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de Pablo E, O'Connell P, Fernández-García R, Marchand S, Chauzy A, Tewes F, Dea-Ayuela MA, Kumar D, Bolás F, Ballesteros MP, Torrado JJ, Healy AM, Serrano DR. Targeting lung macrophages for fungal and parasitic pulmonary infections with innovative amphotericin B dry powder inhalers. Int J Pharm 2023; 635:122788. [PMID: 36863544 DOI: 10.1016/j.ijpharm.2023.122788] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/04/2023]
Abstract
The incidence of fungal pulmonary infections is known to be on the increase, and yet there is an alarming gap in terms of marketed antifungal therapies that are available for pulmonary administration. Amphotericin B (AmB) is a highly efficient broad-spectrum antifungal only marketed as an intravenous formulation. Based on the lack of effective antifungal and antiparasitic pulmonary treatments, the aim of this study was to develop a carbohydrate-based AmB dry powder inhaler (DPI) formulation, prepared by spray drying. Amorphous AmB microparticles were developed by combining 39.7 % AmB with 39.7 % γ-cyclodextrin, 8.1 % mannose and 12.5 % leucine. An increase in the mannose concentration from 8.1 to 29.8 %, led to partial drug crystallisation. Both formulations showed good in vitro lung deposition characteristics (80 % FPF < 5 µm and MMAD < 3 µm) at different air flow rates (60 and 30 L/min) when used with a DPI, but also during nebulisation upon reconstitution in water.
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Affiliation(s)
- E de Pablo
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - P O'Connell
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
| | - R Fernández-García
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - S Marchand
- UMR 1070, Université de PoitiersPôle Biologie Santé, 1, Rue Georges Bonnet, 86073 Poitiers, France; Laboratoire de Toxicologie-Pharmacocinétique, CHU de Poitiers, 2, Rue de la milétrie, 86021 Poitiers, France
| | - A Chauzy
- UMR 1070, Université de PoitiersPôle Biologie Santé, 1, Rue Georges Bonnet, 86073 Poitiers, France
| | - F Tewes
- UMR 1070, Université de PoitiersPôle Biologie Santé, 1, Rue Georges Bonnet, 86073 Poitiers, France; Laboratoire de Toxicologie-Pharmacocinétique, CHU de Poitiers, 2, Rue de la milétrie, 86021 Poitiers, France
| | - M A Dea-Ayuela
- Pharmacy Department, School of Life Sciences, Universidad Cardenal Herrera-CEU, Moncada 46113 Valencia, Spain
| | - D Kumar
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, India
| | - F Bolás
- Parasitology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - M P Ballesteros
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto Universitario de Farmacia Industrial, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - J J Torrado
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto Universitario de Farmacia Industrial, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - A M Healy
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
| | - D R Serrano
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto Universitario de Farmacia Industrial, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain.
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2
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Tanida K, Balczun C, Hahn A, Veit A, Nickel B, Poppert S, Scheid PL, Hagen RM, Frickmann H, Loderstädt U, Tannich E. Comparison of Three In-House Real PCR Assays Targeting Kinetoplast DNA, the Small Subunit Ribosomal RNA Gene and the Glucose-6-Phosphate Isomerase Gene for the Detection of Leishmania spp. in Human Serum. Pathogens 2021; 10:pathogens10070826. [PMID: 34209257 PMCID: PMC8308501 DOI: 10.3390/pathogens10070826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
To perform PCR from serum for the diagnosis of visceral leishmaniasis is convenient and much less invasive than the examination of deeper compartments such as bone marrow. We compared three Leishmania-specific real-time PCRs with three different molecular targets (kinetoplast DNA, the small subunit-ribosomal RNA-(ssrRNA-)gene, the glucose-6-phosphate isomerase-(gpi-)gene) regarding their sensitivity and specificity in human serum. Residual sera from previous diagnostic assessments at the German National Reference Center for Tropical Pathogens Bernhard Nocht Institute for Tropical Medicine Hamburg and the Swiss Tropical and Public Health Institute were used. The sensitivities of kinetoplast DNA-PCR, ssrRNA-gene PCR, and gpi-PCR were 93.3%, 73.3%, and 33.3%, respectively, with 15 initial serum samples from visceral leishmaniasis patients, as well as 9.1%, 9.1%, and 0.0%, respectively, with 11 follow-up serum samples taken at various time points following anti-leishmanial therapy. Specificity was 100.0% in all assays as recorded with 1.137 serum samples from deployed soldiers and migrants without clinical suspicion of visceral leishmaniasis. Kinetoplast-DNA PCR from serum was confirmed as a sensitive and specific approach for the diagnosis of visceral leishmaniasis. The results also indicate the suitability of serum PCR for diagnostic follow-up after therapy, in particular regarding therapeutic failure in case of persisting positive PCR results.
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Affiliation(s)
- Konstantin Tanida
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
| | - Carsten Balczun
- Department XXI, Microbiology and Hospital Hygiene, Section B, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany; (C.B.); (P.L.S.); (R.M.H.)
| | - Andreas Hahn
- Department of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany;
| | - Alexandra Veit
- Bernhard Nocht Institute for Tropical Medicine Hamburg, National Reference Centre for Tropical Pathogens, 20359 Hamburg, Germany; (A.V.); (E.T.)
| | - Beatrice Nickel
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland; (B.N.); (S.P.)
- University of Basel, 4001 Basel, Switzerland
| | - Sven Poppert
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland; (B.N.); (S.P.)
- University of Basel, 4001 Basel, Switzerland
| | - Patrick Leander Scheid
- Department XXI, Microbiology and Hospital Hygiene, Section B, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany; (C.B.); (P.L.S.); (R.M.H.)
| | - Ralf Matthias Hagen
- Department XXI, Microbiology and Hospital Hygiene, Section B, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany; (C.B.); (P.L.S.); (R.M.H.)
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
- Department of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany;
- Correspondence: ; Tel.: +49-40-6947-28743
| | - Ulrike Loderstädt
- Department of Hospital Hygiene & Infectious Diseases, University Medicine Göttingen, 37075 Göttingen, Germany;
| | - Egbert Tannich
- Bernhard Nocht Institute for Tropical Medicine Hamburg, National Reference Centre for Tropical Pathogens, 20359 Hamburg, Germany; (A.V.); (E.T.)
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Elmahallawy EK, Alkhaldi AAM, Saleh AA. Host immune response against leishmaniasis and parasite persistence strategies: A review and assessment of recent research. Biomed Pharmacother 2021; 139:111671. [PMID: 33957562 DOI: 10.1016/j.biopha.2021.111671] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 12/13/2022] Open
Abstract
Leishmaniasis, a neglected parasitic disease caused by a unicellular protozoan of the genus Leishmania, is transmitted through the bite of a female sandfly. The disease remains a major public health problem and is linked to tropical and subtropical regions, with an endemic picture in several regions, including East Africa, the Mediterranean basin and South America. The different causative species display a diversity of clinical presentations; therefore, the immunological data on leishmaniasis are both scarce and controversial for the different forms and infecting species of the parasite. The present review highlights the main immune parameters associated with leishmaniasis that might contribute to a better understanding of the pathogenicity of the parasite and the clinical outcomes of the disease. Our aim was to provide a concise overview of the immunobiology of the disease and the factors that influence it, as this knowledge may be helpful in developing novel chemotherapeutic and vaccine strategies.
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Affiliation(s)
- Ehab Kotb Elmahallawy
- Department of Zoonoses, Faculty of Veterinary Medicine, Sohag University, Sohag 82524, Egypt.
| | | | - Amira A Saleh
- Department of Medical Parasitology, Faculty of Medicine, Zagazig University, Zgazig, Egypt
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An immunoproteomics approach to identify Leishmania infantum proteins to be applied for the diagnosis of visceral leishmaniasis and human immunodeficiency virus co-infection. Parasitology 2020; 147:932-939. [PMID: 32308186 DOI: 10.1017/s0031182020000578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The co-infection between visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) has increased in several countries in the world. The current serological tests are not suitable since they present low sensitivity to detect the most of VL/HIV cases, and a more precise diagnosis should be performed. In this context, in the present study, an immunoproteomics approach was performed using Leishmania infantum antigenic extracts and VL, HIV and VL/HIV patients sera, besides healthy subjects samples; aiming to identify antigenic markers for these clinical conditions. Results showed that 43 spots were recognized by antibodies in VL and VL/HIV sera, and 26 proteins were identified by mass spectrometry. Between them, β-tubulin was expressed, purified and tested in ELISA experiments as a proof of concept for validation of our immunoproteomics findings and results showed high sensitivity and specificity values to detect VL and VL/HIV patients. In conclusion, the identified proteins in the present work could be considered as candidates for future studies aiming to improvement of the diagnosis of VL and VL/HIV co-infection.
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Bispo AJB, Almeida MLD, de Almeida RP, Bispo Neto J, de Oliveira Brito AV, França CM. Pulmonary involvement in human visceral leishmaniasis: Clinical and tomographic evaluation. PLoS One 2020; 15:e0228176. [PMID: 31999729 PMCID: PMC6992183 DOI: 10.1371/journal.pone.0228176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022] Open
Abstract
Visceral leishmaniasis (VL) is a severe, systemic and potentially lethal parasitosis. The lung, like any other organ, can be affected in VL, and interstitial pneumonitis has been described in past decades. This research aimed to bring more recent knowledge about respiratory impairment in VL, characterizing pulmonary involvement through clinical, radiographic and tomographic evaluation. This is an observational, cross-sectional study that underwent clinical evaluation, radiography and high-resolution computed tomography of the chest in patients admitted with the diagnosis of VL in a university service in Northeast Brazil, from January 2015 to July 2018. The sample consisted of 42 patients. Computed tomography was considered abnormal in 59% of patients. Images compatible with pulmonary interstitial involvement were predominant (50%). The most observed respiratory symptom was cough (33.3%), followed by tachypnea (14.1%). Chest radiography was altered in only four patients. VL is a disease characterized by systemic involvement and broad spectrum of clinical manifestations. The respiratory symptoms and tomographic alterations found show that the involvement of respiratory system in VL deserves attention because it is more common than previously thought. Chest X-ray may not reveal this impairment.
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Affiliation(s)
- Ana Jovina Barreto Bispo
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- * E-mail:
| | - Maria Luiza Dória Almeida
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Medical College of the Federal University of Sergipe, Department of Medicine, Aracaju, Sergipe, Brazil
| | - Roque Pacheco de Almeida
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Medical College of the Federal University of Sergipe, Department of Medicine, Aracaju, Sergipe, Brazil
| | - José Bispo Neto
- Radiology Service, University Hospital, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Camila Mendonça França
- Medical College of the Federal University of Sergipe, Department of Medicine, Aracaju, Sergipe, Brazil
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Rashidi S, Mojtahedi Z, Shahriari B, Kalantar K, Ghalamfarsa G, Mohebali M, Hatam G. An immunoproteomic approach to identifying immunoreactive proteins in Leishmania infantum amastigotes using sera of dogs infected with canine visceral leishmaniasis. Pathog Glob Health 2019; 113:124-132. [PMID: 31099725 DOI: 10.1080/20477724.2019.1616952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Visceral leishmaniasis (VL), the most severe form of leishmaniasis, is caused by Leishmania donovani and Leishmania infantum. The infected dogs with canine visceral leishmaniasis (CVL) are important reservoirs for VL in humans, so the diagnosis, treatment and vaccination of the infected dogs will ultimately decrease the rate of human VL. Proteomics and immunoproteomics techniques have facilitated the introduction of novel drug, vaccine and diagnostic targets. Our immunoproteomic study was conducted to identify new immunoreactive proteins in amastigote form of L. infantum. The strain of L. infantum (MCAN/IR/07/Moheb-gh) was obtained from CVL-infected dogs. J774 macrophage cells were infected with the L. infantum promastigotes. The infected macrophages were ruptured, and pure amastigotes were extracted from the macrophages. After protein extraction, two-dimensional gel electrophoresis was employed for protein separation followed by Western blotting. Western blotting was performed, using symptomatic and asymptomatic sera of the infected dogs with CVL. Thirteen repeatable immunoreactive spots were identified by Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Some, including prohibitin, ornithine aminotransferase, annexin A4, and apolipoprotein A-I, have been critically involved in metabolic pathways, survival, and pathogenicity of Leishmania parasites. Further investigations are required to confirm our identified immunoreactive proteins as a biomarker for CVL.
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Affiliation(s)
- Sajad Rashidi
- a Department of Parasitology and Mycology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Zahra Mojtahedi
- b Institute for Cancer Research, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Bahador Shahriari
- c Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Kurosh Kalantar
- d Department of Immunology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Ghasem Ghalamfarsa
- e Medicinal Plants Research Center, Faculty of Medicine , Yasuj University of Medical Sciences , Yasuj , Iran
| | - Mehdi Mohebali
- f Department of Medical Parasitology and Mycology , School of Public Health, Tehran University of Medical Sciences , Tehran , Iran
| | - Gholamreza Hatam
- c Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences , Shiraz , Iran
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Henn GADL, Ramos Júnior AN, Colares JKB, Mendes LP, Silveira JGC, Lima AAF, Aires BP, Façanha MC. Is Visceral Leishmaniasis the same in HIV-coinfected adults? Braz J Infect Dis 2018; 22:92-98. [PMID: 29601790 PMCID: PMC9428234 DOI: 10.1016/j.bjid.2018.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/02/2018] [Accepted: 03/08/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Visceral Leishmaniasis is the most severe form of disease caused by the Leishmania donovani complex, with significant morbidity and mortality in developing countries. Worse outcomes occur among HIV-positive individuals coinfected with Leishmania. It is unclear, however, if there are significant differences on presentation between Visceral Leishmaniasis patients with or without HIV coinfection. Methods We reviewed medical records from adult patients with Visceral Leishmaniasis treated at a reference healthcare center in Fortaleza – Ceará, Brazil, from July 2010 to December 2013. Data from HIV-coinfected patients have been abstracted and compared to non-HIV controls diagnosed with Visceral Leishmaniasis in the same period. Results Eighty one HIV-infected patients and 365 controls were enrolled. The diagnosis in HIV patients took significantly longer, with higher recurrence and death rates. Kala-azar's classical triad (fever, constitutional symptoms and splenomegaly) was less frequently observed in Visceral Leishmaniasis-HIV patients, as well as jaundice and edema, while diarrhea was more frequent. Laboratory features included lower levels of hemoglobin, lymphocyte counts and liver enzymes, as well as higher counts of blood platelets and eosinophils. HIV-infected patients were diagnosed mainly through amastigote detection on bone marrow aspirates and treated more often with amphotericin B formulations, whereas in controls, rK39 was the main diagnostic tool and pentavalent antimony was primarily used for treatment. Conclusions Clinical and laboratory presentation of Visceral Leishmaniasis in HIV-coinfected patients may differ from classic kala-azar, and these differences may be, in part, responsible for the delay in diagnosing and treating leishmaniasis, which might lead to worse outcomes.
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Affiliation(s)
- Guilherme Alves de Lima Henn
- Universidade Federal do Ceará, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, CE, Brazil; Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil.
| | | | - Jeová Keny Baima Colares
- Secretaria de Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil; Universidade de Fortaleza, Faculdade de Medicina, Fortaleza, CE, Brazil
| | - Lorena Pinho Mendes
- Secretaria de Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil
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Echchakery M, Nieto J, Boussaa S, El Fajali N, Ortega S, Souhail K, Aajly H, Chicharro C, Carrillo E, Moreno J, Boumezzough A. Asymptomatic carriers of Leishmania infantum in patients infected with human immunodeficiency virus (HIV) in Morocco. Parasitol Res 2018; 117:1237-1244. [PMID: 29478175 DOI: 10.1007/s00436-018-5805-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/08/2018] [Indexed: 02/02/2023]
Abstract
In Morocco, visceral leishmaniasis (VL) is a parasitic disease caused by the flagellated protozoan parasite Leishmania infantum. L. infantum is transmitted by the bite of female phlebotomine sandflies, and its main reservoir hosts are domestic dogs. Asymptomatic infection with L. infantum is more frequent than clinically apparent disease. In HIV-infected patients, the risk of clinical VL is increased due to immunosuppression that may reactivate latent infections. However, coinfected subjects do not necessarily develop VL and may remain as asymptomatic carriers depending on their immune status. The present study investigates the asymptomatic carriers of L. infantum in HIV-infected patients in central Morocco, where human cases of visceral leishmaniasis by L. infantum have been reported. A total of 200 HIV-infected patients attending the Infectious Diseases Unit of the Ibn Zohar Hospital of Marrakech participated in the study. Parasitological and serological blood analyses included a direct microscopic examination (DME), culture in Novy-McNeal-Nicolle (NNN) medium, and serology by indirect immunofluorescence (IFI). We found prevalence rates of 5% (10/200) by IFI, 3% (6/200) by DME, and 2.5% (5/200) by culture. The parasite was identified as L. infantum by PCR from positive cultures.
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Affiliation(s)
- M Echchakery
- Laboratory of Medical Analysis, Ibn Zohr Regional Hospital Center, Marrakech, Morocco.,Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - J Nieto
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - S Boussaa
- Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco. .,ISPITS-Higher Institute of Nursing and Health Technology, Marrakech, Morocco.
| | - N El Fajali
- Department of Infectious Diseases, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - S Ortega
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - K Souhail
- Laboratory of Medical Analysis, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - H Aajly
- Department of Infectious Diseases, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - C Chicharro
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - E Carrillo
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - J Moreno
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - A Boumezzough
- Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
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Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63:e202-e264. [PMID: 27941151 DOI: 10.1093/cid/ciw670] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
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10
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Worldwide risk factors in leishmaniasis. ASIAN PAC J TROP MED 2016; 9:925-932. [PMID: 27794384 DOI: 10.1016/j.apjtm.2016.06.021] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/01/2016] [Accepted: 06/10/2016] [Indexed: 11/22/2022] Open
Abstract
Recently, vector-borne parasitic diseases such as leishmaniasis have been emerged or re-emerged in many geographical areas and resulted in global health and economic concerns that involve humans, domestic animals and wild life. The ecology and epidemiology of leishmaniasis are affected by the between host, reservoir and vector (human, animal and sandfly) and the environment. Important drivers for the emergence and spread of leishmaniasis include environmental factors such as alterations in temperature and water storage, irrigation habits, deforestation, climate changes, immunosuppression by HIV or organ transplant, development of drug resistance, increase traveling to endemic regions and dog importation. War, poor socio-economic status and low level household are also major contributors to the spread of this disease. Health education via the public media and training should be implemented by international organizations and governmental agencies in collaboration with research institutions. Fully protection during transmission season, using bednets and insecticides and reservoirs' control should be also mentioned in the planning. Based on the findings of the recent studies and high prevalence of leishmaniasis, it is concluded that serious public health monitoring should be considered.
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Diro E, Lynen L, Gebregziabiher B, Assefa A, Lakew W, Belew Z, Hailu A, Boelaert M, van Griensven J. Clinical aspects of paediatric visceral leishmaniasis in North-west Ethiopia. Trop Med Int Health 2014; 20:8-16. [PMID: 25329449 DOI: 10.1111/tmi.12407] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Visceral leishmaniasis (VL) in north-west Ethiopia is causing an overwhelming case load among adult migrant workers that masked the disease burden in children. This study describes the clinical profile and explores comorbidities in paediatric VL patients. METHODS A prospective study at two hospitals in this region (Gondar and Humera) was conducted in a year period, 2011-2012. The clinical manifestations and comorbidities such as malnutrition, intestinal parasitosis and vitamin D deficiency and HIV infection were assessed, and treatment outcomes noted. RESULTS A total of 122 children with VL were detected during the study period with median age of 8.5 years (IQR 5-12 years); 23% were under 5 years. Eighty-five (69.7%) cases were male. The clinical manifestations were similar to the adult patients. High rates of malnutrition, intestinal parasitosis (47.5%) and hypovitaminosis D (56.4%) were detected. The proportion of stunting and wasting was 63% and 22.2% in children aged under five years, and 50.5% and 75.9% in 5-year and older children, respectively, using WHO standard growth curves. Only one child had HIV infection. In 95% of the cases, sodium stibogluconate (20 mg/kg/day for 30 days) was used for treatment. The treatment success rate at end of therapy was 98.3%, but the definitive outcome at 6 months could not be determined because of a high loss to follow-up (80.2%). CONCLUSION While HIV co-infection was rare, malnutrition, intestinal parasitosis and vitamin D deficiency were frequent indicating the need for further research on their role in the pathophysiology. Meanwhile, systematic assessment and management of malnutrition and intestinal parasitosis in VL programmes is recommended.
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Affiliation(s)
- Ermias Diro
- University of Gondar, Gondar, Ethiopia; Institute of Tropical Medicine, Antwerp, Belgium
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Abstract
Visceral leishmaniasis is a chronic parasitic disease associated with severe immune dysfunction. Treatment options are limited to relatively toxic drugs, and there is no vaccine for humans available. Hence, there is an urgent need to better understand immune responses following infection with Leishmania species by studying animal models of disease and clinical samples from patients. Here, we review recent discoveries in these areas and highlight shortcomings in our knowledge that need to be addressed if better treatment options are to be developed and effective vaccines designed.
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Cheepsattayakorn A, Cheepsattayakorn R. Parasitic pneumonia and lung involvement. BIOMED RESEARCH INTERNATIONAL 2014; 2014:874021. [PMID: 24995332 PMCID: PMC4068046 DOI: 10.1155/2014/874021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 11/17/2022]
Abstract
Parasitic infestations demonstrated a decline in the past decade as a result of better hygiene practices and improved socioeconomic conditions. Nevertheless, global immigration, increased numbers of the immunocompromised people, international traveling, global warming, and rapid urbanization of the cities have increased the susceptibility of the world population to parasitic diseases. A number of new human parasites, such as Plasmodium knowlesi, in addition to many potential parasites, have urged the interest of scientific community. A broad spectrum of protozoal parasites frequently affects the respiratory system, particularly the lungs. The diagnosis of parasitic diseases of airway is challenging due to their wide varieties of clinical and roentgenographic presentations. So detailed interrogations of travel history to endemic areas are critical for clinicians or pulmonologists to manage this entity. The migrating adult worms can cause mechanical airway obstruction, while the larvae can cause airway inflammation. This paper provides a comprehensive review of both protozoal and helminthic infestations that affect the airway system, particularly the lungs, including clinical and roentgenographic presentations, diagnostic tests, and therapeutic approaches.
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Affiliation(s)
- Attapon Cheepsattayakorn
- 10th Zonal Tuberculosis and Chest Disease Center, Chiang Mai, Thailand
- 10th Office of Disease Prevention and Control, Department of Disease Control, Ministry of Public Health, Chiang Mai 50100, Thailand
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Cota GF, de Sousa MR, de Mendonça ALP, Patrocinio A, Assunção LS, de Faria SR, Rabello A. Leishmania-HIV co-infection: clinical presentation and outcomes in an urban area in Brazil. PLoS Negl Trop Dis 2014; 8:e2816. [PMID: 24743472 PMCID: PMC3990491 DOI: 10.1371/journal.pntd.0002816] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/10/2014] [Indexed: 11/24/2022] Open
Abstract
Background Visceral leishmaniasis (VL) is an emerging condition affecting HIV-infected patients living in Latin America, particularly in Brazil. Leishmania-HIV coinfection represents a challenging diagnosis because the clinical picture of VL is similar to that of other disseminated opportunistic diseases. Additionally, coinfection is related to treatment failure, relapse and high mortality. Objective To assess the clinical-laboratory profile and outcomes of VL-HIV-coinfected patients using a group of non HIV-infected patients diagnosed with VL during the same period as a comparator. Methods The study was conducted at a reference center for infectious diseases in Brazil. All patients with suspected VL were evaluated in an ongoing cohort study. Confirmed cases were divided into two groups: with and without HIV coinfection. Patients were treated according to the current guidelines of the Ministry of Health of Brazil, which considers antimony as the first-choice therapy for non HIV-infected patients and recommends amphotericin B for HIV-infected patients. After treatment, all patients with CD4 counts below 350 cells/mm3 received secondary prophylaxis with amphotericin B. Results Between 2011 and 2013, 168 patients with suspected VL were evaluated, of whom 90 were confirmed to have VL. In total, 51% were HIV coinfected patients (46 patients). HIV-infected patients had a lower rate of fever and splenomegaly compared with immunocompetent patients. The VL relapse rate in 6 months was 37% among HIV-infected patients, despite receiving secondary prophylaxis. The overall case-fatality rate was 6.6% (4 deaths in the HIV-infected group versus 2 deaths in the non HIV-infected group). The main risk factors for a poor outcome at 6 months after the end of treatment were HIV infection, bleeding and a previous VL episode. Conclusion Although VL mortality rates among HIV-infected individuals are close to those observed among immunocompetent patients treated with amphotericin B, HIV coinfection is related to a low clinical response and high relapse rates within 6 months. Visceral leishmaniasis (VL) is of a higher clinical importance as an opportunistic infection in individuals infected with HIV (human immunodeficiency virus type-1) in areas where both infections are endemic. Co-infected patients classically present a chronic clinical course, with high rates of treatment failure and relapse. Differences in the clinical presentation of VL between HIV-infected and uninfected patients and the factors related to an unfavorable outcome remain rarely studied. In this work, the clinical and laboratory characteristics of patients with VL were compared according to HIV infection status, and the main determinants of a poor outcome at 6 months were identified.
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Affiliation(s)
- Gláucia F. Cota
- Laboratory of Clinical Research – Centro de Pesquisas René Rachou - Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
- Eduardo de Menezes Hospital – Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Marcos R. de Sousa
- Post-Graduate Program in Adult Health Sciences - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Allan Patrocinio
- Eduardo de Menezes Hospital – Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil
| | - Luiza Siqueira Assunção
- Eduardo de Menezes Hospital – Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil
| | - Sidnei Rodrigues de Faria
- Eduardo de Menezes Hospital – Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Laboratory of Clinical Research – Centro de Pesquisas René Rachou - Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
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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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Five-year retrospective Italian multicenter study of visceral leishmaniasis treatment. Antimicrob Agents Chemother 2013; 58:414-8. [PMID: 24189252 DOI: 10.1128/aac.00840-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The treatment of visceral leishmaniasis (VL) is poorly standardized in Italy in spite of the existing evidence. All consecutive patients with VL admitted at 15 Italian centers as inpatients or outpatients between January 2004 and December 2008 were retrospectively considered; outcome data at 1 year after treatment were obtained for all but 1 patient. Demographic characteristics, underlying diseases, diagnostic procedures, treatment regimens and outcomes, as well as side effects were recorded. A confirmed diagnosis of VL was reported for 166 patients: 120 (72.3%) immunocompetent, 21 (12.6%) patients with immune deficiencies other than HIV infection, and 25 (15.1%) coinfected with HIV. Liposomal amphotericin B (L-AmB) was the drug almost universally used for treatment, administered to 153 (92.2%) patients. Thirty-seven different regimens, including L-AmB were used. The mean doses were 29.4 ± 7.9 mg/kg in immunocompetent patients, 32.9 ± 8.6 mg/kg in patients with non-HIV-related immunodeficiencies, and 40.8 ± 6.7 mg/kg in HIV-infected patients (P < 0.001). The mean numbers of infusion days were 7.8 ± 3.1 in immunocompetent patients, 9.6 ± 3.9 in non-HIV-immunodeficient patients, and 12.0 ± 3.4 in HIV-infected patients (P < 0.001). Mild and reversible adverse events were observed in 12.2% of cases. Responsive patients were 154 (93.3%). Successes were 98.4% among immunocompetent patients, 90.5% among non-HIV-immunodeficient patients, and 72.0% among HIV-infected patients. Among predictors of primary response to treatment, HIV infection and age held independent associations in the final multivariate models, whereas the doses and duration of L-AmB treatment were not significantly associated. Longer treatments and higher doses of L-AmB were not able to significantly modify treatment outcomes either in the immunocompetent or in the immunocompromised population.
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Lima IP, Müller MC, Holanda TA, Harhay M, Costa CHN, Costa DL. Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010. Rev Soc Bras Med Trop 2013; 46:156-60. [PMID: 23666663 DOI: 10.1590/0037-8682-0033-2012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/07/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) coinfection with Leishmania infantum or Leishmania donovani, the agents of visceral leishmaniasis (or kala-azar), has become a fatal public health problem in the tropics where kala-azar is endemic. METHODS The clinical presentation of patients with HIV and L. infantum coinfection is described using two unique databases that together produce the largest case series of patients with kala-azar infected with HIV in South America. First, a retrospective study paired the list of all patients with kala-azar from 1994 to 2004 with another of all patients with HIV/AIDS from the reference hospital for both diseases in the City of Teresina, State of Piauí, Brazil. Beginning in 2005 through to 2010 this information was prospectively collected at the moment of hospitalization. RESULTS During the study, 256 admissions related to 224 patients with HIV/L. infantum coinfection were registered and most of them were males between 20-40 years of age. Most of the 224 patients were males between 20-40 years of age. HIV contraction was principally sexual. The most common symptoms and signs were pallor, fever, asthenia and hepatosplenomegaly. 16.8% of the cohort died. The primary risk factors associated to death were kidney or respiratory failure, somnolence, hemorrhagic manifestations and a syndrome of systemic inflammation. The diagnosis of HIV and kala-azar was made simultaneously in 124 patients. CONCLUSIONS The urban association between HIV and kala-azar coinfection in South America is worrisome due to difficulty in establishing the diagnosis and higher mortality among the coinfected then those with either disease independently. HIV/L. infantum coinfection exhibits some singular characteristics and due to its higher mortality it requires immediate assistance to patients and greater research on appropriate combination therapy.
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Affiliation(s)
- Iúri Paz Lima
- Departamento de Medicina Comunitária, Universidade Federal do Piauí, Teresina, PI, Brasil
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Garcia-Cordoba F, Ortuño FJ, Segovia M, Gonzalez Diaz G. Fatal visceral leishmaniasis, with massive bone-marrow infection, in an immunosuppressed but HIV-negative Spanish patient, after the initiation of treatment with meglumine antimoniate. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 99:125-30. [PMID: 15814031 DOI: 10.1179/136485905x19810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although visceral leishmaniasis is often fatal in the developing world, Leishmania-attributable deaths in Europe are relatively rare and nowadays almost always linked to HIV infection. In Spain, however, a HIV-negative man with a history of chronic obstructive pulmonary disease and prednisone treatment was recently hospitalized because of hypotension and asthenia. Although the patient was afebrile, a bone-marrow aspirate, collected after thrombo- and leuco-cytopenia had been observed, was found to contain huge numbers of amastigotes. A course of antileishmanial treatment with meglumine antimoniate was initiated but the patient went into refractory shock and died within 6 h. The significance of this case, in terms of the routine investigation and treatment of immunosuppressed patients who may have leishmaniasis, is discussed.
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Affiliation(s)
- F Garcia-Cordoba
- Intensive Care Unit, Hospital Morales Meseguer, Marques de los Velez s/n, E-30008, Murcia, Spain.
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Geramizadeh B, Fakhar M, Motazedian MH. Visceral leishmaniasis with duodenal involvement: three immunocompetent cases from southern Iran. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 100:637-40. [PMID: 16989690 DOI: 10.1179/136485906x112149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- B Geramizadeh
- Department of Pathology, Transplant Research Centre, School of Medicine, Shiraz University of Medical Sciences, P.O. Box 71345-1864, Shiraz, Iran.
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Pandey K, Sinha PK, Das VNR, Kumar N, Hassan SM, Verma N, Lal CS, Bimal S, Das P, Bhattacharya SK. HIV-1 infection, visceral leishmaniasis, Koch's chest and tuberculous meningitis in the same patient — a case report. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 99:807-11. [PMID: 16297295 DOI: 10.1179/136485905x75386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- K Pandey
- Rajendra Memorial Research Institute of Medical Sciences (ICMR), Agam Kuan, P.O. Gulzarbagh, Patna - 800007, Bihar, India.
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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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Takele Y, Abebe T, Weldegebreal T, Hailu A, Hailu W, Hurissa Z, Ali J, Diro E, Sisay Y, Cloke T, Modolell M, Munder M, Tacchini-Cottier F, Müller I, Kropf P. Arginase activity in the blood of patients with visceral leishmaniasis and HIV infection. PLoS Negl Trop Dis 2013; 7:e1977. [PMID: 23349999 PMCID: PMC3547864 DOI: 10.1371/journal.pntd.0001977] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/05/2012] [Indexed: 11/21/2022] Open
Abstract
Background Visceral leishmaniasis is a parasitic disease associated with high mortality. The most important foci of visceral leishmaniasis in Ethiopia are in the Northwest and are predominantly associated with high rates of HIV co-infection. Co-infection of visceral leishmaniasis patients with HIV results in higher mortality, treatment failure and relapse. We have previously shown that arginase, an enzyme associated with immunosuppression, was increased in patients with visceral leishmaniasis and in HIV seropositive patients; further our results showed that high arginase activity is a marker of disease severity. Here, we tested the hypothesis that increased arginase activities associated with visceral leishmaniasis and HIV infections synergize in patients co-infected with both pathogens. Methodology/Principal Findings We recruited a cohort of patients with visceral leishmaniasis and a cohort of patients with visceral leishmaniasis and HIV infection from Gondar, Northwest Ethiopia, and recorded and compared their clinical data. Further, we measured the levels of arginase activity in the blood of these patients and identified the phenotype of arginase-expressing cells. Our results show that CD4+ T cell counts were significantly lower and the parasite load in the spleen was significantly higher in co-infected patients. Moreover, our results demonstrate that arginase activity was significantly higher in peripheral blood mononuclear cells and plasma of co-infected patients. Finally, we identified the cells-expressing arginase in the PBMCs as low-density granulocytes. Conclusion Our results suggest that increased arginase might contribute to the poor disease outcome characteristic of patients with visceral leishmaniasis and HIV co-infection. Visceral leishmaniasis (VL) in Ethiopia is caused by the parasite Leishmania donovani. This disease has one of the highest mortality rates: if left untreated, it is almost always fatal. VL belongs to the most neglected tropical diseases, affecting the poorest populations, for whom access to diagnosis and effective treatment are often not available. VL is worsened when the patients are co-infected with HIV. We have recently shown that patients with visceral leishmaniasis (VL patients) and HIV seropositive patients (HIV+ patients) have increased levels of an enzyme, arginase, in their blood. This enzyme has been shown to prevent cells of the immune system from mounting an efficient response and controlling the replication of the virus in HIV+ patients or the parasites in VL patients. In this study, we show that arginase is considerably higher in the blood of VL/HIV co-infected patients as compared to VL patients. Our results suggest that this abnormally high arginase might contribute to the poor prognosis associated to VL/HIV patients.
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Affiliation(s)
- Yegnasew Takele
- Gondar University Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology, Parasitology and Pathology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teklu Weldegebreal
- Gondar University Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Asrat Hailu
- Department of Microbiology, Immunology, Parasitology and Pathology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workagegnehu Hailu
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewdu Hurissa
- Gondar University Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Jemal Ali
- Department of Microbiology, Immunology and Parasitology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermiyas Diro
- Gondar University Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Yifru Sisay
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tom Cloke
- Department of Medicine, Section of Immunology, Imperial College London, London, United Kingdom
| | - Manuel Modolell
- Department of Cellular Immunology, Max-Planck-Institute for Immunobiology and Epigenetics, Freiburg, Germany
| | - Markus Munder
- Third Department of Medicine (Hematology, Oncology, and Pneumology), University Medical Center Mainz, Mainz, Germany
| | - Fabienne Tacchini-Cottier
- Department of Biochemistry, WHO Immunology Research and Training Center, University of Lausanne, Lausanne, Switzerland
| | - Ingrid Müller
- Department of Medicine, Section of Immunology, Imperial College London, London, United Kingdom
| | - Pascale Kropf
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Paul J, Karmakar S, De T. TLR-mediated distinct IFN-γ/IL-10 pattern induces protective immunity against murine visceral leishmaniasis. Eur J Immunol 2012; 42:2087-99. [DOI: 10.1002/eji.201242428] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Joydeep Paul
- Division of Infectious Disease and Immunology; Council of Scientific and Industrial Research; Indian Institute of Chemical Biology; Kolkata; India
| | - Subir Karmakar
- Division of Infectious Disease and Immunology; Council of Scientific and Industrial Research; Indian Institute of Chemical Biology; Kolkata; India
| | - Tripti De
- Division of Infectious Disease and Immunology; Council of Scientific and Industrial Research; Indian Institute of Chemical Biology; Kolkata; India
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Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge on human immunodeficiency virus type 1 (hereinafter called HIV)/protozoan co-infections in the case of three important, although neglected, tropical diseases: malaria, trypanosomiasis (Chagas disease) and leishmaniasis. The HIV pandemic has modified the immunopathogenic, epidemiological and therapeutic aspects of these human diseases. RECENT FINDINGS In-vitro data suggests that HIV favors Leishmania infection, whereas different parasites have contrasting effects on HIV. However, many of the previous models are a limited representation of the complex interactions within the host; this situation is particularly the case when microbial products are used in place of live parasites. SUMMARY In the host, protozoan parasites generally enhance HIV replication and accelerate AIDS progression. HIV alters parasite pathogenesis, often worsening disease outcome. These aspects bring significant complications for the treatment of co-infected individuals.
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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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Souza GFD, Biscione F, Greco DB, Rabello A. Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients. Rev Soc Bras Med Trop 2012; 45:147-50. [DOI: 10.1590/s0037-86822012000200001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 01/10/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.
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Sánchez-Moreno M, Gómez-Contreras F, Navarro P, Marín C, Ramírez-Macías I, Olmo F, Sanz AM, Campayo L, Cano C, Yunta MJR. In vitro leishmanicidal activity of imidazole- or pyrazole-based benzo[g]phthalazine derivatives against Leishmania infantum and Leishmania braziliensis species. J Antimicrob Chemother 2011; 67:387-97. [PMID: 22127582 DOI: 10.1093/jac/dkr480] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the in vitro leishmanicidal activity of imidazole-based (1-4) and pyrazole-based (5-6) benzo[g]phthalazine derivatives against Leishmania infantum and Leishmania braziliensis. METHODS The in vitro activity of compounds 1-6 was assayed on extracellular promastigote and axenic amastigote forms, and on intracellular amastigote forms of the parasites. Infectivity and cytotoxicity tests were performed on J774.2 macrophage cells using meglumine antimoniate (Glucantime) as the reference drug. The mechanisms of action were analysed by iron superoxide dismutase (Fe-SOD) and copper/zinc superoxide dismutase (CuZn-SOD) inhibition, metabolite excretion and transmission electronic microscopy (TEM). RESULTS Compounds 1-6 were more active and less toxic than meglumine antimoniate. Data on infection rates and amastigote mean numbers showed that 2, 4 and 6 were more active than 1, 3 and 5 in both L. infantum and L. braziliensis. The inhibitory effect of these compounds on the antioxidant enzyme Fe-SOD of promastigote forms of the parasites was remarkable, whereas inhibition of human CuZn-SOD was negligible. The ultrastructural alterations observed in treated promastigote forms confirmed the greater cell damage caused by the most active compounds 2, 4 and 6. The modifications observed by (1)H-NMR in the nature and amounts of catabolites excreted by the parasites after treatment with 1-6 suggested that the catabolic mechanisms could depend on the structure of the side chains linked to the benzo[g]phthalazine moiety. CONCLUSIONS All the compounds assayed were active in vitro against the two Leishmania species and were less toxic against mammalian cells than the reference drug, but the monosubstituted compounds were significantly more effective and less toxic than their disubstituted counterparts.
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Affiliation(s)
- Manuel Sánchez-Moreno
- Instituto de Biotecnología, Facultad de Ciencias, Universidad de Granada, 18071 Granada, Spain
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Srividya G, Kulshrestha A, Singh R, Salotra P. Diagnosis of visceral leishmaniasis: developments over the last decade. Parasitol Res 2011; 110:1065-78. [DOI: 10.1007/s00436-011-2680-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 10/04/2011] [Indexed: 10/15/2022]
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Ritmeijer K, ter Horst R, Chane S, Aderie EM, Piening T, Collin SM, Davidson RN. Limited Effectiveness of High-Dose Liposomal Amphotericin B (AmBisome) for Treatment of Visceral Leishmaniasis in an Ethiopian Population With High HIV Prevalence. Clin Infect Dis 2011; 53:e152-8. [DOI: 10.1093/cid/cir674] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Santos-Oliveira JR, Da-Cruz AM, Pires LHS, Cupolillo E, Kuhls K, Giacoia-Gripp CBW, Oliveira-Neto MP. Atypical lesions as a sign of cutaneous dissemination of visceral leishmaniasis in a human immunodeficiency virus-positive patient simultaneously infected by two viscerotropic Leishmania species. Am J Trop Med Hyg 2011; 85:55-9. [PMID: 21734124 DOI: 10.4269/ajtmh.2011.10-0398] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Leishmaniasis is considered an emerging opportunistic disease in human immunodeficiency virus (HIV)-infected patients who have considerably variable clinical presentation. We report a patient with visceral leishmaniasis who had unexpected clinical aspects (atypical cutaneous lesions appearing after long-term evidence of visceral parasites). The patient had hepatoesplenomegaly in the absence of fever, but was otherwise generally healthy. The HIV viral load was low despite severe immunossupression (low lymphocyte proliferation and low level of interferon-γ, concomitant with a high lymphocyte activation status). Surprisingly, two Leishmania strains were isolated from his bone marrow (typical L. infantum sequence MON-1, type A) and skin (L. donovani MON-2 sequence); this second strain had not been previously identified in Brazil. The association of visceral leishmaniasis and HIV/acquired immunodeficiency syndrome is a largely unknown disease, particularly in areas in which leishmaniasis is not endemic. Such atypical cases indicate that this disease can be undiagnosed in clinical settings.
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Affiliation(s)
- Joanna R Santos-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, e Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.
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Sheets D, Mubayi A, Kojouharov HV. Impact of socio-economic conditions on the incidence of visceral leishmaniasis in Bihar, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2010; 20:415-430. [PMID: 21161803 DOI: 10.1080/09603123.2010.491853] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Visceral leishmaniasis (VL) is one of the world's worst parasitic killers, second only to Malaria, claiming thousands of lives every year. More than three fifths of the world's VL cases occur in the Indian state of Bihar alone. While some research has been conducted with emphasis on the effects of climatic variables on the VL incidence rate, rigorous analysis of the effects of socio-economic variables is still lacking. In this paper a regression model is developed that describes the relationship between VL incidence rate and a variety of socio-economic factors. It uses data from 2005 and explains 92% of the observed variance. In addition, a stepwise regression model is also used to identify the most important factors that facilitate the prevalence of the VL disease. A discussion on how to most effectively distribute Bihar's limited resources on various control measures to decrease the incidence of VL is also presented.
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Affiliation(s)
- Darren Sheets
- Department of Economics, University of Texas at Arlington, Arlington, Texas 76019 0479, USA
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Hume SC, Aboltins CA, Thursky KA, Daffy JR, Stanley PA. Visceral leishmaniasis due to Leishmania donovani in a patient with advanced HIV infection. Med J Aust 2010; 192:474-5. [PMID: 20402615 DOI: 10.5694/j.1326-5377.2010.tb03591.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 12/22/2009] [Indexed: 11/17/2022]
Abstract
An Eritrean-born man observed over an extended period had upper gastrointestinal symptoms, fever, hepatosplenomegaly and pancytopenia in the setting of advanced HIV infection and poor adherence to antiretroviral therapy. Despite thorough investigation, it was not until a repeat gastroscopic examination and gastric biopsy were performed 18 months after initial presentation that Leishmania infection was diagnosed. The species was identified by polymerase chain reaction assay as L. donovani. Physicians managing HIV-infected patients from regions where Leishmania is endemic should consider visceral leishmaniasis, even in patients who have not lived in a Leishmania-endemic region for many years.
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Affiliation(s)
- Samuel C Hume
- Department of Infectious Diseases, The Northern Hospital, Melbourne, VIC, Australia.
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Hurissa Z, Gebre-Silassie S, Hailu W, Tefera T, Lalloo DG, Cuevas LE, Hailu A. Clinical characteristics and treatment outcome of patients with visceral leishmaniasis and HIV co-infection in northwest Ethiopia. Trop Med Int Health 2010; 15:848-55. [DOI: 10.1111/j.1365-3156.2010.02550.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kouyialis S, Archontakis S, Bilinis C, Nikolaou S, Stavropoulou E, Samaras C, Sarafoglou C, Nicolaou I, Parasi A, Minadaki M. Report of an atypical case of leishmaniasis presented as acute tonsillitis in an immunocompetent patient. ACTA ACUST UNITED AC 2009; 37:916-8. [PMID: 16308231 DOI: 10.1080/00365540500262609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Visceral leishmaniasis typically presents with symptoms such as fever, enlargement of the spleen and the liver, hypergammaglobulinaemia and infection of the bone marrow resulting in anaemia and leukopenia. The disease is sporadic in the countries of the Mediterranean basin. We report an unusual case of acute tonsillitis due to tonsillar leishmaniasis, in an immunocompetent 34-y-old male patient. Diagnosis was confirmed by serological tests and histopathological examination following biopsy of the right tonsil. The patient was successfully treated with liposomal amphotericin-B.
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Affiliation(s)
- Sofoclis Kouyialis
- Second Internal Medicine Department of General State Hospital of Nikea-Piraeus, Nikea-Piraeus, Greece
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Daher EF, Fonseca PP, Gerhard ES, Silva Leitão TMJ, Silva Júnior GB. Clinical and Epidemiological Features of Visceral Leishmaniasis and Hiv Co-infection in Fifteen Patients from Brazil. J Parasitol 2009; 95:652-5. [DOI: 10.1645/ge-1678.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Accepted: 08/21/2008] [Indexed: 11/10/2022] Open
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The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 2008; 21:334-59, table of contents. [PMID: 18400800 DOI: 10.1128/cmr.00061-07] [Citation(s) in RCA: 574] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To date, most Leishmania and human immunodeficiency virus (HIV) coinfection cases reported to WHO come from Southern Europe. Up to the year 2001, nearly 2,000 cases of coinfection were identified, of which 90% were from Spain, Italy, France, and Portugal. However, these figures are misleading because they do not account for the large proportion of cases in many African and Asian countries that are missed due to a lack of diagnostic facilities and poor reporting systems. Most cases of coinfection in the Americas are reported in Brazil, where the incidence of leishmaniasis has spread in recent years due to overlap with major areas of HIV transmission. In some areas of Africa, the number of coinfection cases has increased dramatically due to social phenomena such as mass migration and wars. In northwest Ethiopia, up to 30% of all visceral leishmaniasis patients are also infected with HIV. In Asia, coinfections are increasingly being reported in India, which also has the highest global burden of leishmaniasis and a high rate of resistance to antimonial drugs. Based on the previous experience of 20 years of coinfection in Europe, this review focuses on the management of Leishmania-HIV-coinfected patients in low-income countries where leishmaniasis is endemic.
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ter Horst R, Collin S, Ritmeijer K, Bogale A, Davidson R. Concordant HIV Infection and Visceral Leishmaniasis in Ethiopia: The Influence of Antiretroviral Treatment and Other Factors on Outcome. Clin Infect Dis 2008; 46:1702-9. [DOI: 10.1086/587899] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Mazumder S, Ravindran R, Banerjee A, Ali N. Non-coding pDNA bearing immunostimulatory sequences co-entrapped with leishmanial antigens in cationic liposomes elicits almost complete protection against experimental visceral leishmaniasis in BALB/c mice. Vaccine 2007; 25:8771-81. [PMID: 18031874 DOI: 10.1016/j.vaccine.2007.10.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 09/12/2007] [Accepted: 10/12/2007] [Indexed: 11/30/2022]
Abstract
The difficulty in making successful vaccines against leishmaniasis is partly due to lack of an appropriate adjuvant. Non-coding plasmid DNA (pDNA) bearing immunostimulatory sequences (ISS) is a potent activator of innate immunity, and can thus act as an adjuvant with vaccine antigen. We therefore evaluated the efficacy of pDNA and soluble leishmanial antigens (SLA) to protect against challenge with Leishmania donovani infection. We demonstrate that immunomodulatory activity of pDNA, which potentiated a Th1 immune responses, led to enhanced protection with SLA. Importantly, adding cationic liposomes as vehicle to the antigen, with pDNA either complexed or entrapped within, significantly increased the potentiating effect of pDNA. Further, comparison of the two vaccine formulations demonstrated an impressive increase in the protective efficacy up to two folds when both antigen and pDNA were within the vehicle. Thus, these studies establish the utility of non-coding pDNA bearing ISS as strong promoters of vaccine potency of liposomal antigens especially when co-entrapped with the antigen in cationic liposomes.
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Affiliation(s)
- Saumyabrata Mazumder
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, 4 Raja S. C. Mullick Road, Jadavpur, Kolkata 700032, India
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Abstract
PURPOSE OF REVIEW Parasitic pneumonia is being increasingly reported from many parts of the world due to globalization and travel across the continents. This review outlines the recent developments in the diagnosis and management of parasitic pneumonias. RECENT FINDINGS A polymerase chain reaction that can differentiate pathogenic Entamoeba histolytica from nonpathogenic species has been reported. It has been observed that pulmonary infection with Leishmania donovani can occur in immunodeficient and lung transplant patients. Acute respiratory distress syndrome, seen in severe falciparum malaria, has also been observed in vivax malaria. A study has demonstrated the return of chloroquine-sensitive falciparum malaria several years after chloroquine treatment was discontinued. Pulmonary hypertension has been reported in Schistosoma hematobium, S. mansoni and S. japonicum infections. Strongyloides hyperinfection and disseminated disease are frequently reported in immunocompromised individuals. Parenteral ivermectin is found to be useful in the treatment of disseminated strongyloidiasis. A chronic mild interstitial lung disease has been found to persist in tropical pulmonary eosinophilia despite treatment. Studies are in progress to develop vaccines against amoebiasis, malaria and hookworm infections. SUMMARY Parasitic pneumonia can sometimes be life threatening. If proper diagnosis is made early, the pneumonia can be treated successfully with currently available drugs.
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Baptista-Fernandes T, Marques C, Roos Rodrigues O, Santos-Gomes GM. Intra-specific variability of virulence in Leishmania infantum zymodeme MON-1 strains. Comp Immunol Microbiol Infect Dis 2006; 30:41-53. [PMID: 17109961 DOI: 10.1016/j.cimid.2006.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2006] [Indexed: 11/20/2022]
Abstract
This study aims to characterize the intra-specific variability of virulence in Leishmania infantum zymodeme MON-1 strains isolated from dogs and immunocompetent and immunosuppressed patients through the evaluation of growth pattern, infective ability and immunopathogenicity. Two of the strains, classified as the most virulent, presented higher levels of macrophage infection, increased promastigote replication in culture medium and as well as amastigote multiplication within macrophages. These strains caused the most pathogenic infection inducing splenomegalia and maximum parasite loads in spleen and liver of BALB/c mice. The other strains exhibited either low virulence, with reduced infective capability and low replication levels, or an intermediate virulent phenotype showing mixed features similar to low and high virulent phenotypes. A correlation between the infectivity, growth dynamics and pathogenicity of each strain and the humoral and cellular immune response was demonstrated. Strains with accentuated virulent phenotype induced higher levels of anti-Leishmania IgG1 antibodies and TGF-beta but reduced production of IFN-gamma. Virulence phenotype seems to be a characteristic of each strain regardless of the host (dog or human) from which it was firstly isolated.
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Affiliation(s)
- Teresa Baptista-Fernandes
- Unidade de Leishmanioses, Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 96, 1349-008 Lisboa, Portugal
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Halonen SK, Tanowitz HB. Summary of Presentations on Kinetoplastid Flagellates. J Eukaryot Microbiol 2006; 53 Suppl 1:S169-71. [PMID: 17169048 DOI: 10.1111/j.1550-7408.2006.00219.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sandra K Halonen
- Department of Microbiology, Montana Sate University, 304A Cooley, Bozeman, Montana 59717, USA.
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Bassetti M, Pizzorni C, Gradoni L, Del Bono V, Cutolo M, Viscoli C. Visceral leishmaniasis infection in a rheumatoid arthritis patient treated with adalimumab. Rheumatology (Oxford) 2006; 45:1446-8. [PMID: 16887847 DOI: 10.1093/rheumatology/kel235] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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45
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Rama Iñiguez S, Dea-Ayuela MA, Sanchez-Brunete JA, Torrado JJ, Alunda JM, Bolas-Fernández F. Real-time reverse transcription-PCR quantification of cytokine mRNA expression in golden Syrian hamster infected with Leishmania infantum and treated with a new amphotericin B formulation. Antimicrob Agents Chemother 2006; 50:1195-201. [PMID: 16569829 PMCID: PMC1426985 DOI: 10.1128/aac.50.4.1195-1201.2006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A real-time quantitative reverse transcription-PCR assay was developed for the quantification of cytokine mRNA expression in the golden Syrian hamster Mesocricetus auratus infected with Leishmania infantum and treated with amphotericin B (AMB) formulated in microspheres made of human serum albumin (HSA). Treatment was administered intravenously on days 69, 71, and 73 postinfection (p.i.) with 10(7) metacyclic promastigotes, at doses of 2 and 40 mg/kg of AMB. High infection levels were recorded for untreated animals by day 76 p.i., with parasite loads always about 2 log10 per gram higher in the liver than in the spleen. Treatment was highly effective with both doses, but at 40 mg/kg, almost complete parasite elimination was achieved. mRNA expression of gamma interferon (IFN-gamma) and, to a lesser extent, tumor necrosis factor alpha (TNF-alpha) and transforming growth factor beta (TGF-beta) in spleen cells was up-regulated in most animals of the untreated group. The mRNA expression of interleukin-4 was strongly down-regulated in untreated as well as treated infected animals. Treatment with the lower dose of AMB-HSA down-regulated the mRNA expression of IFN-gamma and TNF-alpha, with no effect on the deactivating cytokine TGF-beta. In contrast, treatment with the higher dose (40 mg/kg) of the formulation caused moderate up-regulation of IFN-gamma and TNF-alpha and strong suppression of TGF-beta. Treatment of noninfected animals did not alter the cytokine expression pattern with regard to untreated controls. Our results suggest that treatment of L. infantum-infected Syrian hamsters with highly effective nontoxic doses of AMB-HSA causes deactivation of the anti-inflammatory cytokine TGF-beta, which in turn results in up-regulation of the Th1 cytokines IFN-gamma and TNF-alpha.
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Affiliation(s)
- S Rama Iñiguez
- Departamento de Parasitología, Facultad de Farmacia, Universidad Complutense, Plaza de Ramón y Cajal s/n, Ciudad Universitaria, 28040 Madrid, Spain
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Rafati S, Zahedifard F, Nazgouee F. Prime-boost vaccination using cysteine proteinases type I and II of Leishmania infantum confers protective immunity in murine visceral leishmaniasis. Vaccine 2005; 24:2169-75. [PMID: 16325969 DOI: 10.1016/j.vaccine.2005.11.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 11/01/2005] [Indexed: 11/26/2022]
Abstract
Vaccination with a cocktail of DNA encoding cysteine proteinases has been previously shown to confer protection against experimental cutaneous leishmaniasis (CL). In the present study we test the efficacy of immunization against Leishmania infantum in a murine model of infection, using a prime-boost strategy. BALB/c mice were immunized twice, in a 3 weeks interval, with cocktail of plasmids DNA encoding type I (cpb) and II (cpa) cysteine proteinases. DNA immunization was then followed by a boost with rCPA/rCPB in addition to CpG ODN and Montanide720 as adjuvant. Analysis of the immune response showed that vaccination mainly elicited antigen-specific IgG2a antibodies, suggesting the induction of a Th1 immune response. This was further confirmed by the analysis of the splenic cytokine production: at all time points the ratio of IFN-gamma/IL-5 induced upon restimulation with rCPA and rCPB was always significantly higher in vaccinated group compared to both control groups.
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Affiliation(s)
- Sima Rafati
- Molecular Immunology and Vaccine Research Lab., Pasteur Institute of Iran, P.O. Box 11365-6699, Tehran, Iran.
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Singh G, Jayanarayan KG, Dey CS. Novobiocin induces apoptosis-like cell death in topoisomerase II over-expressing arsenite resistant Leishmania donovani. Mol Biochem Parasitol 2005; 141:57-69. [PMID: 15811527 DOI: 10.1016/j.molbiopara.2005.01.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 12/18/2004] [Accepted: 01/29/2005] [Indexed: 12/11/2022]
Abstract
Leishmaniasis affects millions of people worldwide every year. Lack of effective vaccination, co-infection with other dreaded diseases like AIDS and generation of drug resistant strains demand immediate attention into this neglected area of research. The sodium m-arsenite (NaAsO2) resistant Leishmania donovani used in this study is resistant to 20 microM NaAsO2, which shows a 13-fold increase in resistance compared with wild type. Here we report that the arsenite resistant strain of L. donovani promastigotes shows cross-resistance to novobiocin, a catalytic inhibitor of topoisomerase II, with IC50 value of 320 microg ml-1 as compared with 242 microg ml-1 for wild type L. donovani. Leishmanicidal action of novobiocin induces dose- and time-dependent increase in cell death. Treatment with IC50 of novobiocin caused morphological and biochemical changes which lead to induction of cell death exhibiting characteristic features of metazoan apoptosis. Phosphatidylserine externalization, cytochrome C release to cytoplasm, activation of caspases, oligonucleosomal DNA fragmentation and in situ labelling of condensed and fragmented nuclei in both wild type and arsenite resistant L. donovani promastigotes strongly suggest the apoptosis-like mode of cell death. Cross-resistance to novobiocin in arsenite resistant strain has been correlated to over-expression of topoisomerase II and substantiated by differential inhibition of enzyme activity in wild type and arsenite resistant L. donovani.
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Affiliation(s)
- Gaganmeet Singh
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research, Sec. 67, S.A.S. Nagar, Punjab 160062, India
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Bourée P. Maladies exotiques : maladies émergentes du xxe siècle. ANTIBIOTIQUES 2004; 6:219-221. [PMID: 32288528 PMCID: PMC7146783 DOI: 10.1016/s1294-5501(04)94267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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