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Penella A, Muntaner-Virgili C, Marcoval J, González-Compta X, Mesalles-Ruiz M, García Wagner M, Cruellas F, Hamdan M, Nogués J, Notario J. Leishmaniasis in otorhinolaryngology: an emerging disease and its relationship with anti-tumor necrosis factor-alpha drugs. Eur Arch Otorhinolaryngol 2024; 281:2739-2742. [PMID: 38453713 DOI: 10.1007/s00405-024-08569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To investigate the clinical manifestations, management and outcomes of Leishmania lesions in the ear-nose-throat (ENT) region, and its relationship with tumor necrosis factor (TNF)-α blocking drugs. METHODS Single-center retrospective observational study. Patients diagnosed with cutaneous and mucosal leishmaniasis in the otorhinolaryngologic area at a tertiary referral center over a period of 8 years. RESULTS Three cases of Leishmania lesions in the ear and two in the nose were encountered at our institution. All patients were under treatment with TNF-α blocking drugs. Diagnosis was challenging, and it was important to have a clinical suspicion in order to use accurate detection techniques. All patients received systemic treatment and achieved a complete resolution of the lesions. CONCLUSIONS With the increasing use of biologic treatments like TNF-α blockers, this type of infection will be increasingly frequent in endemic areas and also worldwide. It is important to include leishmaniasis in the differential diagnosis of inflammatory/infectious lesions in the ENT region.
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Affiliation(s)
- Anna Penella
- Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain.
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Spain.
| | - Clara Muntaner-Virgili
- Dermatology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - Joaquim Marcoval
- Dermatology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - Xavier González-Compta
- Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - Marta Mesalles-Ruiz
- Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - Miguel García Wagner
- Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - Francesc Cruellas
- Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - Miriam Hamdan
- Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - Julio Nogués
- Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - Jaime Notario
- Dermatology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), IDIBELL, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
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2
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Gimeno-Pitarch L, Almela P, Nos P. Leishmania infection in patients with inflammatory bowel disease: Case series and literature review. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:82-92. [PMID: 37061089 DOI: 10.1016/j.gastrohep.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/17/2023]
Abstract
Infection by Leishmania spp. in patients diagnosed with inflammatory bowel disease (IBD) is rare. Considered endemic in the Mediterranean basin, its manifestations are almost exclusive of patients with impaired cellular immunity. Most of the evidence is found through case reports; without guidelines for its management in patients with IBD. In this study we present three cases of Leishmania infection in patients with IBD that lead us to carry out a review of the current literature. Immunosuppressive treatment contributes to this infection, which presents atypically, with a challenging diagnosis. Initial systemic treatment with withdrawal of the immunosuppressant drug seems to be the best therapeutic strategy. Studies are needed in endemic areas to determine its incidence in IBD patients, as well as its possible association with immunosuppressive therapy. The need for serological screening prior introduction of immunosuppressive drugs could be suggested.
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Affiliation(s)
- Leticia Gimeno-Pitarch
- Servicio de Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España.
| | - Pedro Almela
- Servicio de Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España
| | - Pilar Nos
- Servicio de Aparato Digestivo, Hospital Universitario la Fe de Valencia, Valencia, España
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3
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Rocha R, Gonçalves L, Conceição C, Andrade P, Cristóvão JM, Condeço J, Delgado B, Caeiro C, Kuzmenko T, Vasconcelos E, Escoval MA, Rey C, Guz M, Norte C, Aldeia C, Cruz D, Maia C. Prevalence of asymptomatic Leishmania infection and knowledge, perceptions, and practices in blood donors in mainland Portugal. Parasit Vectors 2023; 16:357. [PMID: 37817278 PMCID: PMC10563231 DOI: 10.1186/s13071-023-05980-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Asymptomatic infection is the most common outcome of exposure to Leishmania parasites. In the Mediterranean region, where Leishmania infantum is endemic, studies on the prevalence of asymptomatic infection have often relied on serological testing in blood donors. In Spain, regional studies have shown seroprevalence in blood donors between 1 and 8%; in Portugal, values of 0 and 2% were suggested by two localized studies, in different populations. The purpose of this study was (i) to estimate the prevalence of asymptomatic Leishmania infection in blood donors in mainland Portugal, and (ii) to study the association between the detection of antibodies to Leishmania and sociodemographic factors, and also the knowledge, perceptions and practices (KPP) of the blood donors regarding leishmaniasis. METHODS A cross-sectional study targeted the population of people who donated blood in mainland Portugal. Participants, distributed proportionally by municipality and aged between 18 and 65 years, were selected randomly in 347 blood collection points between February and June 2022, and completed a sociodemographic and a KPP questionnaire. Detection of anti-Leishmania antibodies in serum was performed using an ELISA commercial kit. Individual KPP scores were calculated by adding grades defined for each question. RESULTS Globally, 201/3763 samples were positive. The estimated national true seroprevalence was 4.8% (95% CI 4.1-5.5%). The proportion of positive results was significantly different between NUTS (Nomenclature of Territorial Units for Statistics) regions. Models suggested that seropositivity was significantly higher in male sex, people older than 25 years, or residing in the Centro NUTS2 region, but not in dog owners nor people with lower KPP scores. Overall, 72.3% of participants had previously heard of leishmaniasis and, in multivariate analysis, a higher Knowledge score was associated with age 25-40 years, female sex, ownership of dogs, and higher education. CONCLUSIONS Global estimated true seroprevalence (4.8%) was similar to previous regional studies in blood donors in neighboring Spain. Higher seroprevalence values in the NUTS2 Centro region were consistent with incidence data from humans and seroprevalence studies in dogs. On the other hand, the low values in the Alentejo and the high values in the northern subregions may be the result of geographical shifts in parasite circulation due to climate change and should prompt localized and integrated, vector, canine, and human research, following a One Health approach.
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Affiliation(s)
- Rafael Rocha
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal
- Centro de Estatística E Aplicações da Universidade de Lisboa (UL), Lisbon, Portugal
- , Z-Stat4life, Lisbon, Portugal
| | - Cláudia Conceição
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal
| | - Patrícia Andrade
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - José Manuel Cristóvão
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal
| | - Jorge Condeço
- Instituto Português Do Sangue E da Transplantação, Lisbon, Portugal
| | - Beatriz Delgado
- Instituto Português Do Sangue E da Transplantação, Lisbon, Portugal
| | - Cristina Caeiro
- Instituto Português Do Sangue E da Transplantação, Lisbon, Portugal
| | - Tetyana Kuzmenko
- Instituto Português Do Sangue E da Transplantação, Lisbon, Portugal
| | | | | | - Carmen Rey
- Centro Hospitalar Universitário Do Algarve, Portimão, Portugal
| | - Madalina Guz
- Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Cláudia Norte
- Unidade Local de Saúde Do Baixo Alentejo, Beja, Portugal
| | - Carlos Aldeia
- Unidade Local de Saúde Do Litoral Alentejano, Santiago Do Cacém, Portugal
| | - Diego Cruz
- Unidade Local de Saúde Do Norte Alentejano, Elvas, Portugal
| | - Carla Maia
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal.
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal.
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Palacios-Diaz RD, Sahuquillo-Torralba A, Rocamora-Durán V, Unamuno-Bustos BD, Salavert-Lleti M, Santos-Alarcón S, Quintero A, Garcías-Ladaria J, Vila-Payeras A, Martínez-Doménech A, Mateu-Puchades A, Nadal-Lladó C, Botella-Estrada R. Klinisch-pathologische Eigenschaften kutaner und mukokutaner Leishmaniose bei mit TNF-α-Inhibitoren behandelten Patienten. J Dtsch Dermatol Ges 2023; 21:473-481. [PMID: 37183744 DOI: 10.1111/ddg.15007_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/03/2023] [Indexed: 05/16/2023]
Affiliation(s)
| | | | | | | | - Miguel Salavert-Lleti
- Infectious Diseases Department, Hospital Universitario y Politécnico La Fe, Valencia, Spanien
| | | | - Adriana Quintero
- Pathology Department, Hospital de Manacor, Illes Baleares, Spanien
| | - Joan Garcías-Ladaria
- Dermatology Department, Hospital Universitario Son Espases, Illes Baleares, Spanien
| | - Aina Vila-Payeras
- Dermatology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Illes Baleares, Spanien
| | | | | | - Cristina Nadal-Lladó
- Dermatology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Illes Baleares, Spanien
| | - Rafael Botella-Estrada
- Dermatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spanien
- Department of Medicine, Universitat de València, Valencia, Spanien
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5
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Underestimation of Human Cutaneous Leishmaniasis Caused by Leishmania infantum in an Endemic Area of the Mediterranean Basin (Balearic Islands). Microorganisms 2023; 11:microorganisms11010126. [PMID: 36677419 PMCID: PMC9867513 DOI: 10.3390/microorganisms11010126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
Leishmaniasis is an infectious zoonotic disease caused by protozoan parasites of the genus Leishmania. In the Mediterranean basin, leishmaniasis is caused by Leishmania infantum and transmitted by bites of sandflies of the genus Phlebotomus, with the dog as the main reservoir host. The most common form is cutaneous leishmaniasis (CL), although visceral cases also occur. The aim of this study was to assess the underestimation of CL in an endemic Mediterranean region. Thus, a retrospective study was performed on all CL cases diagnosed and treated in the Dermatology Service of Manacor Hospital (Majorca, Balearic Islands), and the data obtained were compared with those of local government epidemiological bulletins for the same period. The different clinical presentations were compiled, and data related to sex, age, and lesion type and number were analyzed. The results reveal a clear sub-notification, which indicates that the real incidence of human CL in this area is unknown.
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6
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Valdés Delgado T, Rodríguez Delgado C, Pérez-Pérez M. Mucocutaneous Leishmaniasis Associated With Anti-TNF Therapy: A Case Report. Inflamm Bowel Dis 2022; 28:e3-e4. [PMID: 34417814 DOI: 10.1093/ibd/izab197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- T Valdés Delgado
- Gastroenterology Department, University Hospital Virgen Macarena, Seville, Spain
| | - C Rodríguez Delgado
- Gastroenterology Department, University Hospital Virgen Macarena, Seville, Spain
| | - M Pérez-Pérez
- Pathological Anatomy Department, University Hospital Virgen Macarena, Seville, Spain
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7
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Khattak FA, Akbar NU, Riaz M, Hussain M, Rehman K, Khan SN, Khan TA. Novel IL-β12R1 deficiency-mediates recurrent cutaneous leishmaniasis. Int J Infect Dis 2021; 112:338-345. [PMID: 34438084 DOI: 10.1016/j.ijid.2021.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The IL-12/IFN-γ axis plays a vital role in the control of intramacrophagic pathogens including Leishmania infections. OBJECTIVE The aim of this study was to investigate genetic defects in the IL-12/IFN-γ axis in cutaneous leishmaniasis patients, using immunological and genetic evaluation. METHODS Enzyme-linked immunosorbent assay was used to quantify IFN-γ , while flow cytometry was performed to analyze surface IL-12Rβ1/IL-12Rβ2 expression and phosphorylation of signal transducers as well as the activator of transcription 4 (pSTAT4). Sequencing was carried out for genetic analysis. RESULTS The peripheral blood mononuclear cells from the two patients (P1 and P2) demonstrated impaired production of IFN-γ. Furthermore, abolishment of the surface expression of Il-12Rβ1 was observed in lymphocytes, with consequent impairment of STAT4 phosphorylation in the lymphocytes of P1 and P2. IL-12Rββ1 deficiency was identified, which was caused by a novel homozygous missense mutation (c.485>T/p.P162L) and a novel homozygous nonsense mutation (c.805G>T/P.E269*) in the IL-12Rβ2 gene of P1 and P2, respectively. In silico analyses predicted these novel mutations as being pathogenic, causing truncated proteins, with consequent inactivation. CONCLUSION Our data have expanded the phenotype and mutation spectra associated with IL-12Rβ1 deficiency, and suggest that patients with CL should be screened for mutations in genes of the IL-12/IFN-γ axis.
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Affiliation(s)
- Farhad Ali Khattak
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan; Khyber College of Dentistry, Peshawar, Pakistan.
| | - Noor Ul Akbar
- Department of Zoology, Kohat University of Science and Technology, Kohat, Pakistan.
| | - Maira Riaz
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan.
| | - Mubashir Hussain
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan.
| | - Khalid Rehman
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
| | - Shahid Niaz Khan
- Department of Zoology, Kohat University of Science and Technology, Kohat, Pakistan.
| | - Taj Ali Khan
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan.
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8
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Garcia-Melendo C, Cubiró X, Tubau C, Mozos A, Muñoz C, Puig L. Erythematous plaques with zosteriform distribution in a patient treated with TNF-α inhibitor adalimumab for psoriasis. Int J Dermatol 2021; 60:1366-1367. [PMID: 34138480 DOI: 10.1111/ijd.15710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Cristina Garcia-Melendo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Cubiró
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carla Tubau
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Mozos
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carme Muñoz
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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9
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Di Altobrando A, Misciali C, Raone B, Attard L, Gaspari V. Case Report: Cutaneous Leishmaniasis Misdiagnosed as Pyoderma Gangrenosum. Am J Trop Med Hyg 2020; 104:640-642. [PMID: 33319736 PMCID: PMC7866308 DOI: 10.4269/ajtmh.20-0735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/14/2020] [Indexed: 11/07/2022] Open
Abstract
With an estimated prevalence of 0.7%, pyoderma gangrenosum (PG) is the most frequent type of reactive skin lesions seen in the setting of inflammatory bowel disease, together with metastatic Crohn's disease. However, in the case of persistent cutaneous ulcerations in patients with Crohn's disease under biologic and/or immunosuppressive therapy, infectious or malignant etiologies should be excluded. We report a case of multiple difficult-to-treat skin ulcerations due to Leishmania in a patient with Crohn's disease treated with antitumor necrosis factor-alpha drugs, misinterpreted for a long time as PG.
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Affiliation(s)
- Ambra Di Altobrando
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Beatrice Raone
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luciano Attard
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, St. Orsola Malpighi University Hospital, Bologna, Italy
| | - Valeria Gaspari
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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10
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Shah S, Shelburne S. Skin and Soft Tissue Infections in Non-Human Immunodeficiency Virus Immunocompromised Hosts. Infect Dis Clin North Am 2020; 35:199-217. [PMID: 33303336 DOI: 10.1016/j.idc.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Skin and soft tissue infections among the non-human immunodeficiency virus infected immunosuppressed population are a serious and growing concern. Many pathogens can cause cutaneous infections in these patients owing to the highly varied and profound immune deficits. Although patients can be infected by typical organisms, the diversity and antimicrobial-resistant nature of the organisms causing these infections result in significant morbidity and mortality. The diagnostic approach to these infections in immunocompromised hosts can differ dramatically depending on the potential causative organisms. An understanding of new immunosuppressive treatments and evolving antimicrobial resistance patterns are required to optimally manage these difficult cases.
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Affiliation(s)
- Shivan Shah
- Department of Infectious Diseases, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 1460, Houston, TX 77030, USA
| | - Samuel Shelburne
- Department of Infectious Diseases, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 1460, Houston, TX 77030, USA.
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11
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Ródenas-Herranz T, Linares-González L, Carpena-Martínez I, Pérez-Ramos M, Ruiz-Villaverde R. Cutaneous leishmaniasis induced by TNF-α blockers: a diagnostic challenge. Int J Dermatol 2020; 60:e101-e103. [PMID: 32989744 DOI: 10.1111/ijd.15222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/14/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Miguel Pérez-Ramos
- Pathology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
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12
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Li X, Körner H, Liu X. Susceptibility to Intracellular Infections: Contributions of TNF to Immune Defense. Front Microbiol 2020; 11:1643. [PMID: 32760383 PMCID: PMC7374010 DOI: 10.3389/fmicb.2020.01643] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
An interesting puzzle is the fact that an infection of a tumor necrosis factor α (TNF)-deficient host with pathogens such as bacteria or parasites that reside intracellularly inevitably ends fatally. Is this due to one specific role of TNF in the immune defense or are different functions responsible for this outcome? In this review we provide an update of the functions of TNF in the defense against the intracellular pathogens Listeria monocytogenes, Mycobacterium tuberculosis, and Leishmania major. Furthermore, we discuss the role of TNF in the generation of proinflammatory macrophages in mouse models of infection and summarize briefly the potential consequences of anti-TNF treatment for infectious diseases.
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Affiliation(s)
- Xinying Li
- Translational Research Institute, Academy of Medical Science, Henan Provincial People's Hospital, Zhengzhou, China.,School of Life Sciences, Anhui Medical University, Hefei, China
| | - Heinrich Körner
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Institute of Clinical Pharmacology, Ministry of Education, Engineering Technology Research Center of Anti-inflammatory and Immunodrugs in Anhui Province, Anhui Medical University, Hefei, China
| | - Xiaoying Liu
- Translational Research Institute, Academy of Medical Science, Henan Provincial People's Hospital, Zhengzhou, China.,School of Life Sciences, Anhui Medical University, Hefei, China
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13
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Guillén MC, Alcover MM, Borruel N, Sulleiro E, Salvador F, Berenguer D, Herrera-de Guise C, Rodríguez V, Moure Z, Sánchez-Montalvà A, Molina I, Fisa R, Riera C. Leishmania infantum asymptomatic infection in inflammatory bowel disease patients under anti-TNF therapy. Heliyon 2020; 6:e03940. [PMID: 32420499 PMCID: PMC7218013 DOI: 10.1016/j.heliyon.2020.e03940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/12/2019] [Accepted: 05/04/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In recent years anti-TNF therapy has been associated with leishmaniasis in immunocompromised patients from endemic areas. Nevertheless, data on asymptomatic Leishmania infection in such patients is scarce. The aim of this study was to determine the prevalence of asymptomatic infection in inflammatory bowel disease (IBD) patients treated with TNF inhibitors living in an endemic area (Catalonia) and to follow up them to study how the infection evolved. METHODS 192 IBD patients (143 Crohn's disease; 49 ulcerative colitis) from Catalonia (Spain), an area endemic for L. infantum, were recruited. Peripheral blood samples were collected and tested for anti-Leishmania antibodies by Western blotting (WB). Leishmania kinetoplast DNA was detected in peripheral blood mononuclear cells (PBMC) by a quantitative PCR. RESULTS Serology was positive in 3.1% and Leishmania DNA was found in 8.8%, with a low parasitic load and humoral response. The prevalence was 10.9%, patients being considered infected if they tested positive by at least one of the techniques. Eight out of the 21 patients with asymptomatic leishmaniasis were monitored for 3-8 months after the first test. None of them showed an increased parasitemia or humoral response, or developed leishmaniasis during the follow-up period. CONCLUSION The prevalence of Leishmania asymptomatic infection detected in our IBD cohort is similar to that found in healthy population in close endemic areas. Due to the short monitoring period, it is not possible to reach a conclusion about the risk of Leishmania reactivation from this study.
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Affiliation(s)
- M. Carmen Guillén
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - M. Magdalena Alcover
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - Natalia Borruel
- Crohn's and Colitis Attention Unit, Vall d’Hebron University Hospital, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Diana Berenguer
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - Claudia Herrera-de Guise
- Crohn's and Colitis Attention Unit, Vall d’Hebron University Hospital, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Verónica Rodríguez
- Crohn's and Colitis Attention Unit, Vall d’Hebron University Hospital, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Zaira Moure
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Adrián Sánchez-Montalvà
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Roser Fisa
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - Cristina Riera
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
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14
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Heinemann M, Omansen TF, Hennigs A, Völker K, Menz A, Addo MM, Schmiedel S. Relapsing cutaneous leishmaniasis in a patient requiring TNF-α-inhibitor Infliximab for Takayasu-arteritis: Case report and review of the literature. Travel Med Infect Dis 2020; 37:101700. [PMID: 32339673 DOI: 10.1016/j.tmaid.2020.101700] [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: 07/16/2019] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Abstract
Leishmaniasis is a protozoan parasitic infection that can manifest as visceral or cutaneous disease. Immunosuppression, mainly through TNF-α) inhibition, is a risk factor for complicated leishmaniasis that is becoming increasingly known. Here, we present a case of cutaneous leishmaniasis (CL) in a patient who suffers from advanced Takayasu-Arteritis, requiring TNF-α inhibition with infliximab. The primary CL lesions in this 47-year-old, female patient were caused by Leishmaniapanamensis and occurred after a touristic trip to Panama on her right foot. The lesions first resolved under treatment with liposomal amphotericin B. However, ten months later, the patient returned with relapsing lesions requiring further treatment. We discuss the challenges and risks of leishmaniasis in patients with TNF-α inhibition and the rare phenomenon of relapsing CL and the management hereof. We review published cases of CL associated with TNF-α inhibition. A growing body of evidence now suggests that especially CL (and visceral leishmaniasis (VL)) can be associated with TNF-α inhibition. The host response to leishmaniasis is of the Th1-type and TNF-α and interferon-gamma expression are crucial for disease control. Inversely, TNF-α inhibition can lead to complicated and relapsing progression of leishmanial infection. Therefore, we propose that CL and VL should be considered in at-risk patients receiving immunosuppressants.
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Affiliation(s)
- Melina Heinemann
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till F Omansen
- Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Annette Hennigs
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Völker
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany
| | - Anne Menz
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Garrido-Jareño M, Sahuquillo-Torralba A, Chouman-Arcas R, Castro-Hernández I, Molina-Moreno JM, Llavador-Ros M, Gómez-Ruiz MD, López-Hontangas JL, Botella-Estrada R, Salavert-Lleti M, Pemán-García J. Cutaneous and mucocutaneous leishmaniasis: experience of a Mediterranean hospital. Parasit Vectors 2020; 13:24. [PMID: 31931865 PMCID: PMC6958673 DOI: 10.1186/s13071-020-3901-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients. Methods An eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed. Results A total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013–2017). The incidence of CL and MCL increased from 3.6/100,000 (2006–2012) to 13.58/100,000 (2013–2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported. Conclusions Some interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.
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16
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Bosch-Nicolau P, Ubals M, Salvador F, Sánchez-Montalvá A, Aparicio G, Erra A, Martinez de Salazar P, Sulleiro E, Molina I. Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression. PLoS Negl Trop Dis 2019; 13:e0007708. [PMID: 31469834 PMCID: PMC6742442 DOI: 10.1371/journal.pntd.0007708] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/12/2019] [Accepted: 08/15/2019] [Indexed: 02/02/2023] Open
Abstract
Background Tumor necrosis factor alpha (TNF-α) blockers are recognized as a risk factor for reactivation of granulomatous infections. Leishmaniasis has been associated with the use of these drugs, although few cases have been reported. Methodology We performed a retrospective observational study including patients with confirmed leishmaniasis acquired in the Mediterranean basin that were under TNF-α blockers therapy at the moment of the diagnosis. Patients diagnosed in our hospital from 2008 to 2018 were included. Moreover, a systematic review of the literature was performed and cases fulfilling the inclusion criteria were also included. Principal findings Forty-nine patients were analyzed including nine cases from our series. Twenty-seven (55.1%) cases were male and median age was 55 years. Twenty-five (51%) patients were under infliximab treatment, 20 (40.8%) were receiving adalimumab, 2 (4.1%) etanercept, one (2%) golimumab and one (2%) a non-specified TNF-α blocker. Regarding clinical presentation, 28 (57.1%) presented as cutaneous leishmaniasis (CL), 16 (32.6%) as visceral leishmaniasis (VL) and 5 (10.2%) as mucocutaneous leishmaniasis (MCL). All VL and MCL patients were treated with systemic therapies. Among CL patients, 13 (46.4%) were treated with a systemic drug (11 received L-AmB, one intramuscular antimonials and one miltefosine) while 14 (50%) patients were given local treatment (13 received intralesional pentavalent antimonials, and one excisional surgery). TNF-α blockers were interrupted in 32 patients (65.3%). After treatment 5 patients (10.2%) relapsed. Four patients with a CL (3 initially treated with local therapy maintaining TNF-α blockers and one treated with miltefosine) and one patient with VL treated with L-AmB maintaining TNF-α blockers. Conclusions This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis in endemic population modulating the expression of the disease leading to atypical presentations. According to the cases reported, the best treatment strategy would be a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution. Tumor necrosis factor alpha (TNF-α) blockers are widely used in numerous inflammatory diseases such rheumatoid arthritis, psoriasis or inflammatory bowel diseases. They have been recognized as a risk factor for reactivation of granulomatous infections. Although few cases have been reported, Leishmaniasis has been associated with the use of these drugs. Leishmania infantum is the main causative agent of leishmaniasis in Southern Europe and is prone to produce the visceral form. However, TNF-α has been implicated in the initial events of the infection mediating the disease expression. In our series, we have observed a surprisingly high proportion of cutaneous form (32.6%) and muco-cutaneous form (10.2%). Clinical outcome observed in this series is also unusual. Four cases (14.3%) with cutaneous leishmaniasis who received local therapy relapsed. Among patients with visceral leishmaniasis, one patient who maintained TNF-α blockers therapy relapsed despite etiological treatment. This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis leading to atypical presentations. According to the cases reported we proposed as best treatment strategy a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution.
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Affiliation(s)
- Pau Bosch-Nicolau
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Maria Ubals
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Gloria Aparicio
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alba Erra
- Department of Rheumatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Pablo Martinez de Salazar
- Department of Clinical Microbiology, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Elena Sulleiro
- Department of Clinical Microbiology, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
- * E-mail:
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17
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Martínez‐Doménech A, García‐Legaz‐Martínez M, Magdaleno‐Tapial J, Torrecillas M, Hernández‐Bel P, Ocete Mochón M, Pérez‐Ferriols A, Miquel VA. Anti‐tumour necrosis factor‐associated cutaneous leishmaniasis: a single‐institution experience. Br J Dermatol 2019; 181:403-405. [DOI: 10.1111/bjd.17644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Martínez‐Doménech
- Department of Dermatology Hospital General Universitario de Valencia Avenida Tres Cruces 2 46014 Valencia Spain
| | - M. García‐Legaz‐Martínez
- Department of Dermatology Hospital General Universitario de Valencia Avenida Tres Cruces 2 46014 Valencia Spain
| | - J. Magdaleno‐Tapial
- Department of Dermatology Hospital General Universitario de Valencia Avenida Tres Cruces 2 46014 Valencia Spain
| | - M. Torrecillas
- Department of Microbiology Hospital General Universitario de Valencia Avenida Tres Cruces 2 46014 Valencia Spain
| | - P. Hernández‐Bel
- Department of Dermatology Hospital General Universitario de Valencia Avenida Tres Cruces 2 46014 Valencia Spain
| | - M.D. Ocete Mochón
- Department of Microbiology Hospital General Universitario de Valencia Avenida Tres Cruces 2 46014 Valencia Spain
| | - A. Pérez‐Ferriols
- Department of Dermatology Hospital General Universitario de Valencia Avenida Tres Cruces 2 46014 Valencia Spain
| | - V. Alegre Miquel
- Department of Dermatology Hospital General Universitario de Valencia Avenida Tres Cruces 2 46014 Valencia Spain
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18
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Caroleo B, Migliore A, Cione E, Zampogna S, Perticone F, Sarro GD, Gallelli L. Double Infection in a Patient with Psoriatic Arthritis Under TNF-alpha Blockers Therapy: A Case Report. Curr Drug Saf 2019; 14:147-150. [PMID: 30648521 DOI: 10.2174/1574886314666190114124625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Either direct or indirect tumor necrosis factor (TNF)-alpha blockers are usually used to treat psoriatic arthritis (PA), but their use can increase susceptibility to infectious diseases. CASE PRESENTATION We report a rare case of double skin-knee wound and lung non-tubercular infection in a patient with PA under TNF-alpha blockers therapy. About 1 year after the beginning of adalimumab, a 48-year-old smoker suffering of PA was hospitalized for the skin-knee wound. RESULTS Clinical evaluation and biochemical markers excluded the presence of a systemic disease, and a skin infection sustained by leishmaniasis probably related to adalimumab was diagnosed (Naranjo score: 6). Adalimumab was discontinued and oral treatment with apremilast and topical treatment with meglumine antimoniate was started with a complete remission of skin wound in 2 weeks. About 7 months later when the patient was under apremilast treatment, he presented to our observation for dyspnea, cough and fever. High-Resolution Computer Tomography (HRCT) chest highlighted alveolar involvement with centrilobular small nodules, branching linear and nodular opacities. Microbiological culture of both broncho-alveolar lavage fluid and sputum documented an infection sustained by nontuberculous mycobacteria. Even if apremilast treatment probably-induced lung infection, we can't exclude that it worsened a clinical condition induced by adalimumab. Apremilast was stopped and an empirical antitubercular treatment was started. Patient's breathlessness and cough improved as confirmed also by HRCT chest. CONCLUSION This case highlights the importance to consider the possibility to develop leishmaniasis and/or non-tubercular mycobacterial infection in patients treated with TNF-alpha inhibitors.
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Affiliation(s)
- Benedetto Caroleo
- Department of Medical and Surgical Science, School of Medicine, University of Catanzaro and Elderly Disease Operative Unit Mater Domini Hospital, Catanzaro, Italy
| | | | - Erika Cione
- Department of Pharmacy Health and Nutritional Sciences, University of Calabria, Rende, Cosenza, Italy
| | - Stefania Zampogna
- Operative Unit of Pediatric diseases, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Science, School of Medicine, University of Catanzaro and Elderly Disease Operative Unit Mater Domini Hospital, Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Health Science, University of Catanzaro and Clinical Pharmacology and Pharmacovigilance Operative Unit, Mater Domini Hospital, Catanzaro, Italy
| | - Luca Gallelli
- Department of Health Science, University of Catanzaro and Clinical Pharmacology and Pharmacovigilance Operative Unit, Mater Domini Hospital, Catanzaro, Italy
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19
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Hernandez Bel L, Hernández Garfella ML, Chiarri Toumit C, Valenzuela Oñate C. Anti-tumour necrosis factor-induced cutaneous leishmaniasis in patient with psoriatic arthritis and uveitis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2018; 93:621-622. [PMID: 30100239 DOI: 10.1016/j.oftal.2018.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/30/2018] [Indexed: 06/08/2023]
Affiliation(s)
- L Hernandez Bel
- Servicio de Oftalmología, Hospital General de Valencia, Valencia, España.
| | | | - C Chiarri Toumit
- Servicio de Oftalmología, Hospital General de Valencia, Valencia, España
| | - C Valenzuela Oñate
- Servicio de Dermatología, Hospital General de Valencia, Valencia, España
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20
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Nieto Gómez P, Casas Hidalgo I, Casas Hidalgo MDLP, Álvarez Sánchez R, Rodríguez Delgado A, Cabeza-Barrera J. Cutaneous leishmaniasis associated with TNF-α blockers: a case report. Eur J Hosp Pharm 2018; 26:233-234. [PMID: 31338176 DOI: 10.1136/ejhpharm-2018-001521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/09/2018] [Accepted: 04/26/2018] [Indexed: 11/04/2022] Open
Abstract
Leishmaniasis is a chronic protozoan disease that is found in diverse geographical areas of the world. Leishmania spp. are endemic in the Mediterranean coasts of southern Europe. Tumour necrosis factor alpha (TNF-α) plays an important role in the defence of the host against infection by Leishmania spp. In this case report we describe Leishmania infection caused by a monoclonal antibody against TNF-α: infliximab. A 51-year-old patient with psoriatic arthritis treated with infliximab, 5 mg/kg every 6 weeks as immunomodulatory treatment and methotrexate 10 mg weekly as a conventional disease-modifying antirheumatic drug, visited his otorhinolaryngologist owing to a lesion in his left nostril. The lesion was diagnosed as cutaneous leishmaniasis so treatment with infliximab was suspended. The patient was then treated with liposomal amphotericin B and showed a total recovery of the lesion; liposomal amphotericin B was maintained at 5 mg/kg monthly.
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Affiliation(s)
- Pelayo Nieto Gómez
- Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, Spain
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21
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Alcover MM, Rocamora V, Guillén MC, Berenguer D, Cuadrado M, Riera C, Fisa R. Case Report: Diffuse Cutaneous Leishmaniasis by Leishmania infantum in a Patient Undergoing Immunosuppressive Therapy: Risk Status in an Endemic Mediterranean Area. Am J Trop Med Hyg 2018; 98:1313-1316. [PMID: 29582737 DOI: 10.4269/ajtmh.17-0769] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This case report highlights the risk of severe cutaneous leishmaniasis (CL) by Leishmania infantum in patients undergoing immunosuppressant therapy who either live in an endemic area or are visiting in the transmission season. The case patient, resident in Majorca (Balearic Islands), presented 12 disseminated erythematous skin lesions, 1-6 cm in diameter, located on the scalp, cheek, umbilical region, and lower extremities 8 years after undergoing anti-tumor necrosis factor (TNF) therapy. Parasite presence in peripheral blood and high levels of specific antibodies were also observed, indicating a possible risk of CL shifting toward a visceral infection. However, once CL was diagnosed, anti-TNF therapy was discontinued and liposomal amphotericin B was administered, resulting in a complete healing of lesions, no Leishmania DNA detection in blood, and an important serological decrease in antibodies. The lack of data on the supposed epidemiological association between leishmaniasis and immunosuppressive therapy highlights the importance of implementing surveillance systems in endemic areas. No obvious relationship was found based on the data provided by the Balearic Islands Epidemiological System, in contrast with data reported in nearby endemic areas. This indicates that if the suspected association is to be clarified, greater efforts are needed to report information about concomitant diseases and therapies in leishmaniasis patients.
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Affiliation(s)
- M Magdalena Alcover
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Vicenç Rocamora
- Department of Dermatology, Hospital de Manacor, Balearic Islands, Spain
| | - M Carmen Guillén
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Diana Berenguer
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Marta Cuadrado
- Department of Pathology, Hospital de Manacor, Balearic Islands, Spain
| | - Cristina Riera
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Roser Fisa
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
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22
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Miró G, López-Vélez R. Clinical management of canine leishmaniosis versus human leishmaniasis due to Leishmania infantum: Putting "One Health" principles into practice. Vet Parasitol 2018; 254:151-159. [PMID: 29657002 DOI: 10.1016/j.vetpar.2018.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/02/2018] [Indexed: 11/20/2022]
Abstract
The initiative One World, "One Health" tries to rapidly detect emerging or reemerging human and animal infectious diseases and prevent epidemiological situations such as deforestation, some agricultural practices or the appearance of new foci of leishmaniosis due to Leishmania infantum with alternative reservoirs. With this objective in mind, we here consider leishmaniosis in the Mediterranean basin and compare its current clinical management from two perspectives: that of a veterinarian specialized in infectious and parasitic diseases, and that of a physician specialized in infectious tropical diseases. We thus prepared a list of 10 key questions from epidemiology to control of the disease in both species: dogs and humans. This issue requires a concise and clear response to help animal and human health clinicians to improve their clinical management and understanding of this important zoonosis. Our ultimate aim is to update and bring together the information available backed by sound scientific evidence.
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Affiliation(s)
- Guadalupe Miró
- Department of Animal Health, Veterinary Faculty, Universidad Complutense de Madrid, Madrid, Spain.
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Madrid, Spain
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Te Velde AA. The C-Type Lectin Mincle: Clues for a Role in Crohn's Disease Adjuvant Reaction. Front Immunol 2017; 8:1304. [PMID: 29109721 PMCID: PMC5660320 DOI: 10.3389/fimmu.2017.01304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/27/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Anje A Te Velde
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, Netherlands
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