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Abdullahi B, Mutiso J, Gicheru M. Social Demographic Characteristics Associated with Visceral Leishmaniasis in West Pokot, Kenya. Am J Trop Med Hyg 2024; 110:930-935. [PMID: 38531111 PMCID: PMC11066342 DOI: 10.4269/ajtmh.23-0241] [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: 04/22/2023] [Accepted: 01/14/2024] [Indexed: 03/28/2024] Open
Abstract
Visceral leishmaniasis is a tropical disease with a significant global public health burden. This study aimed to determine the social demographic characteristics associated with visceral leishmaniasis in West Pokot of Kenya. A mixed-methods research design was adopted where household questionnaires and key informant interviews were administered. Quantitative data was analyzed using SPSS version 22, and qualitative data were analyzed to establish patterns for interpretation. Male children aged 10 years or younger were the most infected by Leishmania donovani in the community. The hospital record indicated that 60% of previously treated visceral leishmaniasis patients were severely malnourished during admission. Risk factors associated with the disease included low formal education (adjusted odds ratio [aOR] = 4.39; 95% CI = 1.66-11.59; P <0.05), peasant farming (aOR = 8.49; 95% CI = 2.77-26.00; P <0.05), and dog ownership (aOR = 4.86; 95% CI = 1.87-12.60; P <0.05). Social demographic risk factors for visceral leishmaniasis remain a major public health concern in West Pokot.
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Affiliation(s)
- Bulle Abdullahi
- Department of Community Health and Epidemiology, School of Health Sciences, Kenyatta University, Nairobi, Kenya
| | - Joshua Mutiso
- Department of Zoological Sciences, School of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
| | - Michael Gicheru
- Department of Zoological Sciences, School of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
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Lu C, Ullah Z, Khan K, Shah SU, Jamal M, Khan NH. Environmental and socio-demographic factors associated with cutaneous leishmaniasis in district Khyber, Pakistan; alarming spread of the disease to new foci. Heliyon 2024; 10:e29571. [PMID: 38681643 PMCID: PMC11053183 DOI: 10.1016/j.heliyon.2024.e29571] [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: 08/04/2023] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
Cutaneous leishmaniasis (CL) is a sand fly-borne infection of significant public health concern in Pakistan (endemic for CL). This study aimed to scrutinize the environmental and socio-economic risk factors for CL in district Khyber (located on Pak-Afghan border), Pakistan. Clinically confirmed 2881 CL case records for (January-December) 2017 and 2020 were obtained from district hospital. In addition, a questionnaire for CL risk factors assessment was administered to 525 households (175 in 2017 and 350 in 2020) in 40 villages throughout the district in a household survey. Higher number of CL cases were recorded in 2020 (N = 1824 belonging to 90 villages) compared to 2017 (N = 1057 from 42 villages). Highest number of CL patient cases were recorded in tehsil Jamrud (N = 2248, 39.01 %), followed by Landi Kotal (N = 398, 6.91 %) and Bara (N = 235, 4.08 %). Records showed higher number of CL cases in males (N = 1,659, 57.58 %) compared to females (N = 1,222, 42.41 %). In 2017 and 2020 the disease burden peaked in January. GIS-based spatial analyses of hospital records revealed that CL cases were abundant at 294-1,916 m elevation, in agriculture and range lands. Univariate logistic regression model analysis of risk factors suggested that higher education, family size >15, knowledge of CL, having family member/s that suffered from CL in the past, knowledge about biting time of sand flies, use of mosquito spray, presence of Afghan refugees in the village/s and living in mud-made houses increased the risk of acquiring CL. The multivariable logistic regression model showed none of the risk factors to be statistically significant. Findings of the study are crucial towards effective and targeted control of CL in district Khyber.
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Affiliation(s)
- Chao Lu
- Hefei University of Technology, Hefei, China
| | - Zerman Ullah
- Department of Zoology, Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Khurshaid Khan
- Department of Zoology, Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Safeer Ullah Shah
- National Centre of Excellence in Geology, University of Peshawar, Peshawar, Pakistan
| | - Muhsin Jamal
- Department of Microbiology, Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Nazma Habib Khan
- Department of Zoology, University of Peshawar, Khyber Pakhtunkhwa, Pakistan
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Getnet M, Minaye Dejen A, Abebaw D, Fentahun GG, Birhanu E. Diagnostic accuracy of serological rk-39 test for visceral Leishmaniasis: Systematic review and meta-analysis. PLoS Negl Trop Dis 2024; 18:e0011938. [PMID: 38446789 PMCID: PMC10917292 DOI: 10.1371/journal.pntd.0011938] [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: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL), or kala-azar, is a vector-borne tropical disease caused by a group of intracellular hemoflagellate protozoa belonging to the family of Trypanosomatide and the genus Leishmania. The disease is distributed around the world and transmitted via the bite of infected female Phlebotomine sandflies, and there is variation in the diagnostic accuracy. Therefore, this systematic review and meta-analysis aimed to determine the pooled global sensitivity and specificity of the rk-39 test and to evaluate if there is a difference between the different parts of the world. METHODS A systematic review and meta-analysis have been conducted on the diagnostic accuracy of dermoscopy. After setting eligibility criteria, literature was searched in four databases and one searching engine. Articles were screened, critically appraised, and extracted independently by two reviewers, and any disagreements were resolved with the involvement of a third person. The quality of the included studies had been assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS 2) tool. Pooled sensitivity and specificity were determined by bivariate random effect analysis. Heterogeneity was assessed by Higgins's I2, and when it was present, mitigation was conducted by using sensitivity analysis. RESULT A total of 409 studies were identified, and finally 18 articles were eligible for the review with a total sample size of 5, 253. The bivariate random effect meta-analysis of the 7 diagnostic accuracy studies showed a pooled sensitivity of 0.89 (0.76-0.95) and specificity of 0.86 (0.72-0.94). The +LR was 6.32 (95% CI: 2.85-14.02), the-LR was 0.13 (95% CI: 0.06-0.30), and the diagnostic odds ratio (DOR) was 47.8 (95% CI: 11.3-203.2). Abdel-Latif (2018) was both an outlier and influential for sensitivity, and Walter (2011) was both an outlier and influential for specificity, and removing them from sensitivity and specificity, respectively, was beneficial for reducing the heterogeneity. CONCLUSION Rk-39 is found to have highly accurate measures in the diagnosis of visceral leishmaniasis. Both sensitivity and specificity were found to be highly accurate in the diagnosis of leishmaniasis, with a pooled sensitivity of 0.91 (0.88-0.93) and a pooled specificity of 0.89 (0.85-0.91). ETHICAL CONSIDERATION As we will use secondary data for the systematic review and meta-analysis, ethical concerns are not necessary.
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Affiliation(s)
- Mihret Getnet
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and biostatistics, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addisu Minaye Dejen
- Department of Epidemiology and biostatistics, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Pathology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw
- Department of Epidemiology and biostatistics, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Gedefaw Fentahun
- Department of Epidemiology and biostatistics, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emebet Birhanu
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and biostatistics, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Alemu C, Wudu H, Dessie G, Gashu C. Time to death and its determinant factors of visceral leishmaniasis with HIV co-infected patients during treatment period admitted at Metema hospital, Metema, Ethiopia: a hospital-based cross-sectional study design. Trop Dis Travel Med Vaccines 2023; 9:18. [PMID: 37898767 PMCID: PMC10613359 DOI: 10.1186/s40794-023-00203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/21/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Visceral leishmaniasis is caused by the parasites Leishmania donovani spices complex that can spread to internal organs and the disease is fatal with a fatality rate of nearly 100% if left untreated. Visceral Leishmania-HIV (HIV1) coinfection disease is a new clinical form of leishmaniasis very serious disease in the endemic part of the world. It also served as the primary cause of death in the lowlands of Ethiopia with the endemic Humara and Metema that are located near the Sudanese border. METHODS A total of 153 visceral leishmaniases with HIV co-infection secondary data was taken from the medical chart of patients from January 2015 to January 2021 and a hospital-based cross-sectional study design was carried out to retrieve relevant information. The data entered by SPSS and analysed using STATA version 14 and R4.2.1 statistical software packages using a non-parametric Model, semi-parametric Cox proportional hazard survival models at 5% significance level. RESULT Among the total visceral leishmaniasis with HIV co-infected patients 3.27% were females and 96.73% were males, 19 (12.42%) patients died and 134(87.58%) patients were censored. The Cox proportional hazard model result indicates that severe acute malnutrition, baseline CD4+ cell count ≥100, and underweight significantly contributed to the survival time of a patient. Cox proportional hazard model shows that severe acute malnutrition (HR=4.40027, 95% CI= 2.455061 262.7934, P-value=0.007), baseline CD4+cell count ≥100 (HR=0.2714623, 95% CI= 0.0764089 0.9644395, P-value=0.044), and Underweight (HR=4.678169, 95% CI= 1.970097 11.10872, P-value=0.040) significantly contributed to a shorter survival time. CONCLUSION Visceral leishmaniases with HIV co-infected patients show a large number of deaths occurred in the earlier days of treatment this implies that Visceral leishmaniasis accelerates HIV replication and disease progression death. The researcher suggests that people be aware of the burden posed by those risk factors and knowledgeable about the diseases. So, the researcher recommended that to health workers implement primary health care in those patients and careful consideration of a neglected parasitic disease.
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Affiliation(s)
- Chekol Alemu
- Department of Statistics, College of Natural and Computational Sciences, Gambella University, Gambella, Ethiopia.
| | - Habitamu Wudu
- Department of Statistics, College of Natural and Computational Sciences, Gambella University, Gambella, Ethiopia
| | - Getu Dessie
- Department of Statistics, College of Natural and Computational Sciences, Dambi Dollo University, Dembi Dolo, Ethiopia
| | - Chalachew Gashu
- Department of Statistics, College of Natural and Computational Sciences, Oda Bultum University, Chiro, Ethiopia
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Tiruneh FN, Ntenda PAM, Tamir T. The association of intimate Partner violence and decision making power on nutritional status of married women in Ethiopia: a multilevel mixed-effect analysis. BMC Womens Health 2023; 23:308. [PMID: 37312125 DOI: 10.1186/s12905-023-02459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/02/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND A growing body of research has established a link between intimate partner violence (IPV) and decision-making autonomy on women's mental, physical, and reproductive health consequences, as well as child nutritional status. However, there is a scarcity of research on the effects of IPV and decision-making autonomy on women's nutritional status. To date, no research has been conducted in Ethiopia to investigate the impact of IPV and decision-making autonomy on women's nutritional status. Therefore, the purpose of this study was to investigate the relationship between IPV and decision-making power at both the individual and community levels on women's nutritional status. METHODS We analyzed data from the 2016 Ethiopian demographic and health survey. Our study focused on 3,660 married non-pregnant women of reproductive age. We used the chi-squared test and spearman correlation coefficients for bivariate analysis. The relationship between IPV and decision making power with nutritional status was evaluated using multilevel binary logistic regression models while controlling other determinants. RESULTS Around 28% of women reported at least one of the four types of IPV. Approximately 32% of women had no decision-making power at home. About 27.1% of women were underweight (BMI < 18.5), while 10.6% were overweight/obese (BMI ≥ 25). Women who had sexual IPV had a higher chance of being underweight (AOR = 2.97; 95% CI: 2.02-4.38) than women who had no sexual IPV. While women who had decision-making power at home were at lower odds of being underweight (AOR = 0.83; 95% CI: 0.69-0.98) than their counterparts. The findings also revealed a negative relationship between being overweight/obese and community-level women's decision-making autonomy (AOR = 0.75; 95% CI 0.34-0.89). CONCLUSIONS Our findings show the presence of a significant association between IPV & decision-making autonomy with women's nutritional status. Therefore, effective policies and programs to end violence against women and encourage women to participate in decision-making are required. This will help to improve the nutritional status of women as well as the nutritional outcomes of their families. This study suggests that efforts to achieve Sustainable Development Goal (SDG5) may have an impact on other SDGs particularly SDG2.
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Affiliation(s)
- Fentanesh Nibret Tiruneh
- Department of Applied Human Nutrition, Faculty of Chemical and Food Engineering, Bahir Dar Institute of Technology, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Peter Austin Morton Ntenda
- Malaria Alert Centre, Kamuzu University of Health Sciences, Private Bag 360, Blantyre 3, Chichiri, Malawi
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Osorio EY, Uscanga-Palomeque A, Patterson GT, Cordova E, Travi BL, Soong L, Melby PC. Malnutrition-related parasite dissemination from the skin in visceral leishmaniasis is driven by PGE2-mediated amplification of CCR7-related trafficking of infected inflammatory monocytes. PLoS Negl Trop Dis 2023; 17:e0011040. [PMID: 36630476 PMCID: PMC9873180 DOI: 10.1371/journal.pntd.0011040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/24/2023] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
People are infected with Leishmania donovani when the parasite is deposited in the dermis during the blood meal of the sand fly vector. Most infected people develop a subclinical latent infection, but some develop progressive visceral leishmaniasis. Malnutrition is a risk factor for the development of active VL. We previously demonstrated increased parasite dissemination from the skin to visceral organs in a murine model of malnutrition. Here we investigated the mechanism of early parasite dissemination. After delivery of L. donovani to the skin, we found enhanced capture of parasites by inflammatory monocytes and neutrophils in the skin of malnourished mice. However, parasite dissemination in malnourished mice was driven primarily by infected inflammatory monocytes, which showed increased CCR7 expression, greater intrinsic migratory capacity, and increased trafficking from skin to spleen. PGE2 production, which was increased at the site of skin infection, increased monocyte CCR7 expression and promoted CCR7-related monocyte-mediated early parasite dissemination in malnourished mice. Parasite dissemination in monocytes was reduced by inhibition of PGE2, knockdown or silencing of CCR7 in monocytes, and depletion of inflammatory monocytes through administration of diphtheria toxin to CSFR1-DTR transgenic mice that have monocyte-specific DT receptor expression. CCR7-driven trafficking of infected inflammatory monocytes through the lymph node was accompanied by increased expression of its ligands CCL19 and CCL21. These results show that the CCR7/PGE2 axis is responsible for the increased trafficking of L. donovani-infected inflammatory monocytes from the skin to the spleen in the malnourished host. Undernutrition and production of PGE2 are potential targets to reduce the risk of people developing VL. Nutritional interventions that target improved immune function and reduced PGE2 synthesis should be studied in people at risk of developing VL.
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Affiliation(s)
- E. Yaneth Osorio
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail: (PCM); (EYO)
| | - Ashanti Uscanga-Palomeque
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Grace T. Patterson
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Erika Cordova
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Bruno L. Travi
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
- Center for Tropical Diseases and Institute for Human Infection and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Lynn Soong
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
- Center for Tropical Diseases and Institute for Human Infection and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Peter C. Melby
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
- Center for Tropical Diseases and Institute for Human Infection and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail: (PCM); (EYO)
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Leishmania major Strain-Dependent Macrophage Activation Contributes to Pathogenicity in the Absence of Lymphocytes. Microbiol Spectr 2022; 10:e0112622. [PMID: 36190414 PMCID: PMC9603372 DOI: 10.1128/spectrum.01126-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Infection of C57BL/6 wild-type mice with Leishmania major 5-ASKH or Friedlin strains results in relatively similar pathogenicity with self-healing lesions within weeks. Parasite clearance depends on nitric oxide production by activated macrophages in response to cytokines produced mainly by CD4+ Th1 cells. In contrast, C57BL/6 Rag2 knockout mice, which lack T and B lymphocytes, show distinct pathologies during infection with these strains. Despite of the similar parasite number, the 5-ASKH infection induced severe inflammation rather than the Friedlin. To determine the immunological factors behind this phenomenon, we infected C57BL/6 Rag2 knockout mice with these two strains and compared immune cell kinetics and macrophage activation status. Compared with the Friedlin strain, the 5-ASKH strain elicited increased pathology associated with the accumulation of CD11bhigh, Ly6Ghigh neutrophils by week four and increased the expression of macrophage activation markers. We then analyzed the differentially expressed transcripts in infected bone marrow-derived macrophages by RNA sequencing. It showed upregulation of multiple inflammatory transcripts, including Toll-like receptor 1/2 (TLR1/2), CD69, and CARD14, upon 5-ASKH infection. Our findings suggest that different L. major strains can trigger distinct macrophage activation, contributing to the disease outcome observed in the absence of lymphocytes but not in the presence of lymphocytes. IMPORTANCE Disease manifestations of cutaneous leishmaniasis (CL) range from self-healing cutaneous lesions to chronic forms of the disease, depending on the infecting Leishmania sp. and host immune protection. Previous works on mouse models of CL show the distinct pathogenicity of Leishmania major strains in the absence of lymphocytes. However, the mechanisms of this pathology remain uncovered. In the trial to understand the immunological process involved in lymphocyte-independent pathology, we have found a specific induction of macrophages by different L. major strains that affect their ability to mount innate responses leading to neutrophilic pathology when lymphocytes are ablated.
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Savino W, Durães J, Maldonado-Galdeano C, Perdigon G, Mendes-da-Cruz DA, Cuervo P. Thymus, undernutrition, and infection: Approaching cellular and molecular interactions. Front Nutr 2022; 9:948488. [PMID: 36225882 PMCID: PMC9549110 DOI: 10.3389/fnut.2022.948488] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Undernutrition remains a major issue in global health. Low protein-energy consumption, results in stunting, wasting and/or underweight, three deleterious forms of malnutrition that affect roughly 200 million children under the age of five years. Undernutrition compromises the immune system with the generation of various degrees of immunodeficiency, which in turn, renders undernourished individuals more sensitive to acute infections. The severity of various infectious diseases including visceral leishmaniasis (VL), influenza, and tuberculosis is associated with undernutrition. Immunosuppression resulting from protein-energy undernutrition severely impacts primary and secondary lymphoid organs involved in the response to related pathogens. The thymus-a primary lymphoid organ responsible for the generation of T lymphocytes-is particularly compromised by both undernutrition and infectious diseases. In this respect, we will discuss herein various intrathymic cellular and molecular interactions seen in undernutrition alone or in combination with acute infections. Many examples illustrated in studies on humans and experimental animals clearly revealed that protein-related undernutrition causes thymic atrophy, with cortical thymocyte depletion. Moreover, the non-lymphoid microenvironmental compartment of the organ undergoes important changes in thymic epithelial cells, including their secretory products such as hormones and extracellular matrix proteins. Of note, deficiencies in vitamins and trace elements also induce thymic atrophy. Interestingly, among the molecular interactions involved in the control of undernutrition-induced thymic atrophy is a hormonal imbalance with a rise in glucocorticoids and a decrease in leptin serum levels. Undernutrition also yields a negative impact of acute infections upon the thymus, frequently with the intrathymic detection of pathogens or their antigens. For instance, undernourished mice infected with Leishmania infantum (that causes VL) undergo drastic thymic atrophy, with significant reduction in thymocyte numbers, and decreased levels of intrathymic chemokines and cytokines, indicating that both lymphoid and microenvironmental compartments of the organ are affected. Lastly, recent data revealed that some probiotic bacteria or probiotic fermented milks improve the thymus status in a model of malnutrition, thus raising a new field for investigation, namely the thymus-gut connection, indicating that probiotics can be envisioned as a further adjuvant therapy in the control of thymic changes in undernutrition accompanied or not by infection.
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Affiliation(s)
- Wilson Savino
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Rio de Janeiro Research Network on Neuroinflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jonathan Durães
- Rio de Janeiro Research Network on Neuroinflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Laboratory on Leishmaniasis Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Carolina Maldonado-Galdeano
- Laboratory of Immunology, Reference Center for Lactobacilli Centro de Referencia para Lactobacilos-Consejo Nacional de Investigaciones Científicas y Técnicas (CERELA-CONICET), San Miguel de Tucumán, Argentina
- Laboratory of Immunology, Faculty of Biochemistry, Chemistry and Pharmacy, National University of Tucumán, San Miguel de Tucumán, Argentina
| | - Gabriela Perdigon
- Laboratory of Immunology, Reference Center for Lactobacilli Centro de Referencia para Lactobacilos-Consejo Nacional de Investigaciones Científicas y Técnicas (CERELA-CONICET), San Miguel de Tucumán, Argentina
- Laboratory of Immunology, Faculty of Biochemistry, Chemistry and Pharmacy, National University of Tucumán, San Miguel de Tucumán, Argentina
| | - Daniella Arêas Mendes-da-Cruz
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Rio de Janeiro Research Network on Neuroinflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, United Kingdom
| | - Patricia Cuervo
- Rio de Janeiro Research Network on Neuroinflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Laboratory on Leishmaniasis Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Issah AN, Yeboah D, Kpordoxah MR, Boah M, Mahama AB. Association between exposure to intimate partner violence and the nutritional status of women and children in Nigeria. PLoS One 2022; 17:e0268462. [PMID: 35550652 PMCID: PMC9098093 DOI: 10.1371/journal.pone.0268462] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Globally, intimate partner violence (IPV) epitomizes a greater proportion of the violence experienced by women, with more than a third of women (41.3%) in sub-Saharan Africa reporting IPV during their lifetime. This study examined the association between exposure to IPV and the nutritional status of women and their children in Nigeria. Methods The study analyzed secondary data obtained from the 2018 Nigeria Demographic and Health Survey. Data on women’s lifetime experience of psychological, physical, and sexual IPV, as well as demographic and socioeconomic characteristics, were collected. We used regression models to determine the association between exposure to IPV and women and child nutrition indicators. A weighted sample of 4,391 women aged 15–49 years and 2,145 children 6–59 months were analyzed. Results The lifetime experience of IPV in the study was 35.31% (95% CI: 33.35, 37.33), 30.43% (95% CI: 28.54, 32.38) experienced psychological IPV, 19.43% (95% CI: 17.79, 21.19) experienced physical IPV, and 6.03% (95% CI: 5.12, 7.09) experienced sexual IPV. After adjusting for a range of characteristics, maternal lifetime exposure to IPV was associated with underweight (ARRR = 0.63; 95% CI: 0.44, 0.91) and overweight/obesity (ARRR = 1.28; 95% CI: 1.04, 1.58). We also found that, children whose mothers experienced IPV were less likely to be underweight compared to their counterparts (ARRR = 0.69; 95% CI: 0.50, 0.96). Conclusions Overall, IPV against women, particularly psychological, physical, and sexual IPV, is common in Nigeria and has an association with the nutritional status of affected women and their children. According to the study, women with a lifetime experience of IPV were more likely to be overweight. On the other hand, affected women’s children were less likely to be underweight. A far-reaching effort is required to curb IPV against women, particularly policies, programs, and laws are needed to protect women and children from the unfavourable effects of IPV to reduce the prevalence and impact of such violence.
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Affiliation(s)
- Abdul-Nasir Issah
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Daudi Yeboah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
- * E-mail: ,
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Appiah PK, Osei B, Amu H. Factors associated with nutritional status, knowledge and attitudes among tuberculosis patients receiving treatment in Ghana: A cross-sectional study in the Tema Metropolis. PLoS One 2021; 16:e0258033. [PMID: 34648547 PMCID: PMC8516225 DOI: 10.1371/journal.pone.0258033] [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: 05/17/2020] [Accepted: 09/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background Nutritional deficiencies are generally associated with increased risk and severity of tuberculosis. This study investigated the nutritional status, knowledge, and attitudes of tuberculosis (TB) patients receiving treatment in the Tema Metropolis. Method A cross-sectional design was used to collect data on the nutritional knowledge, attitude, and status of TB patients. Nutritional status was analysed using World Health Organization’s formula for body mass index. Pearson’s chi-square and logistic regression models were used to assess associations between predictor and outcome variables. All statistical analyses were considered significant at p-values < 0.05. Result The prevalence of malnutrition among TB patients was 39.7%, 14.4%, and 4.8% for underweight, overweight, and obesity respectively. There was a high (61.0%) knowledge of nutrition among the patients. Also, 65.8% had good attitude towards nutrition. There were significant associations between normal nutritional status and age of the TB patients (p = 0.041), highest educational level attained (p = 0.036), employment status (p = 0.019), status of alcohol intake (p = 0.031), number of months on TB treatment (p = 0.021), and attitude towards nutrition (p = 0.028). Conclusion There was a reasonable nutrition-related knowledge and attitude towards nutrition among the TB patients. However, that did not reflect on their nutritional status. We recommend continuing education on smoking cessation, avoidance of harmful use of alcohol, and the establishment of food aid and other livelihood intervention programs for TB patients.
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Affiliation(s)
- Prince Kubi Appiah
- Department of Family and Community Health, School of Public Health (Hohoe Campus), University of Health and Allied Sciences, Ho, Ghana
- Department of Medical Law and Ethics, Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, South Korea
- * E-mail: ,
| | - Bright Osei
- Department of Family and Community Health, School of Public Health (Hohoe Campus), University of Health and Allied Sciences, Ho, Ghana
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health (Hohoe Campus), University of Health and Allied Sciences, Ho, Ghana
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11
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Monteiro MJDSD, da Silva MNP, Paiva ADA, Marreiro DDN, Luzia LA, Henriques GS, Rondó PHDC, Sene IDS, de Almeida ATA, Costa CHN, Costa DL. Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil. Rev Soc Bras Med Trop 2021; 54:e08002020. [PMID: 34495261 PMCID: PMC8437443 DOI: 10.1590/0037-8682-0800-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/26/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.
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Affiliation(s)
| | - Maria Nauside Pessoa da Silva
- Universidade Federal do Piauí, Programa de Pós-Graduação em Biotecnologia, Rede Nordeste de Biotecnologia, Teresina, PI, Brasil
| | | | | | - Liania Alves Luzia
- Universidade de São Paulo, Laboratório de Micronutrientes, São Paulo, SP, Brasil
| | - Gilberto Simeone Henriques
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Laboratório Experimental de Nutrição, Belo Horizonte, MG, Brasil
| | | | - Ingridi de Souza Sene
- Universidade Federal do Piauí, Laboratório de Pesquisas em Leishmanioses, Teresina, PI, Brasil
- Laboratório de Anatomia Patológica e Biologia Molecular, Teresina, PI, Brasil
| | | | - Carlos Henrique Nery Costa
- Universidade Federal do Piauí, Laboratório de Pesquisas em Leishmanioses, Teresina, PI, Brasil
- Centro de Inteligência para Agravos Tropicais Emergentes e Negligenciados, Teresina, PI, Brasil
- Universidade Federal do Piauí, Departamento de Medicina Comunitária, Teresina, PI, Brasil
| | - Dorcas Lamounier Costa
- Universidade Federal do Piauí, Laboratório de Pesquisas em Leishmanioses, Teresina, PI, Brasil
- Centro de Inteligência para Agravos Tropicais Emergentes e Negligenciados, Teresina, PI, Brasil
- Universidade Federal do Piauí, Departamento Materno-Infantil, Teresina, PI, Brasil
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12
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Shaheen N, Verma C, Pacheco-Fernandez T, Volpedo G, Hamid A, Zeb I, Shah SAA, Fahad S, Iqbal A, Ashraf A, Khan A, Gul M, Khan MI, Fatima H, Afzal M, Satoskar AR, Qureshi NA. Molecular characterization and genetic diversity of cutaneous leishmaniasis from North Eastern Pakistan. Acta Trop 2021; 221:105964. [PMID: 34023304 DOI: 10.1016/j.actatropica.2021.105964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022]
Abstract
The genetic diversity of Leishmania spp. in North Eastern Pakistan remains undetermined despite increased cases of cutaneous leishmaniasis (CL). This study was designed to decipher the molecular characterization and genetic diversity of Leishmania spp. in North Eastern Pakistan. Out of 13761 CL suspected cases, 567 cases were microscopically positive and confirmed as Leishmania spp. by internal transcribed spacer (ITS) gene amplification through the PCR- RFLP technique. Further, isolates were directly sequenced to conduct phylogenetic analysis for genetic diversity. Among suspected CL cases, Mirpur showed the highest proportion of CL infection with 4.85% (118/2431) of the cases, while the Neelum district showed the lowest percentage at 3.29% (9/273). The slide positivity rate, annual blood examination rate, and annual parasite incidence rate were 3.84, 0.27, and 0.01% respectively, and the incidence of CL in the age group 1-20 years old was higher in males (50.92%) than females (25.75%). The RFLP analysis and sequencing confirmed the occurrence of Leishmania tropica, Leishmania major, and Leishmania infantum. Leishmania tropica (p = 0.02) confirmed significantly higher nucleotides variation than L. major (p = 0.05). Current findings confirmed the prior assumption that anthroponotic CL is the primary CL form present in North Eastern Pakistan. Moreover, this is the first report based on molecular identification of L. major, and L. infantum from North Eastern Pakistan. This remarkable heterogeneity in the Leishmania spp. is the leading cause of treatment failure and emergence of new haplotypes. Therefore more extensive investigations are recommended from all geographical regions of North Eastern Pakistan, especially those using a large sample size.
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Affiliation(s)
- Nargis Shaheen
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan; Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Chaitenya Verma
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Thalia Pacheco-Fernandez
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Greta Volpedo
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Aneeqa Hamid
- Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Ismail Zeb
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Syed Aizaz Ali Shah
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Shah Fahad
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Attiya Iqbal
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Asma Ashraf
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Amjad Khan
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan; Departement of Zoology, Faculty of Science,University of lakki marwat 28420, Khyber Pakhtunkhwa, Pakistan
| | - Misbah Gul
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Muhammad Ilyas Khan
- Department of Zoology, Kohat University of Science and Technology Khyber Pakhtunkhwa Islamabad, Pakistan
| | - Huma Fatima
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Muhammad Afzal
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan
| | - Abhay R Satoskar
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Naveeda Akhter Qureshi
- Department of Zoology, Faculty of Biological Science, Quaid-i-Azam University Islamabad 45320, Pakistan.
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13
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Jones CM, Welburn SC. Leishmaniasis Beyond East Africa. Front Vet Sci 2021; 8:618766. [PMID: 33732738 PMCID: PMC7959848 DOI: 10.3389/fvets.2021.618766] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/15/2021] [Indexed: 01/25/2023] Open
Abstract
Climate change is having a substantial impact on our environment and ecosystems and has altered the way humans live, access, and utilize resources with increased risk of zoonotic infectious disease encounters. As global temperatures continue to increase, they impact on public health, migration, food security and land conflict, and as new environments become favorable, exposure to disease carrying vectors. Increased forests or natural habitat clearance for land repurposing, urbanization, road building, and water management are related to an increase in emerging vector borne parasitic diseases. The East African region remains one of the most impacted regions globally for leishmaniasis, a vector borne disease that impacts significantly on the health, wellbeing and livelihoods of affected communities and for which a lack of reporting and control interventions hinder progress toward elimination of this neglected tropical disease. As our world continues to transform, both politically and climatically, it is essential that measures are put in place to improve surveillance and disease management with implementation of control measures, including vector control, especially in low- and middle-income countries that are expected to be most impacted by changes in climate. Only through effective management, now, can we be sufficiently resilient to preventing the inevitable spread of vectors into suitable habitat and expansion of the geographical range of leishmaniasis. This review offers a current perspective on Leishmaniasis as an endemic disease in East Africa and examines the potential of the recent emergence of Leishmania infection in hitherto unaffected regions to become a public health concern if no disease management is achieved.
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Affiliation(s)
- Caitlin M Jones
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, International Campus, Zhejiang University, Haining, China.,Infection Medicine, Deanery of Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Susan C Welburn
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, International Campus, Zhejiang University, Haining, China.,Infection Medicine, Deanery of Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
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14
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Mohebali M, Yimam Y. Prevalence estimates of human immunodeficiency virus (HIV) infection among visceral leishmaniasis infected people in Northwest Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:214. [PMID: 32164607 PMCID: PMC7069024 DOI: 10.1186/s12879-020-4935-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background In Ethiopia, by the end of 2018, an estimated 690,000 people are infected with HIV and the annual cases of Visceral Leishmaniasis (VL) is estimated to be between 4000 and 5000 with over 3.2 million people are at risk. Northwest Ethiopia accounts for over 60% cases of VL in the country. Prevalence of HIV infection among VL infected people in Ethiopia has not yet been synthesized. Therefore, we aimed to estimate the pooled prevalence of HIV infection among VL infected people in Northwest Ethiopia with the hope that it would guide the development of a more robust and cost-effective intervention strategies. Methods In this systematic review and meta-analysis, we searched six international databases: PubMed, Ovid MEDLINE®, Embase, Scopus, Google Scholar, and ProQuest Dissertations & Theses. We also searched reference lists of included studies and Ethiopian universities electronic thesis and dissertation repositories. The search was performed until June 30,2019. Funnel plot symmetry visualization confirmed by Egger’s regression asymmetry test and Begg rank correlation methods was used to assess publication bias. Pooled prevalence estimate was calculated using Der Simonian and Laird’s random Effects model. We went further to perform univariate meta-regression and subgroup analysis to identify a possible sources of heterogeneity among the studies. STATA software (version 14, Texas, USA) was used for analysis. Results From 1286 citations identified by our search, 19 relevant studies with 5355 VL infected individuals were included in this meta-analysis. The pooled prevalence of HIV infection among VL infected individuals in Northwest Ethiopia was 24% (95%CI: 17–30%). The result of sensitivity analysis demonstrated that the pooled prevalence estimate was robust and not one-study dependent. The pooled prevalence estimate of HIV infection among VL infected people in Northwest Ethiopia ranged from 20.88% (95%CI: 15.91–25.86) to 24.86% (95%CI: 18.57–31.14) after a single study was deleted. Conclusions The burden of HIV infection in people infected with VL in Northwest Ethiopia is considerably high. Integrating HIV/AIDS surveillance among VL infected people would improve case detection as well as prevention and control of disease spread.
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Affiliation(s)
- Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Yonas Yimam
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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15
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Nweze JA, Nweze EI, Onoja US. Nutrition, malnutrition, and leishmaniasis. Nutrition 2019; 73:110712. [PMID: 32078915 DOI: 10.1016/j.nut.2019.110712] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/01/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023]
Abstract
Leishmaniasis is a vector-borne infectious disease with a long history of infecting humans and other animals. It is a known emerging or resurging disease. The host nutritional state has an indispensable role in defense against pathogens. The host defense system disorganization as a result of undernutrition is responsible for asymptomatic infections and even severe diseases. Host susceptibility and pathophysiologic severity to infection can be aggravated owing to undernourishment in a number of pathways, and infection also may aggravate preexisting poor nutrition or further increase host susceptibility. This study suggests that there may be some relationship between malnutrition and the endemicity of the parasite. The susceptibility to and severity of leishmanial infection can be altered by the body weight and serum levels of micronutrients. Nutrition not only affects the vulnerability of the host but also may affect the desire of sandfly to bite a specific host. Apart from host defense mechanism, nutritional stress also greatly influences vector competence and host-seeking behavior, especially during larvae development. The host and sandfly vector nutritional states could also influence the evolution of the parasite. It is essential to elucidate the roles that diets and nutrition play in the leishmanial life cycle. The aim of this article is to review the influences of nutrition and diets on the host susceptibility and severity of infection, preemptive and therapeutic strategy feedback, parasite evolution, and vector competence.
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Affiliation(s)
- Justus Amuche Nweze
- Department of Science Laboratory Technology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Emeka Innocent Nweze
- Department of Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria.
| | - Uwakwe Simon Onoja
- Department of Nutrition and Dietetics, University of Nigeria, Nsukka, Enugu State, Nigeria.
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16
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Feleke BE. Nutritional status of visceral leishmaniasis patients: A comparative cross-sectional study. Clin Nutr ESPEN 2019; 33:139-142. [DOI: 10.1016/j.clnesp.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
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17
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Mohamed NS, Osman HA, Muneer MS, Samy AM, Ahmed A, Mohammed AO, Siddig EE, Abdel Hamid MM, Ali MS, Omer RA, Elaagip AH. Identifying asymptomatic Leishmania infections in non-endemic villages in Gedaref state, Sudan. BMC Res Notes 2019; 12:566. [PMID: 31511056 PMCID: PMC6737656 DOI: 10.1186/s13104-019-4608-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/04/2019] [Indexed: 01/30/2023] Open
Abstract
Objectives Infection with the causative agent of visceral leishmaniasis (VL) may be either symptomatic or asymptomatic. In this study we aimed at investigating the prevalence of asymptomatic infections of leishmania in non-endemic villages in Gedaref state, Sudan. A descriptive cross-sectional study conducted during September and October 2014. Blood samples were collected for serological and molecular analysis. Sticky-traps, knockdown spray and CDC-miniature light traps were used for the collection of sandflies. Results Ninety-Five participants were included; 52 from Abukishma, 15 Algadamblia Tirfa, 25 Abualnaja and 3 were from Algadamblia Aljabal. Females constituted 56 (58.9%) of the study participants while males were 39 (41.1%). The most frequent age group was > 40-years (54.7%). Balanites/Acacia trees were the most planted tree inside the houses; 78 (82.1%). Also, 85 (89.5%) of the participants breed animals inside the house. DAT test revealed 5 positive participants (5.2%). 4/5 DAT positive were past VL infection. PCR detected 35 (36.8%) positive participants. A total of 31/35 was considered asymptomatic infections based on PCR. Households planted Balanites/Acacia trees or breed domestic animals were found in high percentages with L. donovani PCR positive participants (60.1%, 91.4%). No statistically significant was found for VL associated risk factors and VL asymptomatic participants.
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Affiliation(s)
- Nouh Saad Mohamed
- Department of Parasitology and Medical Entomology, Faculty of Medical Laboratory Sciences, University of Sinner, 11111, Khartoum, Sudan. .,Department of Parasitology and Medical Entomology, Faculty of Medical Laboratory Sciences, Nile University, Khartoum, Sudan. .,Department of Molecular Biology, Institute of Zoology, University of Hohenheim, Stuttgart, Germany.
| | - Hussam A Osman
- Biomedical Research Laboratory, Ahfad University for Women, Omdurman, Sudan
| | - Mohamed S Muneer
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.,Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Abdallah M Samy
- Entomology Department, Faculty of Science, Ain Shams University, Abbassia, Cairo, 11566, Egypt
| | - Ayman Ahmed
- Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Anwar O Mohammed
- Malaria Control Program and Vector Control, Gedaref Ministry of Health, Gedaref, Sudan
| | - Emmanuel Edwar Siddig
- Department of Basic Medical Sciences, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan.,Mycetoma Research Center, University of Khartoum, Khartoum, Sudan.,School of Medicine, Nile College, Khartoum, Sudan
| | - Muzamil M Abdel Hamid
- Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Mohamed Siralkhatim Ali
- Department of Molecular Biology, National University Research Institute, National University, Khartoum, Sudan.,Faculty of Medicine, Neelain University, Khartoum, Sudan
| | - Rihab A Omer
- Department of Molecular Biology, Institute of Zoology, University of Hohenheim, Stuttgart, Germany.,Department of Molecular Biology, Institute of Parasitology, University of Leipzig, Leipzig, Germany
| | - Arwa H Elaagip
- Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan.,Department of Parasitology and Medical Entomology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
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18
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Lombardi P, Palatucci AT, Giovazzino A, Mastellone V, Ruggiero G, Rubino V, Musco N, Crupi R, Cutrignelli MI, Britti D, Vassalotti G, Terrazzano G, Cortese L. Clinical and Immunological Response in Dogs Naturally Infected by L. infantum Treated with a Nutritional Supplement. Animals (Basel) 2019; 9:ani9080501. [PMID: 31366122 PMCID: PMC6721201 DOI: 10.3390/ani9080501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 12/23/2022] Open
Abstract
Simple Summary We evaluated the effects of a commercial nutraceutical supplementation in dogs naturally affected by Leishmania infantum. This nutraceutical supplement is proposed to be added to dog diet to foster physiological immune-response during chronic leishmaniasis. Parasite clearance is infrequently obtained by immune response in both the human and canine leishmaniasis. Pharmacological therapies frequently fail in the elimination of L. infantum that could have settled in deep organs, escaping immune responses and therapy. The conventional drug therapy improves clinical signs, reduces parasitemia as well as relapse of infection. This nutraceutical supplementation can improve the impaired immune response of the infected dogs to fight the disease. Abstract The use of nutraceuticals as immunomodulators in the treatment of visceral leishmaniasis has generated interest in the current approaches to treat the disease. In this clinical and immunological study, we investigated whether the administration of a nutritional supplement mediates the immune-modulatory response in canine leishmaniosis (CL) and improves the clinical outcome of the disease. With this purpose, we analysed T lymphocyte subsets in peripheral blood (PB) of 12 dogs naturally infected by Leishmania infantum, following treatment with a nutritional supplement. The regulatory T (Treg) cells and the T helper (Th) 1 population were specifically evaluated. The animals underwent complete clinical examination and blood sample collection for haematological, biochemical, serological and immunological analysis before treatment (T0), one month (T30) and 3 months (T90) after the onset of the nutraceutical supplementation. We observed that nutraceutical supplementation was associated with immunomodulation of Th1 response and significant clinical improvement of the animals. No side effects were observed. Therefore, a potential supportive role for the nutraceutical supplement during canine leishmaniasis is proposed.
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Affiliation(s)
- Pietro Lombardi
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, 80138 Napoli NA, Italy
| | | | - Angela Giovazzino
- Department of Science, University of Basilicata, 85100 Potenza PZ, Italy
| | - Vincenzo Mastellone
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, 80138 Napoli NA, Italy
| | - Giuseppina Ruggiero
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Napoli NA, Italy
| | - Valentina Rubino
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Napoli NA, Italy
| | - Nadia Musco
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, 80138 Napoli NA, Italy
| | - Rosalia Crupi
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98122 Messina ME, Italy
| | - Monica Isabella Cutrignelli
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, 80138 Napoli NA, Italy
| | - Domenico Britti
- Department of Health Sciences, University Magna Graecia, 88100 Catanzaro CZ, Italy
| | - Giuseppe Vassalotti
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, 80138 Napoli NA, Italy
| | - Giuseppe Terrazzano
- Department of Science, University of Basilicata, 85100 Potenza PZ, Italy.
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Napoli NA, Italy.
| | - Laura Cortese
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, 80138 Napoli NA, Italy.
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19
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Chakravarty J, Sundar S. Current and emerging medications for the treatment of leishmaniasis. Expert Opin Pharmacother 2019; 20:1251-1265. [DOI: 10.1080/14656566.2019.1609940] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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20
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Sundar S, Chakravarty J, Meena LP. Leishmaniasis: treatment, drug resistance and emerging therapies. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2019.1552853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Lalit P Meena
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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21
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Gebremichael D. Zoonotic impact and epidemiological changes of leishmaniasis in Ethiopia. Open Vet J 2018; 8:432-440. [PMID: 30538935 PMCID: PMC6258520 DOI: 10.4314/ovj.v8i4.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/21/2018] [Indexed: 11/28/2022] Open
Abstract
Leishmaniasis is one of the growing public health challenges in Ethiopia and estimated over 7,000 and 50,000 new cases of visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL) per year, respectively. The aim of the review is to address zoonotic impact and epidemiological changes of leishmaniasis in Ethiopia. VL is caused by L. donovani and it is endemic in many parts of the country with one third of the country’s landmass is highly suitable for VL. CL is principally caused by L. aethiopica. CL is endemic and widespread in the highland of Ethiopia. Northern lowland foci are Humera and Metema plains in the Tigray and Amhara regional states constitute the main VL endemic areas in the country, contributing over 60% of the total burden. The southern foci are the south-western savannah, and the south-eastern semi-arid lowlands which account for approximately 20 % of the total VL burden in Ethiopia. Leishmaniasis is a serious zoonotic disease in Ethiopia with more reservoir hosts maintaining the disease. Dogs and hyraxes are the main reservoir hosts for visceral and cutaneous leishmaniasis in the country, respectively. Epidemiological changes of leishmaniasis may relate to environmental changes and expansion of mega projects such as irrigations and sugar cane factories, knowledge and socio-economic factors, development of new settlements, migration of peoples and HIV/AIDS co-infection. Expansions of mega projects such as sugar factories and irrigations are suitable for reproduction of stray dogs, rodents, wild canids and vectors. VL is one of the major challenges to prevent and control in the endemic areas of the country. Therefore, new research should be imperative, especially in the mega projects to design strategic control and prevention methods.
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Affiliation(s)
- Dawit Gebremichael
- Veterinary Public Health, Aksum University Shire Campus, College of Agriculture, Department of Animal Science, Shire, Ethiopia
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Mulaw T, Tariku A, Tsegaye AT, Abebe Z. Effect of iron-folic acid supplementation on change of hemoglobin among visceral Leishmaniasis patients in northwest Ethiopia: a retrospective follow up study. BMC HEMATOLOGY 2018; 18:29. [PMID: 30258634 PMCID: PMC6151065 DOI: 10.1186/s12878-018-0123-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/10/2018] [Indexed: 01/01/2023]
Abstract
Background An individual with visceral Leishmaniasis (VL) commonly present with anemia and one of the VL treatment center in northwest Ethiopia has been recommended iron-folic acid supplementation to these patients. But there is no documented evidence whether iron-folic acid supplementation improves the hematological profile of patients. Therefore, the study aimed to assess change in hemoglobin (Hb) and its determinant factors among VL patients with and without iron-folic acid supplementation in northwest Ethiopia. Methods A retrospective cohort study was conducted from January 2015 to December 2016. Data were entered into Epi-Data version 3.1 and transferred to Statistical Package for Social Science (SPSS) version 20 for analysis. Independent sample T-test and linear regression were used to compare the change in Hb and identify factors associated with a change in Hb, respectively. A 95% confidence level and p-values less than 0.05 were used determine statistically significant. Results From a total of 602 VL patients, 299 (49.7%) were from University of Gondar hospital. The mean (±SD) change of Hb from baseline to end of treatment was 0.99(±1.64) and 1.61(±1.88) g/dl with and without iron-folate supplementation, respectively, with mean difference 0.62, 95% CI (0.34, 0.90) and a p-value of < 0.0001. In multiple linear regressions, combination therapy of sodium stibogluconate-paramomycin (SSG-PM) was positively associated with a change of Hb (β [SE, p]: 0.710/0.15, < 0.0001). Whereas age (- 0.030/0.009, 0.001), nasal bleeding (- 0.261/0.123, 0.035), baseline white blood cell (- 0.139/0.044, 0.002) and hemoglobin (- 0.513/0.031, < 0.0001), end of treatment spleen size (- 0.059/0.015, < 0.0001) and iron-folic acid supplementation (- 0.574/0.163, < 0.0001) were negatively associated with change of Hb. Conclusion Iron-folic acid supplementation had a negative effect on the change of Hb. A combination therapy of SSG-PM, age, nasal bleeding, baseline white blood cells and Hb, and iron-folic acid supplementation were the determinants of change of Hb. Therefore, avoiding iron-folic acid supplementation and strengthening VL treatment with a combination of SSG-PM and, and early identification of complications is recommended for a better outcome.
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Affiliation(s)
- Tadele Mulaw
- 1University of Gondar Specialized Hospital, Gondar, Ethiopia
| | - Amare Tariku
- 2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- 3Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zegeye Abebe
- 2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Assefa A. Leishmaniasis in Ethiopia: A systematic review and meta-analysis of prevalence in animals and humans. Heliyon 2018; 4:e00723. [PMID: 30101202 PMCID: PMC6082994 DOI: 10.1016/j.heliyon.2018.e00723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/06/2018] [Accepted: 08/01/2018] [Indexed: 01/21/2023] Open
Abstract
Leishmaniasis is a neglected tropical disease caused by obligate intracellular protozoa of the genus Leishmania. Ethiopia does not have an overall estimation of prevalence of leishmaniasis infection at a country level. The objective of this systematic review and meta-analysis was to summarize and pool estimates of studies that report the prevalence of leishmaniasis in Ethiopia. The literature search was conducted to identify all published studies reporting the prevalence of leishmaniasis with clearly designed inclusion and exclusion criteria. From all screened articles, 30 studies were eligible for final meta-analysis and systematic review. Because substantial heterogeneity was expected, random-effects meta-analyses were carried out using the total sample size and number of positives to estimate the prevalence of the disease at a country level. Between-study variability was high (τ2 = 0.02; heterogeneity I2 = 99.72% with Heterogeneity chi-square = 11985.41, a degree of freedom = 33 and P = 0.001). The overall random pooled prevalence of leishmaniasis was 19% (95% CI 14%-24%). Meta-regression analysis showed that diagnosis method used have contributed to the heterogeneity of studies. Molecular diagnosis has significantly lower prevalence than microscopic examination with a coefficient of -0.32, a p-value of 0.024, and CI (-0.6-0.05). The result of effect estimates against its standard error showed there was no publication bias with a P value of 0.084. This review indicated that there is still a higher prevalence of Leishmaniasis in the country. Reporting on risk factors like sex and age affected, species of Leishmania involved and many more other risk factors reviewing was not possible in this study due to lack of completeness in articles included. However, this report is an indication that the country needs nationally coordinated extensive prevention and control plan to reduce public health and socio-economic impact of the disease.
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Affiliation(s)
- Ayalew Assefa
- Sekota Dryland Agricultural Research Center, P.O. Box 62, Sekota, Ethiopia
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Askari A, Sharifi I, Aflatoonian MR, Babaei Z, Ghasemi Nejad Almani P, Mohammadi MA, Alizadeh H, Hemati S, Bamorovat M. A newly emerged focus of zoonotic cutaneous leishmaniasis in South-western Iran. Microb Pathog 2018; 121:363-368. [PMID: 29709689 DOI: 10.1016/j.micpath.2018.04.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 03/14/2018] [Accepted: 04/24/2018] [Indexed: 11/26/2022]
Abstract
Leishmaniasis is rising in many countries, including Iran, due to climate change, refugee crises, urbanization and etc. The aim of this study was to explore the epidemiology, extent and identity of Leishmania species in a newly emerged focus in Abdanan County, Ilam Province, South-western Iran. This study was performed as a descriptive cross-sectional study by a systematic house-to-house approach. The Leishmania species was identified by RFLP-PCR and sequencing. Altogether, 46799 individuals consisting of 22907 (48.9) female and 23892 (51.1%) male were interviewed and physically examined for the presence of skin lesions. Overall, the incidence rate was 0.34% (n = 160). All age groups were affected and the incidence rate was the highest in <10 years of age group (0.49%) and the lowest in >50 years old individuals (0.15%), although there was no significant difference regarding the sex and age. The majority of patients had one lesion (47.5%) on hands (56%) and most of the cases occurred in Abdanan city (%54) in summer. Based on the RFLP-PCR analysis, all the Leishmania isolates were L. major of single genotype. A newly emerged focus of zoonotic CL caused by L. major occurred in South-western of Iran. Multiple risk factors created this epidemic area. Further studies on the vector and reservoir are crucial needed to provide evidences to select the prophylactic and therapeutic measures for future control strategies.
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Affiliation(s)
- A Askari
- Dept. of Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | - I Sharifi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - M R Aflatoonian
- Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran.
| | - Z Babaei
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | | | - M A Mohammadi
- Research Center for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran.
| | - H Alizadeh
- Mazandaran University of Exercise Physiology Sciences, Babolsar, Iran.
| | - S Hemati
- Dept. of Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | - M Bamorovat
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
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Lima ID, Lima ALM, Mendes-Aguiar CDO, Coutinho JFV, Wilson ME, Pearson RD, Queiroz JW, Jeronimo SMB. Changing demographics of visceral leishmaniasis in northeast Brazil: Lessons for the future. PLoS Negl Trop Dis 2018; 12:e0006164. [PMID: 29509765 PMCID: PMC5839541 DOI: 10.1371/journal.pntd.0006164] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/12/2017] [Indexed: 01/08/2023] Open
Abstract
Background Visceral leishmaniasis (VL) caused by Leishmania infantum became a disease of urban areas in Brazil in the last 30 years and there has been an increase in asymptomatic L. infantum infection with these areas. Methodology/Principal findings A retrospective study of human VL was performed in the state of Rio Grande do Norte, Brazil, for the period of 1990–2014. The data were divided into five-time periods. For all VL cases, data on sex, age, nutritional status and childhood vaccination were collected. Geographic information system tools and statistical models were used to analyze the dispersion of human VL. The mean annual incidence of VL was 4.6 cases/100,000 inhabitants, with total 3,252 cases reported. The lethality rate was 6.4%. Over time the annual incidence of VL decreased in the 0–4 years (p<0.0001) and 5–9 (p <0.0001) age groups, but increased in ages 20–39 (p<0.001) and >40 years (p<0.0001). VL occurred more often in males (β2 = 2.5; p<0.0001). The decreased incidence of VL in children was associated with improved nutritional status and childhood immunizations including measles, poliomyelitis, BCG, and hepatitis B. Human VL correlated temporally and geographically with canine L. infantum infection (p = 0.002, R2 = 0.438), with rainfall and with Lutzomyia longipalpis density (r = 0.762). Overall, the incidence of VL decreased, while VL-AIDS increased, especially between 2010–2014. VL was more frequently found in areas that lacked urban infrastructure, detected by lack of garbage collection and sewers, whereas HIV infection was associated with higher levels of schooling and evidence of higher socioeconomic status. Conclusion/Significance The demographics of VL in northeastern Brazil have changed. Disease incidence has decreased in children and increased in adults. They were associated with improvements in nutrition, socioeconomic status and immunization rates. Concurrent VL-AIDS poses a serious challenge for the future. We studied factors associated with the changing demographics of visceral leishmaniasis (VL) in Northeast Brazil, including environmental and socioeconomic determinants of disease, during the period 1990 to 2014. The incidence of VL was higher in urban areas, and regions with higher levels of canine L. infantum infection. Human males were more commonly affected than females. The incidence of VL in children under age 10 decreased during the period of study, simultaneous with increased incidence in adults. Reduction in the VL incidence among children was associated with improved socioeconomic status, administration of childhood vaccines and better nutritional status. Geographic areas with higher rainfall had higher densities of Lu. longipalpis, the primary vector of L. infantum in Brazil. VL was more frequently found in areas with indicators of poverty including sparse garbage collection and lack of urban infrastructure. During the past 25 years, HIV/AIDS has spread to areas where VL is endemic and has contributed to an increased incidence of VL-AIDS co-infection in adults.
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Affiliation(s)
- Iraci Duarte Lima
- Health Graduate Program, Health Science Center; Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte; Natal, RN, Brazil
- State of Rio Grande do Norte Health Secretariat; Natal, RN, Brazil
| | - Adila L. M. Lima
- Health Graduate Program, Health Science Center; Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte; Natal, RN, Brazil
- State of Rio Grande do Norte Health Secretariat; Natal, RN, Brazil
- Center for Zoonosis Control, Natal Health Secretariat, Natal, RN, Brazil
| | | | - José F. V. Coutinho
- Health Graduate Program, Health Science Center; Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte; Natal, RN, Brazil
- Center for Zoonosis Control, Natal Health Secretariat, Natal, RN, Brazil
| | - Mary E. Wilson
- Departments of Internal Medicine, Microbiology and Epidemiology, University of Iowa, and the Veterans’ Affairs Medical Center, Iowa City, IA, United States of America
| | - Richard D. Pearson
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, United States of America
| | - José Wilton Queiroz
- Health Graduate Program, Health Science Center; Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte; Natal, RN, Brazil
- Institute of Science and Technology of Tropical Diseases, INCT-DT, Salvador, Brazil
| | - Selma M. B. Jeronimo
- Health Graduate Program, Health Science Center; Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte; Natal, RN, Brazil
- Institute of Science and Technology of Tropical Diseases, INCT-DT, Salvador, Brazil
- Department of Biochemistry, Bioscience Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- * E-mail:
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Disease severity in patients with visceral leishmaniasis is not altered by co-infection with intestinal parasites. PLoS Negl Trop Dis 2017; 11:e0005727. [PMID: 28732017 PMCID: PMC5540614 DOI: 10.1371/journal.pntd.0005727] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 08/02/2017] [Accepted: 06/19/2017] [Indexed: 12/24/2022] Open
Abstract
Visceral leishmaniasis (VL) is a neglected tropical disease that affects the poorest communities and can cause substantial morbidity and mortality. Visceral leishmaniasis is characterized by the presence of Leishmania parasites in the spleen, liver and bone marrow, hepatosplenomegaly, pancytopenia, prolonged fever, systemic inflammation and low body mass index (BMI). The factors impacting on the severity of VL are poorly characterized. Here we performed a cross-sectional study to assess whether co-infection of VL patients with intestinal parasites influences disease severity, assessed with clinical and haematological data, inflammation, cytokine profiles and BMI. Data from VL patients was similar to VL patients co-infected with intestinal parasites, suggesting that co-infection of VL patients with intestinal parasites does not alter disease severity. Visceral leishmaniasis (VL), a disease caused by a parasite, Leishmania, belongs to the most neglected tropical diseases: they mainly occur in low-income countries and affect the poorest populations. The parasites are transmitted via the bite of an insect vector and migrate to the internal organs. When VL occurs, the patients will present with enlarged spleen and liver, a disturbed haematological profile with low blood cell counts, systemic inflammation and malnutrition. This stage of the disease is fatal if left untreated. The factors that influence VL disease severity are poorly characterized. Here, we recruited patients with VL in an area of Ethiopia with a high prevalence of intestinal parasites. Our aim was to assess whether the disease was more severe in VL patients co-infected with intestinal parasites. Our results show that clinical and haematological data, inflammation, cytokine profile and nutritional status of VL patients are similar in VL patients and in VL patients co-infected with intestinal parasites. These results suggest that co-infection of VL patients with intestinal parasites does not impact on disease severity.
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Concomitant helminth infection downmodulates the Vaccinia virus-specific immune response and potentiates virus-associated pathology. Int J Parasitol 2016; 47:1-10. [PMID: 28003150 DOI: 10.1016/j.ijpara.2016.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 12/16/2022]
Abstract
The aim of this work was to elucidate the immunopathological mechanisms of how helminths may influence the course of a viral infection, using a murine model. Severe virulence, a relevant increase in the virus titres in the lung and a higher mortality rate were observed in Ascaris and Vaccinia virus (VACV) co-infected mice, compared with VACV mono-infected mice. Immunopathological analysis suggested that the ablation of CD8+ T cells, the marked reduction of circulating CD4+ T cells producing IFN-γ, and the robust pulmonary inflammation were associated with the increase of morbidity/mortality in co-infection and subsequently with the negative impact of concomitant pulmonary ascariasis and respiratory VACV infection for the host. On the other hand, when evaluating the impact of the co-infection on the parasitic burden, co-infected mice presented a marked decrease in the total number of migrating Ascaris lung-stage larvae in comparison with Ascaris mono-infection. Taken together, our major findings suggest that Ascaris and VACV co-infection may potentiate the virus-associated pathology by the downmodulation of the VACV-specific immune response. Moreover, this study provides new evidence of how helminth parasites may influence the course of a coincident viral infection.
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Goto Y, Cheng J, Omachi S, Morimoto A. Prevalence, severity, and pathogeneses of anemia in visceral leishmaniasis. Parasitol Res 2016; 116:457-464. [PMID: 27822583 DOI: 10.1007/s00436-016-5313-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/26/2016] [Indexed: 01/22/2023]
Abstract
Anemia is a typical symptom during visceral leishmaniasis (VL). We performed a systematic analysis of the literature on anemia in VL to understand the prevalence, severity, and possible mechanisms. Anemia is very common in VL patients with an overall prevalence higher than 90 %. The degree of anemia in VL is moderate to severe (hemoglobin level ∼7.5 g/dl), and the status can be recovered by treatment with antileishmanial drugs within a certain period of time. Possible pathogeneses of anemia in VL based on clinical observations included anti-RBC antibodies, dysfunction in erythropoiesis, and hemophagocytosis in the bone marrow or spleen, while hemolysis is a more likely cause than dyserythropoiesis. In hamsters with experimental VL, hemophagocytosis induced by immune complex and changes on erythrocyte membrane is speculated as the pathogenesis for anemia. In contrast, our recent study on murine VL indicated that hemophagocytosis contributes to anemia in contrast to lower contribution of anti-RBC antibodies or dysfunction in erythropoiesis. Together, hemophagocytosis is most likely associated with anemia in VL, and elucidation of the immunological mechanisms may lead to development of novel interventions to manage the symptom.
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Affiliation(s)
- Yasuyuki Goto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.
| | - Jingjie Cheng
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.,Faculty of Medicine, Imperial College London, London, England
| | - Satoko Omachi
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Ayako Morimoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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Ullah K, Khan NH, Sepúlveda N, Munir A, Wahid S. Assessing Incidence Patterns and Risk Factors for Cutaneous Leishmaniasis in Peshawar Region, Khyber Pakhtunkhwa, Pakistan. J Parasitol 2016; 102:501-506. [DOI: 10.1645/15-919] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Khan NH, Bari AU, Hashim R, Khan I, Muneer A, Shah A, Wahid S, Yardley V, O'Neil B, Sutherland CJ. Cutaneous Leishmaniasis in Khyber Pakhtunkhwa Province of Pakistan: Clinical Diversity and Species-Level Diagnosis. Am J Trop Med Hyg 2016; 95:1106-1114. [PMID: 27601518 PMCID: PMC5094225 DOI: 10.4269/ajtmh.16-0343] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022] Open
Abstract
This study primarily aimed to identify the causative species of cutaneous leishmaniasis (CL) in the Khyber Pakhtunkhwa Province of Pakistan and to distinguish any species-specific variation in clinical manifestation of CL. Diagnostic performance of different techniques for identifying CL was assessed. Isolates of Leishmania spp. were detected by in vitro culture, polymerase chain reaction (PCR) on DNA extracted from dried filter papers and microscopic examination of direct lesion smears from patients visiting three major primary care hospitals in Peshawar. A total of 125 CL patients were evaluated. Many acquired the disease from Peshawar and the neighboring tribal area of Khyber Agency. Military personnel acquired CL while deployed in north and south Waziristan. Leishmania tropica was identified as the predominant infecting organism in this study (89.2%) followed by Leishmania major (6.8%) and, unexpectedly, Leishmania infantum (4.1%). These were the first reported cases of CL caused by L. infantum in Pakistan. PCR diagnosis targeting kinetoplast DNA was the most sensitive diagnostic method, identifying 86.5% of all samples found positive by any other method. Other methods were as follows: ribosomal DNA PCR (78.4%), internal transcribed spacer 2 region PCR (70.3%), culture (67.1%), and microscopy (60.5%). Clinical examination reported 14 atypical forms of CL. Atypical lesions were not significantly associated with the infecting Leishmania species, nor with “dry” or “wet” appearance of lesions. Findings from this study provide a platform for species typing of CL patients in Pakistan, utilizing a combination of in vitro culture and molecular diagnostics. Moreover, the clinical diversity described herein can benefit clinicians in devising differential diagnosis of the disease.
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Affiliation(s)
- Nazma Habib Khan
- Department of Zoology, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan.,Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Arfan Ul Bari
- Combined Military Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Rizwan Hashim
- Combined Military Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Inamullah Khan
- Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Akhtar Muneer
- Kuwait Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Akram Shah
- Department of Zoology, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sobia Wahid
- Department of Zoology, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan.,Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vanessa Yardley
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Brighid O'Neil
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Colin J Sutherland
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Al-Salem W, Herricks JR, Hotez PJ. A review of visceral leishmaniasis during the conflict in South Sudan and the consequences for East African countries. Parasit Vectors 2016; 9:460. [PMID: 27549162 PMCID: PMC4994383 DOI: 10.1186/s13071-016-1743-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/08/2016] [Indexed: 01/24/2023] Open
Abstract
Background Visceral leishmaniasis (VL), caused predominantly by Leishmania donovani and transmitted by both Phlebotomus orientalis and Phlebotomus martini, is highly endemic in East Africa where approximately 30 thousands VL cases are reported annually. The largest numbers of cases are found in Sudan - where Phlebotomus orientalis proliferate in Acacia forests especially on Sudan’s eastern border with Ethiopia, followed by South Sudan, Ethiopia, Somalia, Kenya and Uganda. Long-standing civil war and unrest is a dominant determinant of VL in East African countries. Here we attempt to identify the correlation between VL epidemics and civil unrest. Objective and methodology In this review, literature published between 1955 and 2016 have been gathered from MSF, UNICEF, OCHA, UNHCR, PubMed and Google Scholar to analyse the correlation between conflict and human suffering from VL, which is especially apparent in South Sudan. Findings Waves of forced migration as a consequence of civil wars between 1983 and 2005 have resulted in massive and lethal epidemics in southern Sudan. Following a comprehensive peace agreement, but especially with increased allocation of resources for disease treatment and prevention in 2011, cases of VL declined reaching the lowest levels after South Sudan declared independence. However, in the latest epidemic that began in 2014 after the onset of a civil war in South Sudan, more than 1.5 million displaced refugees have migrated internally to states highly endemic for VL, while 800,000 have fled to neighboring countries. Conclusion We find a strong relationship between civil unrest and VL epidemics which tend to occur among immunologically naïve migrants entering VL-endemic areas and when Leishmania-infected individuals migrate to new areas and establish additional foci of disease. Further complicating factors in East Africa’s VL epidemics include severe lack of access to diagnosis and treatment, HIV/AIDS co-infection, food insecurity and malnutrition. Moreover, cases of post-kala-azar dermal leishmaniasis (PKDL) can serve as important reservoirs of anthroponotic Leishmania parasites.
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Affiliation(s)
| | - Jennifer R Herricks
- Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| | - Peter J Hotez
- Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA.,Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA.,Department of Biology, Baylor University, Waco, TX, USA
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Cortese L, Annunziatella M, Palatucci AT, Lanzilli S, Rubino V, Di Cerbo A, Centenaro S, Guidetti G, Canello S, Terrazzano G. An immune-modulating diet increases the regulatory T cells and reduces T helper 1 inflammatory response in Leishmaniosis affected dogs treated with standard therapy. BMC Vet Res 2015; 11:295. [PMID: 26634917 PMCID: PMC4669625 DOI: 10.1186/s12917-015-0610-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/27/2015] [Indexed: 11/11/2022] Open
Abstract
Background Clinical appearance and evolution of Canine Leishmaniosis (CL) are the consequence of complex interactions between the parasite and the genetic and immunological backgrounds. We investigated the effect of an immune-modulating diet in CL. Dogs were treated with anti- Leishmania pharmacological therapy combined with standard diet (SD Group) or with the immune-modulating diet (IMMD Group). CD3+ CD4+ Foxp3+ Regulatory T cells (Treg) and CD3+ CD4+ IFN-γ + T helper 1 (Th1) were analyzed by flow cytometry. Results All sick dogs showed low platelet number at diagnosis (T0). A platelet increase was observed after six months (T6) SD Group, with still remaining in the normal range at twelve months (T12). IMMD Group showed an increase in platelet number becoming similar to healthy dogs at T6 and T12. An increase of CD4/CD8 ratio was revealed in SD Group after three months (T3), while at T6 and at T12 the values resembled to T0. The increase in CD4/CD8 ratio at T3 was maintained at T6 and T12 in IMMD Group. A reduction in the percentage of Treg of all sick dogs was observed at T0. A recovery of Treg percentage was observed only at T3 in SD Group, while this effect disappeared at T6 and T12. In contrast, Treg percentage became similar to healthy animals in IMDD Group at T3, T6 and T12. Sick dogs showed an increase of Th1 cells at T0 as compared with healthy dogs. We observed the occurrence of a decrease of Th1 cells from T3 to T12 in SD Group, although a trend of increase was observed at T6 and T12. At variance, IMMD Group dogs showed a progressive decrease of Th1 cells, whose levels became similar to healthy controls at T6 and T12. Conclusion The immune-modulating diet appears to regulate the immune response in CL during the standard pharmacological treatment. The presence of nutraceuticals in the diet correlates with the decrease of Th1 cells and with the increase of Treg in sick dogs. Therefore, the administration of the specific dietary supplement improved the clinical response to the standard treatment in a model of CL.
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Affiliation(s)
- Laura Cortese
- Department of Veterinary Medicine and Animal Productions, Division of Internal Medicine, University of Naples Federico II, Via Delpino, 1, 80137, Naples, Italy
| | - Mariangela Annunziatella
- Department of Veterinary Medicine and Animal Productions, Division of Internal Medicine, University of Naples Federico II, Via Delpino, 1, 80137, Naples, Italy
| | | | - Sarah Lanzilli
- Department of Veterinary Medicine and Animal Productions, Division of Internal Medicine, University of Naples Federico II, Via Delpino, 1, 80137, Naples, Italy
| | - Valentina Rubino
- Department of Translational Medical Sciences, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
| | - Alessandro Di Cerbo
- School of Specialization in Clinical Biochemistry, "G. d'Annunzio" University, Chieti, Italy
| | - Sara Centenaro
- Division of Research and Development, Sanypet SpA, Padova, Italy
| | | | - Sergio Canello
- Division of Research and Development, Sanypet SpA, Padova, Italy
| | - Giuseppe Terrazzano
- Department of Translational Medical Sciences, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy. .,Department of Science, University of Basilicata, Via Sauro, 85, 85100, Potenza, Italy.
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Cotton JA, Amat CB, Buret AG. Disruptions of Host Immunity and Inflammation by Giardia Duodenalis: Potential Consequences for Co-Infections in the Gastro-Intestinal Tract. Pathogens 2015; 4:764-92. [PMID: 26569316 PMCID: PMC4693164 DOI: 10.3390/pathogens4040764] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 12/11/2022] Open
Abstract
Giardia duodenalis (syn. G. intestinalis, or G. lamblia) is a leading cause of waterborne diarrheal disease that infects hundreds of millions of people annually. Research on Giardia has greatly expanded within the last few years, and our understanding of the pathophysiology and immunology on this parasite is ever increasing. At peak infection, Giardia trophozoites induce pathophysiological responses that culminate in the development of diarrheal disease. However, human data has suggested that the intestinal mucosa of Giardia-infected individuals is devoid of signs of overt intestinal inflammation, an observation that is reproduced in animal models. Thus, our understanding of host inflammatory responses to the parasite remain incompletely understood and human studies and experimental data have produced conflicting results. It is now also apparent that certain Giardia infections contain mechanisms capable of modulating their host's immune responses. As the oral route of Giardia infection is shared with many other gastrointestinal (GI) pathogens, co-infections may often occur, especially in places with poor sanitation and/or improper treatment of drinking water. Moreover, Giardia infections may modulate host immune responses and have been found to protect against the development of diarrheal disease in developing countries. The following review summarizes our current understanding of the immunomodulatory mechanisms of Giardia infections and their consequences for the host, and highlights areas for future research. Potential implications of these immunomodulatory effects during GI co-infection are also discussed.
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Affiliation(s)
- James A Cotton
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Christina B Amat
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Inflammation Research Network, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Host-Parasite Interactions, University of Calgary, Calgary, AB T2N 1N4, Canada.
| | - Andre G Buret
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Inflammation Research Network, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Host-Parasite Interactions, University of Calgary, Calgary, AB T2N 1N4, Canada.
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Gadisa E, Tsegaw T, Abera A, Elnaiem DE, den Boer M, Aseffa A, Jorge A. Eco-epidemiology of visceral leishmaniasis in Ethiopia. Parasit Vectors 2015; 8:381. [PMID: 26187584 PMCID: PMC4506599 DOI: 10.1186/s13071-015-0987-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/05/2015] [Indexed: 12/25/2022] Open
Abstract
Visceral leishmaniasis (VL, Kala-azar) is one of the growing public health challenges in Ethiopia with over 3.2 million people at risk and estimated up to 4000 new cases per year. Historically, VL was known as the diseases of the lowlanders; in the lower and upper Kola agro-ecological zones of Ethiopia. The 2005–07 out breaks in highlands of Libo Kemkem and Fogera, in the Woina Degas, that affected thousands and claimed the life of hundreds misdiagnosed as drug resistance malaria marked that VL is no more the problem of the lowlanders. The Kola (lower and upper) and the Woina Dega are the most productive agroecological zones, supporting both the ongoing and planned expansions of large or small scale agriculture and/or agriculture based industries. Thus, the (re)emergence of VL is not only a public health and social problem but also have a direct implication on the country’s economy and further development. Thus is high time for its control and/or elimination. Yet, the available data seem incomplete to plan for a cost-effective and efficient VL control strategy: there is a need to update data on vector behaviour in specific ecosystems and the roles of domestic animals need to be ascertained. The effectiveness and social acceptability of available vector control tools need be evaluated. There is a need for identifying animal reservoir(s), or establish the absence of zoonosis in Ethiopia. The planning of prevention of (re)emergence and spread of VL to areas adjacent to endemic foci need be supported with information from spatio-temporal mapping. In affected communities, available data showed that their knowledge about VL is generally very low. Thus, well designed studies to identify risk factors, as well as better tools for social mobilization with the understanding of their knowledge, aptitude and practice towards VL are necessary.
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Affiliation(s)
| | - Teshome Tsegaw
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adugna Abera
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dia-Eldin Elnaiem
- Department of Natural Sciences, University of Maryland Eastern Shore (for KalaCORE consortium), 1Backbone Rd, Princess Anne, MD, 21853, USA
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Alvar Jorge
- Visceral Leishmaniasis Program, Drugs for Neglected Diseases Initiative (DNDi), Addis Ababa, Ethiopia
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Abstract
INTRODUCTION Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis. The treatment of leishmaniasis is challenging and the armamentarium of drugs is small, duration of treatment is long, and most drugs are toxic. AREAS COVERED A literature search on treatment of leishmaniasis was done on PubMed. Single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin (PM), or miltefosine + PM) are the treatment of choice for VL in the Indian subcontinent. A 17-day combination therapy of pentavalent antimonials (Sb(v)) and PM remains the treatment of choice for East African VL. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen for VL in the Mediterranean region and South America. Treatment of CL should be decided by the severity of clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. EXPERT OPINION There is an urgent need to implement a single-dose L-AmB or combination therapy in the Indian subcontinent. Shorter and more acceptable regimens are needed for the treatment of post - kala-azar dermal leishmaniasis. Combination therapy with newer drugs needs to be tested in Africa. Due to the toxicity of systemic therapy, a trend toward local treatment for New World CL is preferred in patients without risk of mucosal disease.
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Affiliation(s)
- Shyam Sundar
- Banaras Hindu University, Institute of Medical Sciences, Department of Medicine , Varanasi , India +91 542 2369632 ;
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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 (also known as kala-azar) is classified as one of the most neglected tropical diseases. It is becoming a growing health problem in Ethiopia, with endemic areas that are continually spreading. The annual burden of visceral leishmaniasis (VL) in Ethiopia is estimated to be between 4,500 and 5,000 cases, and the population at risk is more than 3.2 million. There has been a change in the epidemiology of VL in Ethiopia. Over the last decades, almost all cases and outbreaks of VL were reported from arid and semi-arid parts of the country; however, recent reports indicated the introduction of this disease into the highlands. Migration of labourers to and from endemic areas, climatic and environmental changes, and impaired immunity due to HIV/AIDS and malnutrition resulted in the change of VL epidemiology. HIV spurs the spread of VL by increasing the risk of progression from asymptomatic infection towards full VL. Conversely, VL accelerates the onset of AIDS. In Ethiopia, VL epidemiology remains complex because of the diversity of risk factors involved, and its control is becoming an increasing challenge. This paper reviews the changes in epidemiology of VL in Ethiopia and discusses some of the possible explanations for these changes. The prospects for novel approaches to VL control are discussed, as are the current and future challenges facing Ethiopia's public health development program.
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Affiliation(s)
- Samson Leta
- Adami Tullu Research Center, Ziway, Ethiopia
- * E-mail:
| | - Thi Ha Thanh Dao
- National Institute of Veterinary Research, No 86, Hanoi, Vietnam
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