F, Buffet P, Gangneux JP, Ravel C, Bastien P, Working Group for the Notification C. Surveillance of leishmaniases in France, 1999 to 2012. Euro Surveill 2013. [DOI: 10.2807/1560-7917.es2013.18.29.20534] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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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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Molina I, Fisa R, Riera C, Falcó V, Elizalde A, Salvador F, Crespo M, Curran A, López-Chejade P, Tebar S, Pérez-Hoyos S, Ribera E, Pahissa A. Ultrasensitive real-time PCR for the clinical management of visceral leishmaniasis in HIV-Infected patients. Am J Trop Med Hyg 2013; 89:105-10. [PMID: 23629932 DOI: 10.4269/ajtmh.12-0527] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Molecular methods have been proposed as an alternative tool for the diagnosis of visceral leishmaniasis (VL), but no data are available regarding use for monitoring clinical outcome. A prospective cohort study of human immunodeficiency virus-(HIV) and VL-coinfected patients was conducted in a university-affiliated hospital in Barcelona, Spain. Leishmania parasite load was monitored using a real-time polymerase chain reaction (PCR) at baseline and every 3 months. Cutoff values for PCR were determined using receiver operating characteristic (ROC) curves. Overall, 37 episodes were analyzed, and 25 of these episodes were considered as relapsing episodes. A significant decrease of parasite load measured 3 months after treatment could predict the clinical evolution of VL. A parasite load over 0.9 parasites/mL measured 12 months after treatment could predicts relapse with a sensitivity of 100% and a specificity of 90.9%. Monitoring parasite load by an ultrasensitive quantitative Leishmania PCR is useful to predict the risk of relapse after a VL episode in HIV-infected patients.
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Affiliation(s)
- Israel Molina
- Infectious Disease Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
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27
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Colasanti J, Altamirano J, Espinoza L. An unwelcome synergy: leishmaniasis and HIV. Am J Med 2013; 126:114-6. [PMID: 23331437 DOI: 10.1016/j.amjmed.2012.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Jonathan Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Srivastava A, Sweat JM, Azizan A, Vesely B, Kyle DE. Real-Time PCR to QuantifyLeishmania donovaniin Hamsters. J Parasitol 2013; 99:145-50. [DOI: 10.1645/ge-3221.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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29
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Aït-Oudhia K, Gazanion E, Sereno D, Oury B, Dedet J, Pratlong F, Lachaud L. In vitro susceptibility to antimonials and amphotericin B of Leishmania infantum strains isolated from dogs in a region lacking drug selection pressure. Vet Parasitol 2012; 187:386-93. [DOI: 10.1016/j.vetpar.2012.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 01/18/2012] [Accepted: 01/26/2012] [Indexed: 10/14/2022]
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Cota GF, de Sousa MR, Demarqui FN, Rabello A. The diagnostic accuracy of serologic and molecular methods for detecting visceral leishmaniasis in HIV infected patients: meta-analysis. PLoS Negl Trop Dis 2012; 6:e1665. [PMID: 22666514 PMCID: PMC3362615 DOI: 10.1371/journal.pntd.0001665] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 04/11/2012] [Indexed: 12/02/2022] Open
Abstract
Background Human visceral leishmaniasis (VL), a potentially fatal disease, has emerged as an important opportunistic condition in HIV infected patients. In immunocompromised patients, serological investigation is considered not an accurate diagnostic method for VL diagnosis and molecular techniques seem especially promising. Objective This work is a comprehensive systematic review and meta-analysis to evaluate the accuracy of serologic and molecular tests for VL diagnosis specifically in HIV-infected patients. Methods Two independent reviewers searched PubMed and LILACS databases. The quality of studies was assessed by QUADAS score. Sensitivity and specificity were pooled separately and compared with overall accuracy measures: diagnostic odds ratio (DOR) and symmetric summary receiver operating characteristic (sROC). Results Thirty three studies recruiting 1,489 patients were included. The following tests were evaluated: Immunofluorescence Antibody Test (IFAT), Enzyme linked immunosorbent assay (ELISA), immunoblotting (Blot), direct agglutination test (DAT) and polimerase chain reaction (PCR) in whole blood and bone marrow. Most studies were carried out in Europe. Serological tests varied widely in performance, but with overall limited sensitivity. IFAT had poor sensitivity ranging from 11% to 82%. DOR (95% confidence interval) was higher for DAT 36.01 (9.95–130.29) and Blot 27.51 (9.27–81.66) than for IFAT 7.43 (3.08–1791) and ELISA 3.06 (0.71–13.10). PCR in whole blood had the highest DOR: 400.35 (58.47–2741.42). The accuracy of PCR based on Q-point was 0.95; 95%CI 0.92–0.97, which means good overall performance. Conclusion Based mainly on evidence gained by infection with Leishmania infantum chagasi, serological tests should not be used to rule out a diagnosis of VL among the HIV-infected, but a positive test at even low titers has diagnostic value when combined with the clinical case definition. Considering the available evidence, tests based on DNA detection are highly sensitive and may contribute to a diagnostic workup. Human visceral leishmaniasis (VL), a potentially fatal disease, has emerged as an important opportunistic condition in HIV infected patients. In immunocompromised patients, serological investigation is considered not an accurate diagnostic method for VL diagnosis and molecular techniques seem especially promising. Demonstration of Leishmania parasites in bone marrow aspirate or in other biologic specimen, either by visualization or culture, remains the most reliable diagnostic technique in the setting of HIV co-infection. However, these tests are difficult to perform in rural areas and some of them are invasive and carry a risk of complication. This work is a systematic review to evaluate the accuracy of serologic and molecular tests for VL diagnosis in HIV-infected patients. Two reviewers searched the literature, evaluating quality of studies and comparing performance of diagnostic tests. Thirty three studies were included. Most studies were carried out in Europe. Serological tests varied in performance, but with overall limited sensitivity. Based on the evidence, serological tests should not be used to rule out a diagnosis of VL among HIV-patients, but a positive test at even low titers has diagnostic value when combined with the clinical case definition. Tests based on DNA detection are highly sensitive and may contribute to a diagnostic workup.
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Affiliation(s)
- Gláucia Fernandes Cota
- Laboratory of Clinical Research, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil.
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31
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Toqeer M, Rahman N, Whitehead MW, Lockwood D. Visceral leishmaniasis in immunosuppressed Caucasian patient. BMJ Case Rep 2012; 2012:bcr.11.2011.5199. [PMID: 22605859 DOI: 10.1136/bcr.11.2011.5199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 64-year-old man was admitted with fever, weight loss, fatigue and night sweats. He was known to have rheumatoid arthritis and had been taking methotrexate for 1 year. He had worked in Saudi Arabia until 1994 and had been living in Spain for 6 months every year. Clinical examination showed an enlarged spleen. Routine investigations showed pancytopaenia. Serial blood cultures were negative. CT scan confirmed splenomegaly and was otherwise unremarkable. Bone marrow biopsy revealed Leishmania amastigote consistent with a diagnosis of visceral leishmaniasis. After discussing with the hospital for tropical diseases (HTD), he was started on liposomal amphotericin B. Following two infusions of amphotericin B, he started improving as his fever, night sweats and weakness had settled. He was then discharged and followed up in HTD clinic 4 weeks later where he was found to be consistently improving.
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Affiliation(s)
- Muhammad Toqeer
- Gastroenterology Department, Conquest Hospital, St Leonard's On Sea, UK.
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32
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Bañuls AL, Bastien P, Pomares C, Arevalo J, Fisa R, Hide M. Clinical pleiomorphism in human leishmaniases, with special mention of asymptomatic infection. Clin Microbiol Infect 2012; 17:1451-61. [PMID: 21933304 DOI: 10.1111/j.1469-0691.2011.03640.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review gives an update of current knowledge on the clinical pleiomorphism of Leishmania, with a special emphasis on the case of asymptomatic carriage. The first part describes the numerous unusual expressions of the disease that occur besides the classic (visceral, cutaneous, and mucocutaneous) forms of leishmaniases. The second part deals with progress in the understanding of disease outcome in humans, and the possible future approaches to improve our knowledge in the field. The third part highlights the role of the too often neglected asymptomatic carrier compartment. This group could be key to understanding infraspecific differences in virulence and pathogenicity of the parasite, as well as identifying the genetic determinants involved in the expression of the disease.
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Affiliation(s)
- A L Bañuls
- UMR MIVEGEC (IRD 224-CNRS 5290-Université Montpellier, France.
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Dupnik KM, Nascimento EL, Rodrigues-Neto JF, Keesen T, Fernandes MZ, Duarte I, Jeronimo SMB. New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas. Drug Dev Res 2011; 72:451-462. [PMID: 25821334 DOI: 10.1002/ddr.20452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Visceral leishmaniasis [VL] represents a major public health problem in many areas of the world. This review focuses on the impact of periurbanization on the epidemiology and treatment of VL, using Brazil as an example. VL continues to be mostly a disease of poverty with impact on families. However, the disease has expanded in Latin America, with foci reported as far south as Argentina. There is an increasing overlap of Leishmania infantum chagasi and HIV infections and other immunosuppressive conditions, resulting in VL emerging as an opportunistic infection. This new setting poses new challenges for VL disease control and patient management.
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Affiliation(s)
- Kathryn M Dupnik
- Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA ; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, INCT-DT, Brazil
| | - Eliana L Nascimento
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, INCT-DT, Brazil ; Department of Infectious Diseases, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Joao F Rodrigues-Neto
- Department of Biochemistry, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Tatjana Keesen
- Department of Biochemistry, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Maria Zélia Fernandes
- Health Post-Graduate Program, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil ; Department of Internal Medicine, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Iraci Duarte
- Fundação Nacional de Saúde, Secretaria de Saúde do Estado do Rio Grande do Norte, Natal, RN, Brazil
| | - Selma M B Jeronimo
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, INCT-DT, Brazil ; Department of Biochemistry, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil ; Health Post-Graduate Program, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Cota GF, de Sousa MR, Rabello A. Predictors of visceral leishmaniasis relapse in HIV-infected patients: a systematic review. PLoS Negl Trop Dis 2011; 5:e1153. [PMID: 21666786 PMCID: PMC3110161 DOI: 10.1371/journal.pntd.0001153] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 03/07/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Visceral leishmaniasis (VL) is a common complication in AIDS patients living in Leishmania-endemic areas. Although antiretroviral therapy has changed the clinical course of HIV infection and its associated illnesses, the prevention of VL relapses remains a challenge for the care of HIV and Leishmania co-infected patients. This work is a systematic review of previous studies that have described predictors of VL relapse in HIV-infected patients. REVIEW METHODS We searched the electronic databases of MEDLINE, LILACS, and the Cochrane Central Register of Controlled Trials. Studies were selected if they included HIV-infected individuals with a VL diagnosis and patient follow-up after the leishmaniasis treatment with an analysis of the clearly defined outcome of prediction of relapse. RESULTS Eighteen out 178 studies satisfied the specified inclusion criteria. Most patients were males between 30 and 40 years of age, and HIV transmission was primarily via intravenous drug use. Previous VL episodes were identified as risk factors for relapse in 3 studies. Two studies found that baseline CD4+ T cell count above 100 cells/mL was associated with a decreased relapse rate. The observation of an increase in CD4+ T cells at patient follow-up was associated with protection from relapse in 5 of 7 studies. Meta-analysis of all studies assessing secondary prophylaxis showed significant reduction of VL relapse rate following prophylaxis. None of the five observational studies evaluating the impact of highly active antiretroviral therapy use found a reduction in the risk of VL relapse upon patient follow-up. CONCLUSION SOME PREDICTORS OF VL RELAPSE COULD BE IDENTIFIED: a) the absence of an increase in CD4+ cells at follow-up; b) lack of secondary prophylaxis; and c) previous history of VL relapse. CD4+ counts below 100 cells/mL at the time of primary VL diagnosis may also be a predictive factor for VL relapse.
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Affiliation(s)
- Gláucia F Cota
- Post-Graduate Program in Health Sciences, René Rachou Institute, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.
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Casabianca A, Marchetti M, Zallio F, Feyles E, Concialdi E, Ferroglio E, Biglino A. Seronegative visceral leishmaniasis with relapsing and fatal course following rituximab treatment. Infection 2011; 39:375-8. [DOI: 10.1007/s15010-011-0109-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 03/29/2011] [Indexed: 11/24/2022]
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Alexandrino-de-Oliveira P, Santos-Oliveira JR, Dorval MEC, Da-Costa FDCB, Pereira GROL, da Cunha RV, Paniago AMM, Da-Cruz AM. HIV/AIDS-associated visceral leishmaniasis in patients from an endemic area in Central-west Brazil. Mem Inst Oswaldo Cruz 2011; 105:692-7. [PMID: 20835619 DOI: 10.1590/s0074-02762010000500016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 05/13/2010] [Indexed: 12/27/2022] Open
Abstract
An increase in morbidity associated with visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)/AIDS patients has been described in Africa and the Mediterranean. Despite the high endemicity of VL and HIV-1/AIDS in Brazil, this association has not been thoroughly investigated. Our aim was to evaluate the epidemiologic and clinical characteristics of VL-HIV-1/AIDS cases from Central-west [Mato Grosso do Sul (MS)] Brazil. Medical records of 23 VL-HIV-1/AIDS patients were reviewed. Patients were predominantly adult males (87%) and 34.8% of the patients were intravenous drug users (IVDU). Leishmaniasis was the first opportunistic infection in 60% of the HIV-1 patients. Fever occurred in all patients, although splenomegaly and hepatomegaly were absent in 21.7% of the cases. CD4+ T-cell counts were below 200 cells/mm(3) in 80% of the cases and the counts did not increase after clinical remission despite antiretroviral therapy. The first drug chosen to treat the cases was antimonial, but the therapeutic regimen was altered to amphotericin B in 12 of 17 cases due to side effects. Relapses were reported in 56.5% of the patients. IVDU may constitute an important risk factor for the transmission of both diseases in MS. VL-HIV-1/AIDS patients in MS share similar clinical characteristics as those from other endemic regions worldwide. Thus, these findings are critical for improving the surveillance of VL-HIV/AIDS patients.
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Buffet PA, Rosenthal É, Gangneux JP, Lightburne E, Couppié P, Morizot G, Lachaud L, Marty P, Dedet JP. [Therapy of leishmaniasis in France: consensus on proposed guidelines]. Presse Med 2010; 40:173-84. [PMID: 21106333 DOI: 10.1016/j.lpm.2010.09.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/09/2010] [Accepted: 09/15/2010] [Indexed: 10/18/2022] Open
Abstract
Because it relies on potentially toxic, difficult-to-handle, or expensive compounds the therapy of leishmaniasis is still a complex issue in 2010, especially for visceral leishmaniasis in immuno-suppressed subjects, or in patients with cutaneous and mucosal involvement. This induces a wide diversity of observed therapeutic practices, some being sub-optimal. The Société de Pathologie Exotique organised a meeting dedicated to the therapy of leishmaniasis in France that led to the first consensus on therapeutic guidelines. Liposomal amphotericin B is the first-line option for visceral leishmaniasis both in immunocompetent, and immunosuppressed patients (cumulated doses of 20 mg/kg and 30-40 mg/kg, respectively). Secondary prophylaxis with either liposomal amphotericin B, pentamidine or meglumine antimoniate is proposed to patients with heavy immunosuppression until immunity has been restored for at least 6 months. While the efficacy of new topical formulations of paromomycin is being tested, patients with Old World cutaneous leishmaniasis may be left untreated, or be administered a combination of superficial cryotherapy plus intralesional antimony, or even--in complex situations--receive systemic therapy. The efficacy of a short course of pentamidine (L. guyanensis/L. panamensis) and a 20-day schedule of meglumine antimoniate (L. braziliensis) is solidly established. However, in well-defined situations, local therapy of New World cutaneous leishmaniasis is now considered acceptable.
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Affiliation(s)
- Pierre A Buffet
- Université Paris 6, UMR945 47, hôpital Pitié-Salpêtrière, service de parasitologie-mycologie, boulevard de l'hôpital, 75651 Paris cedex 13, France.
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Tordini G, Giaccherini R, Sammarro G, Braito A, Zanelli G. Human leishmaniasis in Tuscany: a changing pattern of visceral disease? ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2010; 104:171-4. [PMID: 20406584 DOI: 10.1179/136485910x12647085215499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- G Tordini
- Department of Molecular Biology, Siena University, Policlinico Santa Maria alle Scotte, Siena, Italy.
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Menotti J, Garin YJF, Thulliez P, Sérugue MC, Stanislawiak J, Ribaud P, de Castro N, Houzé S, Derouin F. Evaluation of a new 5'-nuclease real-time PCR assay targeting the Toxoplasma gondii AF146527 genomic repeat. Clin Microbiol Infect 2010; 16:363-8. [DOI: 10.1111/j.1469-0691.2009.02809.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Patel TA, Lockwood DN. Pentamidine as secondary prophylaxis for visceral leishmaniasis in the immunocompromised host: report of four cases. Trop Med Int Health 2009; 14:1064-70. [DOI: 10.1111/j.1365-3156.2009.02329.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lachaud L, Bourgeois N, Plourde M, Leprohon P, Bastien P, Ouellette M. Parasite Susceptibility to Amphotericin B in Failures of Treatment for Visceral Leishmaniasis in Patients Coinfected with HIV Type 1 andLeishmania infantum. Clin Infect Dis 2009; 48:e16-22. [DOI: 10.1086/595710] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Miró JM. Prevención de las infecciones oportunistas en pacientes adultos y adolescentes infectados por el VIH en el año 2008. Enferm Infecc Microbiol Clin 2008; 26:437-64. [DOI: 10.1157/13125642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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