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Dias DS, Machado JM, Ribeiro PAF, Machado AS, Ramos FF, Nogueira LM, Gonçalves AAM, Ramos LDS, Gandra IB, Coutinho FS, dos Santos M, da Silva JO, Chávez-Fumagalli MA, Teixeira-Neto RG, Chaves AT, Campos-da-Paz M, Souza AA, Giunchetti RC, Freitas SM, Lyon S, de Magalhães-Soares DF, Silveira JAG, Silva ES, Coelho EAF, Galdino AS. rMELEISH: A Novel Recombinant Multiepitope-Based Protein Applied to the Serodiagnosis of Both Canine and Human Visceral Leishmaniasis. Pathogens 2023; 12:pathogens12020302. [PMID: 36839574 PMCID: PMC9958779 DOI: 10.3390/pathogens12020302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND visceral leishmaniasis (VL) is a critical public health problem in over ninety countries. The control measures adopted in Brazil have been insufficient when it comes to preventing the spread of this overlooked disease. In this context, a precise diagnosis of VL in dogs and humans could help to reduce the number of cases of this disease. Distinct studies for the diagnosis of VL have used single recombinant proteins in serological assays; however, the results have been variable, mainly in relation to the sensitivity of the antigens. In this context, the development of multiepitope-based proteins could be relevant to solving such problem. METHODS a chimeric protein (rMELEISH) was constructed based on amino acid sequences from kinesin 39 (k39), alpha-tubulin, and heat-shock proteins HSP70 and HSP 83.1, and tested in enzyme-linked immunosorbent (ELISA) for the detection of L. infantum infection using canine (n = 140) and human (n = 145) sera samples. RESULTS in the trials, rMELEISH was able to discriminate between VL cases and cross-reactive diseases and healthy samples, with sensitivity and specificity values of 100%, as compared to the use of a soluble Leishmania antigenic extract (SLA). CONCLUSIONS the preliminary data suggest that rMELEISH has the potential to be tested in future studies against a larger serological panel and in field conditions for the diagnosis of canine and human VL.
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Affiliation(s)
- Daniel Silva Dias
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte 30130-100, MG, Brazil
| | - Juliana Martins Machado
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
| | - Patrícia Aparecida Fernandes Ribeiro
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte 30130-100, MG, Brazil
| | - Amanda Sanchez Machado
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte 30130-100, MG, Brazil
| | - Fernanda Fonseca Ramos
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte 30130-100, MG, Brazil
| | - Lais Moreira Nogueira
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
| | - Ana Alice Maia Gonçalves
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Luana de Sousa Ramos
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
| | - Isadora Braga Gandra
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
| | - Flaviane Silva Coutinho
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
| | - Michelli dos Santos
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
| | - Jonatas Oliveira da Silva
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
| | - Miguel Angel Chávez-Fumagalli
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Urb. San José S/N, Arequipa 04000, Peru
| | - Rafael Gonçalves Teixeira-Neto
- Laboratório de Doenças Infecto-Parasitárias, Universidade Federal de São João Del-Rei, Divinópolis 35501-296, MG, Brazil
| | - Ana Thereza Chaves
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte 30130-100, MG, Brazil
| | - Mariana Campos-da-Paz
- Laboratório de Bioativos & Nanobiotecnologia, Universidade Federal de São João Del-Rei, Divinópolis 35501-296, MG, Brazil
| | - Amanda A. Souza
- Laboratório Nacional de Biociências (LNBio), Centro Nacional de Pesquisa em Energia e Materiais, Campinas 13083-970, SP, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Sonia Maria Freitas
- Laboratorio de Biofísica, Instituto de Biologia, University of Brasilia, Brasília 70910-900, DF, Brazil
| | - Sandra Lyon
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte 30622-020, MG, Brazil
| | | | - Julia Angelica Gonçalves Silveira
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Eduardo Sergio Silva
- Laboratório de Doenças Infecto-Parasitárias, Universidade Federal de São João Del-Rei, Divinópolis 35501-296, MG, Brazil
| | - Eduardo Antonio Ferraz Coelho
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte 30130-100, MG, Brazil
| | - Alexsandro Sobreira Galdino
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
- Correspondence:
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Carvalho AG, Kuhn ALM, Dias JVL, Luz JGG. Epidemiological patterns related to deaths caused by visceral leishmaniasis in the southern Amazon region of Brazil. Trans R Soc Trop Med Hyg 2022; 117:326-335. [PMID: 36479897 DOI: 10.1093/trstmh/trac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/07/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
ABSTRACT
Background
We analysed the spatial and spatiotemporal patterns of visceral leishmaniasis (VL) mortality at the municipality level in an endemic state in the southern Amazon region of Brazil. Individual-level factors associated with death due to VL were also investigated.
Methods
All VL cases and deaths reported between 2007 and 2018 were included. The global and local bivariate Moran's index assessed the space–time autocorrelation of smoothed triennial VL mortality. Kulldorff's scan statistics investigated spatial and spatiotemporal clusters. A multivariable logistic regression explored sociodemographic, diagnostic and clinical variables associated with death due to VL.
Results
We observed an overall VL mortality and lethality of 0.14 cases/100 000 inhabitants and 11.2%, respectively. A total of 14% of the municipalities registered at least one VL-related death. In the southeastern mesoregion of the state, we detected high-risk spatial (relative risk [RR] 14.14; p<0.001) and spatiotemporal (RR 15.91; p<0.001) clusters for VL mortality. Bivariate Moran's analysis suggested a high space–time autocorrelation of VL mortality. Death by VL was associated with age ≥48 y (odds ratio [OR] 7.2 [95% confidence interval {CI} 3.4 to 15.3]), displacement for notification (OR 3.3 [95% CI 1.5 to 7.2]) and occurrence of oedema (OR 2.8 [95% CI 1.3 to 6.1]) and bleeding (OR 5.8 [95% CI 2.6 to 12.8]).
Conclusions
VL mortality has a heterogeneous spatiotemporal distribution. The death-related factors suggest late diagnosis as an underlying cause of mortality.
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Affiliation(s)
- Amanda G Carvalho
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
| | - André Luiz M Kuhn
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
| | - João Victor L Dias
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys , 1 Cruzeiro St. Teófilo Otoni, Minas Gerais, 39803-371, Brazil
| | - João Gabriel G Luz
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
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Lyvannak S, Sreynich K, Heng S, Thyl M, Chandna A, Chanpheaktra N, Pises N, Farrilend P, Jarzembowski J, Leventaki V, Davick J, Neunert C, Keller F, Kean LS, Camitta B, Tarlock K, Watkins B. Case Report: The First Case Report of Visceral Leishmaniasis in Cambodia. Am J Trop Med Hyg 2022; 107:336-338. [PMID: 35895585 PMCID: PMC9393436 DOI: 10.4269/ajtmh.22-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/31/2022] [Indexed: 08/03/2023] Open
Abstract
Leishmaniasis is considered a neglected tropical disease that is commonly found in Asia, Africa, South America, and Mediterranean countries. Visceral leishmaniasis (VL) is the most severe form of the disease and is almost universally fatal if left untreated. The symptoms of VL overlap with many infectious diseases, malignancies, and other blood disorders. The most common findings include fever, cytopenias, and splenomegaly. Given the nonspecific symptoms, the diagnosis requires detailed laboratory investigations, including bone marrow examination, that can be challenging in low- and middle-income countries. Diagnostic limitations likely lead to the underdiagnosis or delay in diagnosis of VL. We describe, to our knowledge, the first case report of VL in Cambodia in a child presenting with fever, anemia, and thrombocytopenia. The diagnosis required a liver biopsy and multiple bone marrow biopsies to visualize intracellular Leishmania spp. Our case illustrates the diagnostic challenges and the importance of timely diagnosis. This case also highlights the need for heightened awareness of the diagnostic findings of VL and improved reporting of tropical diseases.
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Affiliation(s)
- Sam Lyvannak
- Angkor Hospital for Children, Siem Reap, Cambodia
| | | | - Sing Heng
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Miliya Thyl
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Arjun Chandna
- Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | | | - Ngeth Pises
- Angkor Hospital for Children, Siem Reap, Cambodia
| | | | | | | | | | | | - Frank Keller
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Leslie S. Kean
- Boston Children’s Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
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Melariri HI, Kalinda C, Chimbari MJ. Enablers and hindrances to health promotion and disease prevention practices among healthcare workers in Nelson Mandela Bay Municipality, South Africa. Prev Med Rep 2021; 23:101462. [PMID: 34258174 PMCID: PMC8254112 DOI: 10.1016/j.pmedr.2021.101462] [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: 01/10/2021] [Revised: 05/16/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Health promotion (HP) and disease prevention (DP) practices among healthcare workers (HCWs) are key to achieving universal health coverage. This study identified HP and DP enablers and hindrances and compared them at different healthcare levels in Nelson Mandela Bay Municipality, South Africa. An exploratory cross-sectional study using a structured questionnaire was conducted among HCWs (n = 501) from 23 hospitals. Bivariate and multinomial regression were used to analyze the data. The highest number of participants (70.46%; n = 353) were from tertiary hospitals. Thirteen and Eight categories of enablers and hindrances respectively were identified. Of these, eleven enablers and six hindrances of HP and DP were associated with tertiary hospitals; no enabler was identified at both primary and secondary while one hindrance was associated with primary level of health care. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28-3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23-0.62) were the predictors of HP and DP among medical doctors, while staff induction training (Coeff: 0.62, 95% CI: 0.40-0.95) and performance appraisal (Coeff: 1.86, 95% CI: 1.16-2.98) were the enablers among allied health workers. On the other hand, 'facility promoting treatment more than prevention' (Coeff: 2.03, 95% CI: 1.30-3.14) and 'practice guidelines incorporating HP' (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers respectively. Our work indicates the need for an operational strategy designed considering enabling and hindering factors to HP and DP practices for empowering HCWs and enhancing health outcomes.
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Affiliation(s)
- Herbert I. Melariri
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
- Eastern Cape Department of Health, South Africa
| | - Chester Kalinda
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
- University of Namibia, Faculty of Agriculture, Engineering and Natural Sciences, School of Science, Katima Mulilo Campus, P/Bag 1096, Katima Mulilo, Namibia
| | - Moses J. Chimbari
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
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Ribeiro CJN, dos Santos AD, Lima SVMA, da Silva ER, Ribeiro BVS, Duque AM, Peixoto MVS, dos Santos PL, de Oliveira IM, Lipscomb MW, de Araújo KCGM, de Moura TR. Space-time risk cluster of visceral leishmaniasis in Brazilian endemic region with high social vulnerability: An ecological time series study. PLoS Negl Trop Dis 2021; 15:e0009006. [PMID: 33465104 PMCID: PMC7846114 DOI: 10.1371/journal.pntd.0009006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/29/2021] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite visceral leishmaniasis (VL) being epidemic in most Brazilian regions, the Northeast region is responsible for the highest morbidity and mortality outcomes within the country. OBJECTIVE To analyse the spatiotemporal dynamics of VL cases to identify the temporal trends and high-risk areas for VL transmission, as well as the association of the disease with social vulnerability in Brazilian Northeast. METHODS We carried out an ecological time series study employing spatial analysis techniques using all VL confirmed cases of 1,794 municipalities of Brazilian Northeast between the years 2000 to 2017. The Social Vulnerability Index (SVI) was used to represent the social vulnerability. Incidence rates were standardized and smoothed by the Local Empirical Bayesian Method. Time trends were examined through segmented linear regression. Spatiotemporal analysis consisted of uni- and bivariate Global and Local Moran indexes and space-time scan statistics. RESULTS Incidence rate remained stable and ranged from 4.84 to 3.52 cases/100,000 inhabitants. There was higher case prevalence between males (62.71%), children and adolescents (63.27%), non-white (69.75%) and urban residents (62.58%). Increasing trends of new cases were observed among adult male subjects (≥ 40 years old) and urban residents. Importantly, VL incidence showed a direct spatial dependence. Spatial and space-time clusters were identified in sertão and meio-norte sub-regions, overlapping with high social vulnerability areas. CONCLUSIONS VL is a persistent health issue in Brazilian Northeast and associated with social vulnerability. Space-time clustering of VL cases in socially vulnerable municipalities demands intersectoral public policies of surveillance and control, with focus on reducing inequalities and improving living conditions for regional inhabitants.
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Affiliation(s)
- Caique J. N. Ribeiro
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | | | - Shirley V. M. A. Lima
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Department of Nursing, Federal University of Sergipe, Lagarto, Brazil
| | | | - Bianca V. S. Ribeiro
- Graduate Program in Parasite Biology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Andrezza M. Duque
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Marcus V. S. Peixoto
- Department of Speech Therapy and Audiology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Priscila L. dos Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Graduate Program in Parasite Biology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Iris M. de Oliveira
- Department of Functional Biology and Health Sciences, University of Vigo, Pontevedra, Spain
| | - Michael W. Lipscomb
- Department of Biology, Howard University, Washington DC, United States of America
| | - Karina C. G. M. de Araújo
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Graduate Program in Parasite Biology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Tatiana R. de Moura
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Graduate Program in Parasite Biology, Federal University of Sergipe, São Cristóvão, Brazil
- * E-mail:
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Sánchez MB, Germanó MJ, Salomón MC, Scelta J, García Bustos MF, Ginevro PM, Cargnelutti DE. Leishmania (L.) amazonensis infection impairs reproductive and fetal parameters in female mice. Rev Argent Microbiol 2020; 53:194-201. [PMID: 33375987 DOI: 10.1016/j.ram.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/15/2020] [Accepted: 08/19/2020] [Indexed: 10/22/2022] Open
Abstract
Leishmaniasis is a group of parasitic zoonotic diseases caused by intracellular protozoans belonging to the genus Leishmania. Little is known about the effects that this parasitosis may have on the reproductive parameters and pregnancy of infected humans and pets. This study aimed to evaluate the influence of chronic cutaneous leishmaniasis caused by Leishmania (Leishmania) amazonensis on reproductive and fetal parameters using a female murine model. A control group of female BALB/c mice and a group infected with L. (L.) amazonensis were mated with healthy males. Clinical parameters were monitored during the pre-mating and gestational periods. Female mice were euthanized on day 19 of gestation, when the fetuses were weighed and their length measured and embryonic resorptions and fetal death were recorded. We observed five fetal deaths and three embryonic resorptions in the infected group. Furthermore, there was a decrease in fertility in the infected group (26.32%). The weight of the offspring from infected mothers was lower than that in the control group (1.019±0.035g and 1.163±0.032g, p<0.01). Fetal length was reduced in the infected group (3.71±0.05cm in the control group and 3.40±0.06cm in the infected group p<0.001). This study shows that cutaneous leishmaniasis caused by L. (L.) amazonensis impairs reproductive and fetal parameters in mice.
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Affiliation(s)
- María Belén Sánchez
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro Científico Tecnológico (CCT), Universidad Nacional de Cuyo (UNCuyo), Mendoza, Argentina
| | - María José Germanó
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro Científico Tecnológico (CCT), Universidad Nacional de Cuyo (UNCuyo), Mendoza, Argentina
| | - María Cristina Salomón
- Área de Parasitología, Facultad de Ciencias Médicas (FCM), Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Julieta Scelta
- Instituto de Histología y Embriología de Mendoza (IHEM), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro Científico Tecnológico (CCT), Universidad Nacional de Cuyo (UNCuyo), Mendoza, Argentina
| | - María Fernanda García Bustos
- Instituto de Patología Experimental (IPE), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro Científico Tecnológico (CCT), Salta, Argentina
| | - Paula María Ginevro
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro Científico Tecnológico (CCT), Universidad Nacional de Cuyo (UNCuyo), Mendoza, Argentina
| | - Diego Esteban Cargnelutti
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro Científico Tecnológico (CCT), Universidad Nacional de Cuyo (UNCuyo), Mendoza, Argentina; Área de Parasitología, Facultad de Ciencias Médicas (FCM), Universidad Nacional de Cuyo, Mendoza, Argentina.
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7
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Salih OAMM, Nail AM, Modawe GA, Swar MO, Ahmed MH, Khalil A, Satti AB, Abuzeid N. Risk Factors of Inpatients Mortality of Visceral Leishmaniasis, Khartoum State, Sudan. J Glob Infect Dis 2020; 12:135-140. [PMID: 33343164 PMCID: PMC7733432 DOI: 10.4103/jgid.jgid_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Visceral leishmaniasis (VL) is one of the common infections in Sudan and can be associated with an increase in morbidity and mortality. The aim of this study was to assess the risk factors associated with mortality and morbidity with VL. Materials and Methods: This is a cross-sectional hospital-based study that recruited 150 patients with VL from two centers in Khartoum. Secondary data were extracted from the patient records, and data were analyzed using SPSS version 24.0. Results: The study included 2.5% of infants, 39.4% children, and 58% of adults. Male represents 77.3% of the cohort, and total mortality was 16%. Among the death reported 12.5% in infants, 16.7% were children, and 70.8% were in adults. Laboratory parameters significantly associated with mortality in univariate analysis were low white cell count, low platelets, high creatinine, and high liver enzymes. While risk factors such as infant, male, acquired infection from Eastern Sudan or White Nile, weight loss, morbid diseases, and concomitant bacterial infections were also associated with significant mortality in univariate analysis. Importantly, logistic regression analysis revealed significant association with infant (P = 0.02), concomitant bacterial infections (P = 0.003), comorbid disease (P = 0.001), low total blood cell count (P = 0.018), low platelets (P = 0.013), and high aspartate transaminase/alanine aminotransferase (P = 0.013). Conclusion: Health education and awareness are needed in terms of prevention and control, especially with high mortality seen in the infant. Treatment of underlying co-morbid diseases and bacterial infections are important to enhance survival. Patients with Leishmania are vulnerable; therefore, regular routine blood tests are an essential part of management to manage complications such as renal, hepatic failure, or severe anemia.
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Affiliation(s)
| | - Abdelsalam M Nail
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Sudan
| | - Gad Allah Modawe
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Sudan
| | - Mohamed Osman Swar
- Department of Pediatrics and Child Health, School of Medicine, Ahfad University for Women, Sudan
| | - Mohamed H Ahmed
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK
| | - Atif Khalil
- Department of Nephrology, Noble Hospital, Isle of Man, UK
| | - Abdelsalam Basheir Satti
- Department of Microbiology, Faculty of Medical Laboratory Sciences, Omdurman Islamic University, Omdurman, Sudan
| | - Nadir Abuzeid
- Department of Microbiology, Faculty of Medical Laboratory Sciences, Omdurman Islamic University, Omdurman, Sudan
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8
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Rostamian M, Bashiri H, Yousefinejad V, Bozorgomid A, Sohrabi N, Raeghi S, Khodayari MT, Ghadiri K, Rezaeian S. Prevalence of human visceral leishmaniasis in Iran: A systematic review and meta-analysis. Comp Immunol Microbiol Infect Dis 2020; 75:101604. [PMID: 33388595 DOI: 10.1016/j.cimid.2020.101604] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
Leishmania infantum is the main cause of human visceral leishmaniasis (HVL; also known as kala-azar) in the Middle East and may be fatal if left untreated. This disease was first reported in 1949 in Iran. Despite marked improvements in hygiene and sanitation conditions, the disease is still endemic in some parts of Iran. It is difficult to determine the current prevalence of HVL in Iran due to the scarcity of comprehensive studies in this regard. In response to this gap, a systematic review and meta-analysis was conducted to gain better understanding of HVL epidemiology in the general population of Iran. English and Persian databases were searched for studies reporting the prevalence and risk factors associated with HVL in the Iranian people from January 1995 to December 2019. The reported data were selected according to inclusion and exclusion criteria. The pooled prevalence of HVL infection and its 95 % confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also done. Literature search revealed 3634 studies, of which 35 studies met our eligibility criteria, with a total of 50,716 individuals. The meta-analysis was performed on 31 out of 35 included studies. The estimated pooled prevalence of HVL infection according to seropositivity was 2% (95 % CI: 1-2%) in the general population of Iran in which western and northern provinces had the lowest and the highest prevalence, 0.5 % (95 %CI, 0.2-0.7%) and 3% (95 %CI, 1-5 %), respectively. The seroprevalence of HVL among females (2%; 95 %CI, 1-2 %) was more than males (1%; 95 %CI, 1-2 %). The ≤10 and >10 years age groups had similar seroprevalence rates (1%, 95 %CI, 1-2 % versus 1%, 95 %CI, 0-1 %, respectively). There was no significant difference in terms of geographic area, age and sex. Of 31 studies included in the meta-analysis, the most common diagnostic test was the direct agglutination test (96.77 %). To the best of our knowledge, this is the first systematic review of the prevalence of HVL in Iran. The results showed a low seroprevalence of HVL infection. However, the lack of published reports of HVL in an area does not exclusively mean the absence of the disease or carrier. We therefore recommend further studies in this regard.
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Affiliation(s)
- Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Homayoon Bashiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Yousefinejad
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Arezoo Bozorgomid
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Nasrollah Sohrabi
- Department of Medical Laboratory Sciences, School of Paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saber Raeghi
- Department of Laboratory Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | | | - Keyghobad Ghadiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Maia-Elkhoury ANS, Sierra Romero GA, O. B. Valadas SY, L. Sousa-Gomes M, Lauletta Lindoso JA, Cupolillo E, Ruiz-Postigo JA, Argaw D, Sanchez-Vazquez MJ. Premature deaths by visceral leishmaniasis in Brazil investigated through a cohort study: A challenging opportunity? PLoS Negl Trop Dis 2019; 13:e0007841. [PMID: 31856199 PMCID: PMC6922316 DOI: 10.1371/journal.pntd.0007841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/11/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is the most severe form of leishmaniasis because it can lead to death. In the Americas, 96% of cases are in Brazil, and despite efforts, the fatality rate has increased in the past years. We analyzed deaths associated to VL in Brazil and investigated the factors that could influence on the timeliness of fatal outcome with emphasis on time (tStoD). METHODOLOGY The registered deaths by VL were sourced from the Brazilian National Notification System from 2007-2014. Through a retrospective cohort study, univariate and multivariable Cox proportional hazards model analysis were performed and investigated the factors that could influence the time (tStoD). These factors were analyzed through survival models. RESULTS Out of the 1,589 reported deaths, the median for onset of the symptoms and the case notification date (tStoN) is 25 days (10-61), and for date of case notification and death (tNotD) is 9 days (4-17). The time (tStoN) to event investigation for HIV non-infected individuals was 1.4 (1.16-1.68) greater than the HIV positive group. At the same time peri-urban and urban area were 0.83 (0.47-1.44) and 1.33 (1.16-1.52), respectively. The explorations revealed apparent differences between the time to event investigation (both for tStoN and tNotD) and the age at the onset of the symptoms. According to the tStoN the rate of notification is 1.73 times greater in patients under 5 years old at the onset of the clinical symptoms compared to older patients. CONCLUSION VL patients under 5 years old were diagnosed earlier and had shorter survival. It could mean that in younger population, although properly diagnosed, the fatality pattern might be related to the severity of the disease. Main host characteristics were evaluated, and age and co-infections seem to have an impact in the disease progression.
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Affiliation(s)
- Ana Nilce S. Maia-Elkhoury
- Communicable Diseases and Environmental Determinants of Health (CDE), Neglected, Tropical and Vector Borne Diseases (VT), Pan American Health Organization/ World Health Organization (PAHO/WHO), Duque de Caxias, Rio de Janeiro, Brazil
| | - Gustavo Adolfo Sierra Romero
- Center for Tropical Medicine, Faculty of Medicine, University of Brasilia (UNB) Brasília, Distrito Federal, Brazil
| | - Samantha Y. O. B. Valadas
- Communicable Diseases and Environmental Determinants of Health (CDE), Neglected, Tropical and Vector Borne Diseases (VT), Pan American Health Organization/ World Health Organization (PAHO/WHO), Duque de Caxias, Rio de Janeiro, Brazil
| | - Marcia L. Sousa-Gomes
- Secretary of Health Surveillance (SVS), Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - José Angelo Lauletta Lindoso
- Institute of Infectology Emilio Ribas and Institute of Tropical Medicine from University of São Paulo, São Paulo, Brazil
| | - Elisa Cupolillo
- Oswaldo Cruz Institute (IOC) Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Jose Antonio Ruiz-Postigo
- Department of Neglected Tropical Diseases (HTM/NTD/IDM), World Health Organization (WHO), Geneva, Switzerland
| | - Daniel Argaw
- Department of Neglected Tropical Diseases (HTM/NTD/IDM), World Health Organization (WHO), Geneva, Switzerland
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Luz JGG, Carvalho AGD, Naves DB, Dias JVL, Fontes CJF. Where, when, and how the diagnosis of human visceral leishmaniasis is defined: answers from the Brazilian control program. Mem Inst Oswaldo Cruz 2019; 114:e190253. [PMID: 31664313 PMCID: PMC6821129 DOI: 10.1590/0074-02760190253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/08/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Timely diagnosis is recommended by the Brazilian Visceral Leishmaniasis (VL) Surveillance and Control Program to reduce case fatality. Attempts at assessing this topic in Brazil are scarce. OBJECTIVE This study aimed to describe where, when, and how the diagnosis of VL has been performed in a Brazilian endemic setting. METHODS Data of all autochthonous cases confirmed between 2011 and 2016 (N = 81) were recorded. The care-seeking itinerary until the confirmation of VL diagnosis was assessed among 57 patients. FINDINGS The majority of VL cases (79.1%) were reported by referral hospitals. The patients mainly sought primary health care centres at the onset of symptoms. However, they had to visit seven health services on average to achieve a confirmed diagnosis. The time from the onset of symptoms to the diagnosis of VL (TD) ranged from 1-212 (median, 25) days. The TD was longer among adult patients. There was a direct correlation between the patient’s age and TD (r = 0.22; p = 0.047) and a higher occurrence of deaths due to the disease among older patients (p = 0.002). Almost all the patients (98.9%) underwent laboratory investigation, and the VL diagnosis was mainly confirmed based on clinical-laboratory criteria (92.6%). Positive results for the indirect fluorescence antibody test (22.7%) and parasitological examination plus rk39-based immunochromatographic tests (21.3%) were commonly employed. MAIN CONCLUSIONS VL diagnosis was predominantly conducted in hospitals with a long TD and wide application of serology. These findings may support measures focused on early diagnosis, including a greater involvement of the primary health care system.
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Affiliation(s)
- João Gabriel Guimarães Luz
- Universidade Federal de Mato Grosso, Instituto de Ciências Exatas e Naturais, Curso de Medicina, Rondonópolis, MT, Brasil.,Universidade Federal de Mato Grosso, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Cuiabá, MT, Brasil
| | - Amanda Gabriela de Carvalho
- Universidade Federal de Mato Grosso, Instituto de Ciências Exatas e Naturais, Curso de Medicina, Rondonópolis, MT, Brasil.,Universidade Federal de Mato Grosso, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Cuiabá, MT, Brasil
| | - Danilo Bueno Naves
- Universidade Federal de Mato Grosso, Instituto de Ciências Exatas e Naturais, Curso de Medicina, Rondonópolis, MT, Brasil
| | - João Victor Leite Dias
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Medicina, Teófilo Otoni, MG, Brasil
| | - Cor Jesus Fernandes Fontes
- Universidade Federal de Mato Grosso, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Cuiabá, MT, Brasil.,Faculdade de Ciências Biomédicas de Cacoal, Curso de Medicina, Cacoal, RO, Brasil
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11
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Abstract
In Sweden, leishmaniasis is an imported disease and its epidemiology and incidence were not known until now. We conducted a retrospective, nationwide, epidemiological study from 1993 to 2016. Probable cases were patients with leishmaniasis diagnoses reported to the Swedish Patient registry, collecting data on admitted patients in Swedish healthcare since 1993 and out-patient visits since 2001. Confirmed cases were those with a laboratory test positive for leishmaniasis during 1993–2016. 299 probable cases and 182 confirmed cases were identified. Annual incidence ranged from 0.023 to 0.35 per 100 000 with a rapid increase in the last 4 years. Of 182 laboratory-verified cases, 96 were diagnosed from 2013 to 2016, and in this group, almost half of the patients were children under 18 years. Patients presented in different healthcare settings in all regions of Sweden. Cutaneous leishmaniasis was the most common clinical manifestation and the majority of infections were acquired in Asia including the Middle East, specifically Syria and Afghanistan. Leishmania tropica was responsible for the majority of cases (42%). A combination of laboratory methods increased the sensitivity of diagnosis among confirmed cases. In 2016, one-tenth of the Swedish population were born in Leishmania-endemic countries and many Swedes travel to these countries for work or vacation. Swedish residents who have spent time in Leishmania-endemic areas, could be at risk of developing disease some time during their lives. Increased awareness and knowledge are needed for correct diagnosis and management of leishmaniasis in Sweden.
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Luz JGG, Naves DB, Carvalho AGD, Meira GA, Dias JVL, Fontes CJF. Visceral leishmaniasis in a Brazilian endemic area: an overview of occurrence, HIV coinfection and lethality. Rev Inst Med Trop Sao Paulo 2018. [PMID: 29538509 PMCID: PMC5962093 DOI: 10.1590/s1678-9946201860012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The Brazilian municipality of Rondonópolis, Mato Grosso State,
represents an important visceral leishmaniasis (VL) endemic area. This study
described epidemiological and clinical aspects of the occurrence, VL/HIV coinfection
and lethality related to VL in Rondonópolis. Data from autochthonous
cases reported between 2011 and 2016 were obtained from official information systems.
During this period, 81 autochthonous cases were reported, with decreasing incidence
through 2016. Contrastingly, the lethality rate was 8.6% overall, but varied widely,
reaching a peak (20%) in 2016. Almost 10% of patients had VL/HIVcoinfection. The
occurrence of VL prevailed among men (56.8%), brown-skinned (49.4%), urban residents
(92.6%), aged 0-4 years (33.3%). Housewives or retired (29.6%) were the most affected
occupational groups. Lower age was the main difference among the total VL cases and
those who were coinfected or died. Clinically, fever, weakness and splenomegaly were
more frequent among all VL cases and VL/HIV coinfected individuals. Bacterial
infections (p=0.001) and bleeding (p<0.001) were associated with death due to VL.
Pentavalent antimonial and liposomal amphotericin B were the first choices for
treatment among all VL cases (71.6%) and those who died (71.4%), respectively. VL/HIV
patients were equally treated with both drugs. These findings may support control
measures and demonstrate the need for further investigations.
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Affiliation(s)
- João Gabriel Guimarães Luz
- Universidade Federal de Mato Grosso, Instituto de Ciências Exatas e Naturais, Curso de Medicina, Rondonópolis, Mato Grosso, Brazil.,Universidade Federal de Mato Grosso, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Cuiabá, Mato Grosso, Brazil
| | - Danilo Bueno Naves
- Universidade Federal de Mato Grosso, Instituto de Ciências Exatas e Naturais, Curso de Medicina, Rondonópolis, Mato Grosso, Brazil
| | - Amanda Gabriela de Carvalho
- Universidade Federal de Mato Grosso, Instituto de Ciências Exatas e Naturais, Curso de Medicina, Rondonópolis, Mato Grosso, Brazil.,Universidade Federal de Mato Grosso, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Cuiabá, Mato Grosso, Brazil
| | - Gilvani Alves Meira
- Secretaria Municipal de Saúde de Rondonópolis, Gerência de Vigilância Epidemiológica, Rondonópolis, Mato Grosso, Brazil
| | - João Victor Leite Dias
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Medicina do Mucuri, Teófilo Otoni, Minas Gerais, Brazil
| | - Cor Jesus Fernandes Fontes
- Universidade Federal de Mato Grosso, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Cuiabá, Mato Grosso, Brazil.,Universidade Federal de Mato Grosso, Hospital Júlio Müller, Cuiabá, Mato Grosso, Brazil
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13
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Assis TSMD, Rosa DCP, Teixeira EDM, Cota G, Azeredo-da-Silva ALF, Werneck G, Rabello A. The direct costs of treating human visceral leishmaniasis in Brazil. Rev Soc Bras Med Trop 2017; 50:478-482. [PMID: 28954068 DOI: 10.1590/0037-8682-0133-2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/19/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: The drugs available for visceral leishmaniasis (VL) treatment in Brazil have specific characteristics in terms of operability, effectiveness, toxicity, and cost. The aim of this study was to estimate the direct costs of therapies recommended by the Ministry of Health (MH) for VL treatment in Brazil. METHODS: The analytical perspective used was that adopted by the Brazilian Public Health System. Three drugs and four regimens were included: 1) N-methyl glucamine antimoniate intramuscularly at 20mg per kg per day for 30 days; 2) N-methyl glucamine antimoniate intravenously at 20mg per kg per day for 30 days; 3) amphotericin B deoxycholate at 1mg per kg per day for 21 days; and 4) liposomal amphotericin B at 3mg per kg per day for a 7 days treatment. RESULTS: The estimated direct costs of treatment for an adult patient using N-methylglucamine antimoniate administered via the intramuscular and intravenous routes were USD 418.52 and USD 669.40, respectively. The estimated cost of treatment with amphotericin B deoxycholate was USD 1,522.70. Finally, the estimated costs of treatment with liposomal amphotericin B were USD 659.79, and USD 11,559.15 using the price adopted by the WHO and the Drug Regulation Board, respectively. CONCLUSIONS: This analysis indicates the economic feasibility of replacing N-methyl glucamine antimoniate with liposomal amphotericin B, which allows a shorter treatment period with less toxicity compared with other treatments, provided that the purchase value used by the WHO and transferred to the MH is maintained.
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Affiliation(s)
- Tália Santana Machado de Assis
- Grupo de Pesquisa: Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil.,Centro Federal de Educação Tecnológica de Minas Gerais, Campus Contagem, Contagem, MG, Brasil
| | - Dian Carlos Pinheiro Rosa
- Grupo de Pesquisa: Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil
| | - Eliane de Morais Teixeira
- Grupo de Pesquisa: Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil
| | - Gláucia Cota
- Grupo de Pesquisa: Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil
| | | | - Guilherme Werneck
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Ana Rabello
- Grupo de Pesquisa: Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil
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14
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Al-Ghazaly J, Al-Dubai W, Abdullah M, Al-Gharasi L. Hematological Characteristics of Yemeni Adults and Children with Visceral Leishmaniasis. Could Eosinopenia be a Suspicion Index? Mediterr J Hematol Infect Dis 2017; 9:e2017056. [PMID: 28894565 PMCID: PMC5584771 DOI: 10.4084/mjhid.2017.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/03/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Delay in the diagnosis of visceral leishmaniasis (VL) particularly in non-endemic areas is associated with higher mortality. In our experience, we found that marked bone marrow eosinopenia was a very frequent accompaniment of VL and might be a useful clue for the diagnosis, which indicates the opportunity for further morphological assessment. The aim of this study was to describe the hematological characteristics including peripheral blood and bone marrow findings of Yemeni adults and children with VL. METHODS We conducted a descriptive analytic study to evaluate systematically peripheral blood and bone marrow findings of Yemeni adults and children with VL. Peripheral blood and bone marrow aspiration of patients with bone marrow aspirate confirmed VL were examined. Forty-seven patients with the main age (±SD) of 17.34±11.37 years (Range: 1-60) were included in the study. Fifty-one non-VL subjects with splenomegaly and pancytopenia or bicytopenia served as control group. RESULTS All patients with VL had anemia, 41 (87%) leukopenia, 42 (89%) neutropenia, 44 (94%) thrombocytopenia, 42 (89%) eosinopenia, 34 (72%) pancytopenia and 13 (28%) had bicytopenia. In bone marrow examination 40 (85%) showed hypercellularity, 44 (94%) eosinopenia, 24 (51%) dyserythropoiesis, 22 (47%) lymphocytosis, 8 (17%) plasmacytosis, 27 (57%) decreased iron stores and 20 (43%) showed decreased sideroblasts. Comparison of VL patients with the control group showed significantly more frequent peripheral blood eosinopenia and lymphopenia and marrow eosinopenia. There was no significant difference between adults and children in any of the hematological features. CONCLUSION Anemia, leukopenia, neutropenia, thrombocytopenia, eosinopenia, pancytopenia and marked bone marrow eosinopenia were the most common findings. The finding of marked bone marrow eosinopenia is a significant clue for the diagnosis of visceral leishmaniasis in patients who present with splenomegaly associated with cytopenias. This finding is particularly valuable in non-endemic areas.
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Affiliation(s)
- Jameel Al-Ghazaly
- Department of Medicine, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
- Department of Medicine, Hematology Unit, Al-Jomhori Teaching Hospital, Sana’a, Yemen
| | - Waled Al-Dubai
- Department of Biochemistry and cytogenetics, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | | | - Leila Al-Gharasi
- Department of Medicine, Hematology Unit, Al-Jomhori Teaching Hospital, Sana’a, Yemen
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