Frequency of Leishmania spp. infection among HIV-infected patients living in an urban area in Brazil: a cross-sectional study

Incidence and persistence of asymptomatic Leishmania infection among HIV-infected patients in Trang province, Southern Thailand: A cohort study

Leishmaniasis poses a significant health burden, particularly among immunocompromised patients. In Thailand, Leishmania infection caused by Leishmania martiniquensis and Leishmania orientalis lacks information about the incidence and risk factors among HIV-infected populations. This longitudinal cohort study aimed to investigate the incidence and persistence of Leishmania infection among HIV-infected individuals in an affected area, Trang Province, Southern Thailand. The study also identified risk factors associated with the incidence of Leishmania infection. The study enrolled 373 participants in the HIV clinic, Trang Hospital, who initially tested negative for Leishmania infection during 2015-2016, and 133 individuals initially tested positive for Leishmania infection. Thus, follow-up visits of 506 participants occurred during 2018-2019. Direct Agglutination Test (DAT) and nested PCR (nPCR) identified incidents and persistent cases of Leishmania infection. Cox proportional-hazards regression analyses were performed to assess risk factors for the incidence of Leishmania infection. Among the initially negative group, 12 incident cases comprised one L. orientalis infection and 11 seropositive cases using DAT, resulting in a cumulative incidence of 3.2% and an incidence density of 10.38 per 1000 person-years. Increasing age was a significant predictor of the incidence of Leishmania infection. Five persistent cases comprised one Leishmania donovani complex and four seropositive cases using DAT in the initially positive group, with a cumulative persistence rate of 3.7% and a persistence density of 12.85 per 1000 person-years. All patients were asymptomatic. This study sheds light on the incidence and persistence of Leishmania infection among HIV-infected individuals in Trang Province, Southern Thailand, underscoring the importance of continued monitoring and tailored interventions to mitigate the impact of this co-infection.

Chagas Disease and Leishmaniasis, Sympatric Zoonoses Present in Human from Rural Communities of Venezuela

PURPOSE

Trypanosoma cruzi and Leishmania spp. coexist in several endemic areas, and there are few studies of Chagas disease and leishmaniasis coinfection worldwide; for this reason, the objective of this work was to determine the Chagas disease and leishmaniasis coinfection in several rural communities co-endemic for these diseases.

METHODS

A total of 1107 human samples from six co-endemic rural communities of Cojedes state, Venezuela, were analyzed. Serum samples were evaluated by ELISA, indirect hemagglutination, and indirect immunofluorescence for Chagas disease diagnosis, and individuals were evaluated for leishmaniasis by leishmanin skin test (LST). Approximately, 30% of the individuals were also analyzed by PCR (blood clot samples) for T. cruzi and for Leishmania spp.

RESULTS

The 14.7% of the individuals were positive to Trypanosoma cruzi infection by serology, and 25.8% were positive to Leishmania spp. current or past infection by LST. Among the group with PCR results, 7.8% were positive for T. cruzi, and 9.4% for Leishmania spp. The coinfection T. cruzi/Leishmania spp. was 6.5%. The T. cruzi DTUs of the positive blood clot samples were TcI, revealed using the molecular markers: (i) intergenic region of the miniexon, (ii) D7 divergent domain of the 24Sα rDNA, (iii) size-variable domain of the 18S rDNA, and (iv) hsp60-PCR-RFLP (EcoRV). The Leishmania species identified were L. (Leishmania) mexicana and L. (Viannia) braziliensis.

CONCLUSION

A high prevalence was found for T. cruzi and Leishmania spp. single and coinfections in almost all communities studied, being these results of relevance for the implementation of control programs in co-endemic areas.

Prevalence of visceral leishmaniasis among people with HIV: a systematic review and meta-analysis

Leishmaniasis is a parasitic infection expressing different clinical phenotypes. Visceral leishmaniasis (VL) is considered an opportunistic infection among people with human immunodeficiency virus (HIV). The objective of this review was to identify published data on the prevalence of Leishmania spp. infection among PWH and to define particular determinants that affect critically the epidemiological characteristics of VL-HIV coinfection and, potentially, its burden on public health. Two independent reviewers conducted a systematic literature search until June 30, 2022. Meta-analyses were conducted using random-effects models to calculate the summary prevalence and respective 95% confidence intervals (CI) of leishmaniasis among PWH. Meta-regression analysis was performed to investigate the impact of putative effect modifiers, such as the mean CD4 cell count, on the major findings. Thirty-four studies were eligible, yielding a summary prevalence of 6% (95%CI, 4-11%) for leishmaniasis (n = 1583) among PWH (n = 85,076). Higher prevalence rates were noted in Asia (17%, 95%CI, 9-30%) and America (9%, 95%CI, 5-17%) than in Europe (4%, 95%CI, 2-8%). Prevalence rates were significantly mediated by the age, sex, and CD4 cell count of participants. Heterogeneity remained significant in all meta-analyses (p < 0.0001). In the majority of included studies, people were coinfected with HIV and Leishmania species associated with VL, as opposed to those associated with cutaneous leishmaniasis. No sign of publication bias was shown (p = 0.06). Our summary of published studies on leishmaniasis among PWH is important to provide prevalence estimates and define potential underlying factors that could guide researchers to generate and further explore specific etiologic hypotheses.

Amino acid containing amphiphilic hydrogelators with antibacterial and antiparasitic activities

Nanoscale self-assembly of peptide constructs represents a promising means to present bioactive motifs to develop new functional materials. Here, we present a series of peptide amphiphiles which form hydrogels based on β-sheet nanofibril networks, several of which have very promising anti-microbial and anti-parasitic activities, in particular against multiple strains of Leishmania including drug-resistant ones. Aromatic amino acid based amphiphilic supramolecular gelators C₁₄-Phe-CONH-(CH₂)_n-NH₂ (n = 6 for P1 and n = 2 for P3) and C₁₄-Trp-CONH-(CH₂)_n-NH₂ (n = 6 for P2 and n = 2 for P4) have been synthesized and characterized, and their self-assembly and gelation behaviour have been investigated in the presence of ultrapure water (P1, P2, and P4) or 2% DMSO(v/v) in ultrapure water (P3). The rheological, morphological and structural properties of the gels have been comprehensively examined. The amphiphilic gelators (P1 and P3) were found to be active against both Gram-positive bacteria B. subtilis and Gram-negative bacteria E. coli and P. aeruginosa. Interestingly, amphiphiles P1 and P3 containing an L-phenylalanine residue show both antibacterial and antiparasitic activities. Herein, we report that synthetic amphiphiles with an amino acid residue exhibit a potent anti-protozoan activity and are cytotoxic towards a wide array of protozoal parasites, which includes Indian varieties of Leishmania donovani and also kill resistant parasitic strains including BHU-575, MIL^R and CPT^R cells. These gelators are highly cytotoxic to promastigotes of Leishmania and trigger apoptotic-like events inside the parasite. The mechanism of killing the parasite is shown and these gelators are non-cytotoxic to host macrophage cells indicating the potential use of these gels as therapeutic agents against multiple forms of leishmaniasis in the near future.

Identification of asymptomatic Leishmania infections: a scoping review

BACKGROUND

Asymptomatic Leishmania infection may play an important role in the transmission of the parasite in endemic areas. At present there is no consensus on the definition of asymptomatic Leishmania infection, nor is there a safe and accessible gold standard test for its identification.

METHODS

This paper presents a scoping review to summarize definitions of asymptomatic Leishmania infection found in the literature, as well as to detail the approach (molecular, serological, cellular, and/or parasitological tests) used by researchers to identify this asymptomatic population. A scoping review of published and gray literature related to asymptomatic Leishmania infection was conducted; retrieved citations were screened based on predefined eligibility criteria, and relevant data items were extracted from eligible articles. The analysis is descriptive and is presented using tables, figures, and thematic narrative synthesis.

RESULTS

We conducted a screening of 3008 articles, of which 175 were selected for the full review. Of these articles, we selected 106 that met the inclusion criteria. These articles were published between 1991 and 2021, and in the last 5 years, up to 38 articles were reported. Most of the studies were conducted in Brazil (26%), Spain (14%), India (12%), Bangladesh (10%), and Ethiopia (7%). Of the studies, 84.9% were conducted in the immunocompetent population, while 15.1% were conducted in the immunosuppressed population (HIV, immunosuppressive drugs, and organ transplantation population). We report 14 different techniques and 10 strategies employed by researchers to define asymptomatic Leishmania infection in an endemic area.

CONCLUSIONS

The definition of asymptomatic Leishmania infection is not unified across the literature, but often includes the following criteria: residence (or extended stay) in a Leishmania-endemic area, no reported signs/symptoms compatible with leishmaniasis, and positive on a combination of serological, molecular, cellular, and/or parasitological tests. Caution is recommended when comparing results of different studies on the subject of asymptomatic infections, as the reported prevalence cannot be confidently compared between areas due to the wide variety of tests employed by research groups. More research on the importance of asymptomatic immunosuppressed and immunocompetent Leishmania-positive populations in leishmaniasis epidemiology is required.

Experimental transmission of Leishmania (Leishmania) amazonensis to immunosuppressed mice through the bite of Lutzomyia longipalpis (Diptera: Psychodidae) results in cutaneous leishmaniasis

Lutzomyia longipalpis is the natural vector of Leishmania (Leishmania) infantum, but it is also permissive for several Leishmania species that are related to cutaneous leishmaniasis (CL). Maranhao State (Northeast of Brazil) is endemic for CL and has the highest number of cases of diffuse cutaneous leishmaniasis (DCL) in the country. It is a rare disease associated with a defective immune response mainly caused by L. (L.) amazonensis. Additionally, the number of immunosuppressed patients infected with the etiologic agents of CL has increased, including regions in which the main vectors of CL are rare. Therefore, we investigated whether Lu. longipalpis is able to transmit L. (L.) amazonensis to uninfected and immunosuppressed mice, resulting in CL. For that, 291 sand flies took an initial blood meal in mice infected with L. (L.) amazonensis. Of these, 17 underwent a second feeding on uninfected and immunosuppressed mice (of which 58.8% were also positive for Leishmania according to data on the dissection of the intestine). After 27 days of infection, these mice exhibited leishmaniotic lesions. The occurrence of parasites on the animal’s skin was confirmed by limiting dilution and immunohistopathological analyses. Parasite DNA was also detected in paw lesions and inguinal lymph nodes. DNA sequencing confirmed the Leishmania species in insects and mice. The results confirmed the ability of Lu. longipalpis to become infected and experimentally transmit L. (L.) amazonensis to immunosuppressed rodents, resulting in leishmaniotic lesions. Our data open perspectives for the potential role of Lu. longipalpis in the epidemiology of urban cutaneous leishmaniasis, especially in immunosuppressed patients.