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Wudu H, Alemu C. Survival analysis of adult visceral leishmaniasis patients admitted to Metema Hospital, Metema, Ethiopia: a hospital-based cross-sectional study. Trans R Soc Trop Med Hyg 2024:trae034. [PMID: 38842679 DOI: 10.1093/trstmh/trae034] [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: 01/27/2024] [Revised: 03/14/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a neglected tropical disease that mostly affects the working class and impoverished segments of society, having a significant negative effect on the economic development of the affected nation. While anti-leishmanial medications lower mortality among VL patients, patients may still die or require more time to recover while receiving treatment. In this regard, there are limited studies in Ethiopia. This study aims to determine the time to recovery and its associated predictors among adult VL patients at Metema Hospital, Metema, Ethiopia. METHODS A hospital-based cross-sectional study was employed and the data were collected from patient's charts from September 2017 to September 2021. Data were entered and analysed using EpiData version 3.1, Stata version 14.2 and R version 3.4.0 statistical software. Kaplan-Meier survival curves and logrank tests were used to compare the survival time. The Cox proportional hazards model assumption and model fitness were checked and used to identify statistical association predictors in VL patients. RESULTS The Cox proportional hazards model was fitted. The overall medium recovery time was 7 d (minimum 4, maximum 14). The variables of nasal bleeding (adjusted hazard ratio [aHR] 0.44 [95% confidence interval {CI} 0.19 to 0.89]), no comorbidity (aHR 2.29 [95% CI 1.27 to 4.11]), relapse of VL (aHR 0.33 [95% CI 0.15 to 0.75]), low parasite load (aHR 2.58 [95% CI 1.48 to 4.51]) and ambulatory (aHR 3.26 [95% CI 2.45 to 6.53]) were significantly associated with time to recovery in VL patients. CONCLUSIONS Patients with comorbidities, nasal bleeding, relapse of VL, bedridden and high parasite load should be treated and monitored carefully to recover quickly from their illness.
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Affiliation(s)
- Habitamu Wudu
- Department of Statistics, College of Natural and Computational Sciences, Gambella University, Gambella, Ethiopia
| | - Chekol Alemu
- Department of Statistics, College of Natural and Computational Sciences, Gambella University, Gambella, Ethiopia
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Ademe M, Osorio Y, Howe R, Atnafu S, Mulaw T, Fikre H, Travi BL, Hailu A, Melby PC, Abebe T. Hematological and Clinical Features Associated with Initial Poor Treatment Outcomes in Visceral Leishmaniasis Patients with and without HIV Coinfection in Gondar, Northwest Ethiopia. Trop Med Infect Dis 2023; 8:36. [PMID: 36668943 PMCID: PMC9867226 DOI: 10.3390/tropicalmed8010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Ethiopia is among the countries with a high leishmaniasis burden. In this retrospective review, we aimed to determine hematological and clinical features associated with initial poor treatment outcomes of visceral leishmaniasis (VL) patients. The majority of VL cases in this study had leucopenia (94.3%), thrombocytopenia (87.1%), and anemia (85.9%). HIV coinfection was present in 7.0% (n = 23) of VL cases. At the center, VL patients without HIV coinfection were treated with sodium stibogluconate and paromomycin combination, whereas HIV coinfected cases were treated with AmBisome and miltefosine combination therapy. End-of-treatment cure rates among HIV-positive and HIV-negative visceral leishmaniasis cases, respectively, were 52.2% and 96.9%. Case fatality rates were 34.8% and 2.7% in HIV-positive and HIV-negative cases, respectively. Overall, non-survivors in this study were more likely to have HIV (55.0% vs. 4.1%, p < 0.001), sepsis (15.0% vs. 1.4%, p = 0.019), and dyspnea (40.0% vs. 2.7%, p < 0.001) at admission. In this regard, particular attention to the management of superimposed disease conditions at admission, including sepsis, HIV, and dyspnea, is needed to improve VL patients’ treatment outcomes. The inadequacy of the current treatments, i.e., AmBisome and miltefosine combination therapy, for HIV coinfected visceral leishmaniasis patients requires further attention as it calls for new treatment modalities.
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Affiliation(s)
- Muluneh Ademe
- Department of Microbiology, Immunology & Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Yaneth Osorio
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Route 0435, Galveston, TX 77555, USA
| | - Rawliegh Howe
- Aramuer Hanson Research Institute (AHRI), Addis Ababa P.O. Box 1005, Ethiopia
| | - Saba Atnafu
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Tadele Mulaw
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Bruno L. Travi
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Route 0435, Galveston, TX 77555, USA
| | - Asrat Hailu
- Department of Microbiology, Immunology & Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Peter C. Melby
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Route 0435, Galveston, TX 77555, USA
| | - Tamrat Abebe
- Department of Microbiology, Immunology & Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
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Tuon FF, Amato VS, Zequinao T, Cruz JAW. Emerging computational technologies in human leishmaniasis: where are we? Trans R Soc Trop Med Hyg 2022; 116:981-985. [PMID: 35640661 DOI: 10.1093/trstmh/trac047] [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: 11/20/2021] [Revised: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 01/19/2023] Open
Abstract
Human leishmaniasis is a neglected tropical disease (NTD) with high morbidity and is endemic in low- to middle-income countries. Its diagnosis, treatment and epidemiological control methods are outdated and obsolete, which has become a challenge for health practitioners in controlling the disease. Computational methods have proven to be beneficial and have become popular in many fields of medicine, especially in affluent countries. However, they have not been widely used for NTDs. To date, few computational technologies have been employed for leishmaniasis. Although new technologies in leishmaniasis are theorized, they have only been minimally applied and have not been updated, even in other infections. Research and development on NTDs suffers from the inherent difficulties of the demographic regions the diseases afflict. In this narrative review we described the e-tools available in managing leishmaniasis, ranging from drug discovery to treatment.
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Affiliation(s)
- Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifical Catholic University of Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná 80215-901, Brazil
| | - Valdir Sabagga Amato
- Departamento de Doenças Infecciosas e Parasitária da Faculdade de Medicina da Universidade de São Paulo São Paulo, Av. Dr Arnaldo 455, São Paulo 05403-000, Brazil
| | - Tiago Zequinao
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifical Catholic University of Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná 80215-901, Brazil
| | - June Alisson Westarb Cruz
- School of Business, Pontifical Catholic University of Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná 80215-901, Brazil.,Fundação Getúlio Vargas, EAESP, São Paulo, Av. 9 de Julho 2029, São Paulo 013013-902, Brazil
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4
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Tuon FF, Dantas LR, de Souza RM, Ribeiro VST, Amato VS. Liposomal drug delivery systems for the treatment of leishmaniasis. Parasitol Res 2022; 121:3073-3082. [DOI: 10.1007/s00436-022-07659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
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Ibiapina AB, Batista FMDA, Aguiar BGA, Mendonça VJ, Costa DL, Costa CHN, Abdala CVM. Evidence map of diagnosis, treatment, prognosis, prevention, and control in visceral leishmaniasis. Rev Panam Salud Publica 2022; 46:e89. [PMID: 35875324 PMCID: PMC9299391 DOI: 10.26633/rpsp.2022.89] [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] [Received: 11/09/2021] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To develop an evidence map on visceral leishmaniasis prevention, control, diagnosis, treatment, and prognosis. Methods Systematic reviews on visceral leishmaniasis were searched using MEDLINE/PubMed and Virtual Health Library. After selection, each included systematic review was assessed, characterized, and categorized by intervention type and by outcomes, according to the methodology offered by the PAHO/WHO Latin American and Caribbean Center on Health Sciences Information (BIREME). The methodological quality was assessed using the AMSTAR2 tool to determine the confidence level of the evidence obtained. Results Among the prevention and control interventions, insecticide spraying, bednets, dog collars, and dog culling were the most assessed, emphasizing that insecticidal dog collars can reduce visceral leishmaniasis incidence in dogs. Regarding diagnosis, polymerase chain reaction (PCR), rK39 immunochromatographic test (rK39 ICT), and direct agglutination test (DAT) presented high sensitivity and specificity. As for treatment, pentavalent antimonials and amphotericin B were the most analyzed drugs and showed therapeutic success; however, serious adverse events can occur due to their use. The prognostic factors identified were anemia, edema, bleeding, jaundice, age, and HIV coinfection. Conclusions The evidence map developed shows rK39 ICT and DAT as promising diagnostic alternatives and reinforces the efficacy of liposomal amphotericin B and pentavalent antimonials. Insecticide-impregnated dog collars appear as a promising measure for the control of visceral leishmaniasis, but there is also a need for future studies and reviews with higher methodological quality, especially on prevention and control interventions.
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Affiliation(s)
- Andressa Barros Ibiapina
- Intelligence Center in Emerging and Neglected Tropical ConditionsTeresinaPiauíBrazilIntelligence Center in Emerging and Neglected Tropical Conditions, Teresina, Piauí, Brazil
| | - Francisca Miriane de Araújo Batista
- Intelligence Center in Emerging and Neglected Tropical ConditionsTeresinaPiauíBrazilIntelligence Center in Emerging and Neglected Tropical Conditions, Teresina, Piauí, Brazil
| | - Bruno Guedes Alcoforado Aguiar
- Intelligence Center in Emerging and Neglected Tropical ConditionsTeresinaPiauíBrazilIntelligence Center in Emerging and Neglected Tropical Conditions, Teresina, Piauí, Brazil
| | - Vagner José Mendonça
- Intelligence Center in Emerging and Neglected Tropical ConditionsTeresinaPiauíBrazilIntelligence Center in Emerging and Neglected Tropical Conditions, Teresina, Piauí, Brazil
| | - Dorcas Lamounier Costa
- Intelligence Center in Emerging and Neglected Tropical ConditionsTeresinaPiauíBrazilIntelligence Center in Emerging and Neglected Tropical Conditions, Teresina, Piauí, Brazil
| | - Carlos Henrique Nery Costa
- Intelligence Center in Emerging and Neglected Tropical ConditionsTeresinaPiauíBrazilIntelligence Center in Emerging and Neglected Tropical Conditions, Teresina, Piauí, Brazil
| | - Carmen Verônica Mendes Abdala
- PAHO/WHO Latin American and Caribbean Center on Health Sciences Information (BIREME)São PauloBrazilPAHO/WHO Latin American and Caribbean Center on Health Sciences Information (BIREME), São Paulo, Brazil
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Mazire PH, Saha B, Roy A. Immunotherapy for visceral leishmaniasis: A trapeze of balancing counteractive forces. Int Immunopharmacol 2022; 110:108969. [PMID: 35738089 DOI: 10.1016/j.intimp.2022.108969] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022]
Abstract
The protozoan parasite Leishmania donovani, residing and replicating within the cells of the monocyte-macrophage (mono-mac) lineage, causes visceral leishmaniasis (VL) in humans. While, Leishmania infantum, is the main causative agent for zoonotic VL, where dogs are the main reservoirs of the disease. The chemotherapy is a serious problem because of restricted repertoire of drugs, drug-resistant parasites, drug-toxicity and the requirement for parenteral administration, which is a problem in resource-starved countries. Moreover, immunocompromised individuals, particularly HIV-1 infected are at higher risk of VL due to impairment in T-helper cell and regulatory cell responses. Furthermore, HIV-VL co-infected patients report poor response to conventional chemotherapy. Recent efforts are therefore directed towards devising both prophylactic and therapeutic immunomodulation. As far as prophylaxis is concerned, although canine vaccines for the disease caused by Leishmania infantum or Leishmania chagasi are available, no vaccine is available for use in humans till date. Therefore, anti-leishmanial immunotherapy triggering or manipulating the host's immune response is gaining momentum during the last two decades. Immunomodulators comprised of small molecules, anti-leishmanial peptides, complex ligands for host receptors, cytokines or their agonists and antibodies have been given trials both in experimental models and in humans. However, the success of immunotherapy in humans remains a far-off target. We, therefore, propose that devising a successful immunotherapy is an act of balancing enhanced beneficial Leishmania-specific responses and deleterious immune activation/hyperinflammation just as the swings in a trapeze.
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Affiliation(s)
- Priyanka H Mazire
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune 411007, India
| | - Bhaskar Saha
- National Centre for Cell Science, Ganeshkhind Road, Pune 411007, India
| | - Amit Roy
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune 411007, India.
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Eyayu T, Yasin M, Workineh L, Tiruneh T, Andualem H, Sema M, Damtie S, Abebaw A, Getie B, Andargie D, Achaw B, Taklual W. Evaluation of urine sample for diagnosis of visceral leishmaniasis using rK-39 immunochromatographic test in Northwest Ethiopia. PLoS One 2022; 17:e0263696. [PMID: 35130316 PMCID: PMC8820633 DOI: 10.1371/journal.pone.0263696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis is the most severe form of leishmaniasis which ranks second in mortality and fourth in morbidity. Parasitological diagnostic techniques with splenic aspirate remain the gold standard. However, sample collection is risky, painful, and difficult. Alternatively, serological techniques provide good diagnostic accuracy using serum sample that is difficult for applying on small children and in the field. So, finding alternative non-invasive and self-collected samples like urine is very important. Thus, the study aimed to evaluate the diagnostic performance of the rK-39 strip test using urine for diagnosis of visceral leishmaniasis. METHODS A multicenter institutional-based cross-sectional study was conducted from November 2019 to March 2021 at Northwest Ethiopia. Sociodemographic information was collected using a structured questionnaire. Blood sample and midstream urine sample were collected for rK-39 test. Data were entered into Epi-data version 4.2 and analyzed using SPSS version 24.0. Diagnostic performance parameters of urine-based rK-39 rapid test, i.e. sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios (LR+/-), and diagnostic accuracy were determined on contingency table by using serum-based rK-39 test result as a reference. An agreement between urine and serum-based rK-39 test was statistically determined by kappa value. RESULT In total, 300 subjects, age ranged between 7 and 60 years, were included in the study. The overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of urine-based rK-39 test were found to be 98.0% (95% CI: 93.0% - 99.8%), 95.5% (95% CI: 91.6% - 97.9%), 91.6% (95% CI: 85.2%- 95.4%), 98.9 (95% CI: 96.0%- 99.7%), and 96.33% (95% CI: 93.53-98.16%), respectively. Additionally, there was a strong agreement between the results obtained on rK-39 ICT using urine and serum samples (kappa = 0.92; P < 0.001). CONCLUSION Urine-based rK-39 ICT had an excellent high sensitivity, specificity and strong agreement with serum-based rK-39 ICT results. This indicates that urine sample would be a promising noninvasive and easy to collect sample for diagnosis of VL in field and rural settings.
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Affiliation(s)
- Tahir Eyayu
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melashu Yasin
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Lemma Workineh
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henok Andualem
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Meslo Sema
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shewaneh Damtie
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aynework Abebaw
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birhanu Getie
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Andargie
- University of Gondar Compressive Specialized Hospital Laboratory, University of Gondar, Gondar, Ethiopia
| | - Barnabas Achaw
- University of Gondar Compressive Specialized Hospital Laboratory, University of Gondar, Gondar, Ethiopia
| | - Wubet Taklual
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Grifferty G, Shirley H, McGloin J, Kahn J, Orriols A, Wamai R. Vulnerabilities to and the Socioeconomic and Psychosocial Impacts of the Leishmaniases: A Review. Res Rep Trop Med 2021; 12:135-151. [PMID: 34188584 PMCID: PMC8236266 DOI: 10.2147/rrtm.s278138] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
The leishmaniases are a group of four vector-borne neglected tropical diseases (NTDs) with 1.6 billion people in some 100 countries at risk. They occur in certain eco-epidemiological foci that reflect manipulation by human activities, such as migration, urbanization and deforestation, of which poverty, conflict and climate change are key drivers. Given their synergistic impacts, risk factors and the vulnerabilities of poor populations and the launch of a new 2030 roadmap for NTDs in the context of the global sustainability agenda, it is warranted to update the state of knowledge of the leishmaniases and their effects. Using existing literature, we review socioeconomic and psychosocial impacts of leishmaniasis within a framework of risk factors and vulnerabilities to help inform policy interventions. Studies show that poverty is an overarching primary risk factor. Low-income status fosters inadequate housing, malnutrition and lack of sanitation, which create and exacerbate complexities in access to care and treatment outcomes as well as education and awareness. The co-occurrence of the leishmaniases with malnutrition and HIV infection further complicate diagnosis and treatment, leading to poor diagnostic outcomes and therapeutic response. Even with free treatment, households may suffer catastrophic health expenditure from direct and indirect medical costs, which compounds existing financial strain in low-income communities for households and healthcare systems. The dermatological presentations of the leishmaniases may result in long-term severe disfigurement, leading to stigmatization, reduced quality of life, discrimination and mental health issues. A substantial amount of recent literature points to the vulnerability pathways and burden of leishmaniasis on women, in particular, who disproportionately suffer from these impacts. These emerging foci demonstrate a need for continued international efforts to address key risk factors and population vulnerabilities if leishmaniasis control, and ultimately elimination, is to be achieved by 2030.
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Affiliation(s)
- Grace Grifferty
- Department of Biology, Northeastern University, College of Science, Boston, MA, USA
| | - Hugh Shirley
- Department of Biochemistry, Northeastern University, College of Science, Boston, MA, USA.,Program in Medical Education, Harvard Medical School, Boston, MA, USA
| | - Jamie McGloin
- Department of Health Sciences, Northeastern University, Bouvé College of Health Sciences, Boston, MA, USA
| | - Jorja Kahn
- Department of Behavioral Neuroscience, Northeastern University, College of Science, Boston, MA, USA
| | - Adrienne Orriols
- Department of Behavioral Neuroscience, Northeastern University, College of Science, Boston, MA, USA
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, College of Social Sciences and Humanities, Integrated Initiative for Global Health, Boston, MA, USA
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High levels of anti-Leishmania IgG3 and low CD4 + T cells count were associated with relapses in visceral leishmaniasis. BMC Infect Dis 2021; 21:369. [PMID: 33874901 PMCID: PMC8056614 DOI: 10.1186/s12879-021-06051-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background Visceral leishmaniasis (VL) is severe and potentially fatal. Brazil is one of the countries with the greatest endemicity for the disease in the world. The reduction of CD4+ T lymphocytes, B cells activation and high levels of inflammatory cytokines (IL-6/IL-8/TNF/IL-1β), plasma LPS, soluble CD14, anti-Leishmania IgG3 and low leptin levels are involved in the immunopathogenesis of VL, most associated with severe VL. Despite relapses occurring in about 4–5% of patients with VL not associated with HIV infection, the factors underlying relapses are little known. Our aim was to identify clinical, laboratory and immunological parameters that may be associated with recurrences in VL. Methods Fifteen VL patients recruited from Hospital Eduardo de Menezes (BH-MG) were grouped into relapsing (R-VL, n = 5) and non-relapsing (NR-VL, n = 10) and evaluated during active disease, immediately after treatment (post-treatment) and 6 months post-treatment (6mpt). Clinical and laboratory data obtained from medical records were correlated with CD4+ and CD8+ T cell counts and anti-Leishmania Igs and IL-6 plasma levels and compared to those parameters of ten healthy controls. Results During the active phase of VL, despite similarity in the clinical symptoms, the rates of thrombocytopenia, elevated transaminases (AST and ALT) and hyperbilirubinemia were higher in the NR-VL group compared to R-VL (p < 0.05), a profile reversed during the post-treatment phase. All patients had low CD4+ T counts in active phase, however, NR-VL patients had a higher gain of this cell type than R-VL in the post-treatment (p < 0.05). There was a significant reduction in IgG3 levels during the follow-up in the NR-VL group compared to the R-VL, especially at 6mpt (p < 0.05). In addition, IgG3 levels were negatively correlated with CD4+ T counts in the R-VL group (r = − 0.52). Elevated levels of IL-6 were observed in active VL and correlated with clinical markers of severity. Conclusions During active phase of VL, the NR-VL patients presented more severe laboratorial abnormalities compared to R-VL, probably because the latter had already received previous treatment. On the other hand, R-VL exhibited greater impairment of immune reconstitution and a high degree of B lymphocyte activation, which must be a factor that favored relapses. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06051-5.
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Feleke BE, Feleke TE. Micronutrient levels and their effects on the prognosis of visceral leishmaniasis treatment, a prospective cohort study. BMC Infect Dis 2020; 20:867. [PMID: 33213392 PMCID: PMC7678206 DOI: 10.1186/s12879-020-05615-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Micronutrients are minerals and vitamins and they are essential for normal physiological activities. The objectives of the study were to describe the progress and determinants of micronutrient levels and to assess the effects of micronutrients in the treatment outcome of kalazar. METHODS A prospective cohort study design was used. The data were collected using patient interviews, measuring anthropometric indicators, and collecting laboratory samples. The blood samples were collected at five different periods during the leishmaniasis treatments: before starting anti-leishmaniasis treatments, in the first week, in the second week, in the third week, and in the 4th week of anti-leishmaniasis treatments. Descriptive statistics were used to describe the profile of patients and to compare the treatment success rate. The generalized estimating equation was used to identify the determinants of serum micronutrients. RESULTS The mean age of the patients were 32.88 years [SD (standard deviation) ±15.95]. Male constitute 62.3% of the patients and problematic alcohol use was present in 11.5% of the patients. The serum zinc level of visceral leishmaniasis patients was affected by alcohol (B - 2.7 [95% CI: - 4.01 - -1.5]), DDS (B 9.75 [95% CI: 7.71-11.79]), family size (B -1.63 [95% CI: - 2.68 - -0.58]), HIV (B -2.95 [95% CI: - 4.97 - -0.92]), and sex (B - 1.28 [95% CI: - 2.5 - -0.07]). The serum iron level of visceral leishmaniasis patients was affected by alcohol (B 7.6 [95% CI: 5.86-9.35]), family size (B -5.14 [95% CI: - 7.01 - -3.28]), malaria (B -12.69 [95% CI: - 14.53 - -10.87]), Hookworm (- 4.48 [- 6.82 - -2.14]), chronic diseases (B -7.44 [95% CI: - 9.75 - -5.13]), and HIV (B -5.51 [95% CI: - 8.23 - -2.78]). The serum selenium level of visceral leishmaniasis patient was affected by HIV (B -18.1 [95% CI: - 20.63 - -15.58]) and family size (B -11.36 [95% CI: - 13.02 - -9.7]). The iodine level of visceral leishmaniasis patient was affected by HIV (B -38.02 [95% CI: - 41.98 - -34.06]), DDS (B 25 .84 [95% CI: 22.57-29.1]), smoking (B -12.34 [95% CI: - 15.98 - -8.7]), chronic illness (B -5.14 [95% CI: - 7.82 - -2.46]), and regular physical exercise (B 5.82 [95% CI: 0.39-11.26]). The serum vitamin D level of visceral leishmaniasis patient was affected by HIV (B -9.43 [95% CI: - 10.92 - -7.94]), DDS (B 16.24 [95% CI: 14.89-17.58]), malaria (B -0.61 [95% CI: - 3.37 - -3.37]), and family size (B -1.15 [95% CI: - 2.03 - -0.28]). The serum vitamin A level of visceral leishmaniasis patient was affected by residence (B 0.81 [95% CI: 0.08-1.54]), BMI (B 1.52 [95% CI: 0.42-2.6]), DDS (B 1.62 [95% CI: 0.36-2.88]), family size (B -5.03 [95% CI: - 5.83 - -4.22]), HIV (B -2.89 [95% CI: - 4.44 - -1.34]),MUAC (B 0.86 [95% CI: 0.52-1.21]), and age (B 0.09 [95% CI: 0.07-0.12]). CONCLUSION The micronutrient levels of visceral leishmaniasis patients were significantly lower. The anti-leishmaniasis treatment did not increase the serum micronutrient level of the patients.
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Affiliation(s)
- Berhanu Elfu Feleke
- Department of Epidemiology and Biostatistics, University of Bahir Dar, Bahir Dar, Ethiopia.
| | - Teferi Elfu Feleke
- Department of pediatrics and child health, Wolkite University, Butajira, Ethiopia
- General hospital, Wolkite, Ethiopia
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11
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Abstract
Visceral leishmaniasis is endemic in the western states of Eritrea, but it is rare in the city of Asmara. We report a case of an 18-month-old female with a high-grade fever, weight loss, and hepatosplenomegaly. No obvious cause of her illness was found. Routine blood investigations showed pancytopenia, and microscopic examination of bone marrow revealed intracellular and extracellular Leishmania amastigotes, so a diagnosis of leishmaniasis (kala-azar) was finally made. Visceral leishmaniasis should be considered when a child presents with fever, weight loss, organomegaly, and pancytopenia.
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Affiliation(s)
- Amin A Alamin
- Department of Pathology, College of Medicine, University of Al-Taif, Al-Taif, SAU
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12
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Johanson GH, Amato VS, Ribeiro VST, Tuon FF. Estimation of Leishmania spp. infection in asymptomatic people from Muzaffarpur, Bihar, India by antigen-antibody and skin testing. Rev Inst Med Trop Sao Paulo 2020; 62:e67. [PMID: 33027391 PMCID: PMC7534399 DOI: 10.1590/s1678-9946202062067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/08/2020] [Indexed: 01/05/2023] Open
Abstract
Asymptomatic VL is a concern, considering the risk of transmission in highly
endemic areas due to human-to-human transmission. The aim of this study was to
report the sero-epidemiological prevalence in Bihar, India, a highly endemic
area of VL, using the leishmanin skin test (LST) and the direct agglutination
test (DAT). This was a cross-sectional study performed in Muzaffarpur, Bihar,
India. Relatives of patients with VL were tested by LST and DAT. Other
epidemiological data were evaluated and correlated with tests results. Forty
individuals (either previous or current patients), and 109 household contacts
were studied. There were 36% of male visceral leishmaniasis family members
versus 17.57% of females visceral leishmaniasis family members, thus showing
more males with symptomatic disease than females (p< 0.01). All visceral
leishmaniasis cases had positive DAT tests, but only 37% of past cases were
positive on the skin testing. Amongst healthy household contacts, 34% were
DAT-positive, whilst 21% were LST-positive. The overall positivity for both
assays combined was 44.8% and 23.8% were DAT-positive alone. The finding of high
infection prevalence amongst asymptomatic individuals, and the estimation of
those at greater risk for overt disease (DAT-positive alone) are important in
the development of future disease control policies.
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Affiliation(s)
- Gustavo Henrique Johanson
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças e Moléstias Infecciosas, São Paulo, São Paulo, Brazil
| | - Valdir Sabbaga Amato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças e Moléstias Infecciosas, São Paulo, São Paulo, Brazil
| | | | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Laboratório de Doenças Infecciosas e Emergentes, Curitiba, Paraná, Brazil
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13
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Boreiko CJ, Rossman TG. Antimony and its compounds: Health impacts related to pulmonary toxicity, cancer, and genotoxicity. Toxicol Appl Pharmacol 2020; 403:115156. [PMID: 32710957 DOI: 10.1016/j.taap.2020.115156] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/04/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
Although occupational exposure to antimony and its compounds can produce pulmonary toxicity, human carcinogenic impacts have not been observed. Inhalation studies with respirable antimony trioxide particles administered to rats and mice have, however, induced carcinogenic responses in the lungs and related tissue sites. Genotoxicity studies conducted to elucidate mechanism(s) for tumor induction have produced mixed results. Antimony compounds do not induce gene mutations in bacteria or cultured mammalian cells, but chromosome aberrations and micronuclei have been observed, usually at highly cytotoxic concentrations. Indirect mechanisms of genotoxicity have been proposed to mediate these responses. In vivo genotoxicity tests have generally yielded negative results although several positive studies of marginal quality have been reported. Genotoxic effects may be related to indirect modes of action such as the generation of excessive reactive oxygen species (ROS), altered gene expression or interference with DNA repair processes. Such indirect mechanisms may exhibit dose-response thresholds. For example, interaction of ROS with in vivo antioxidant systems could yield a threshold for genotoxicity (and cancer) only at concentrations above the capacity of antioxidant defense mechanisms to control and/or eliminate damage from ROS.
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Affiliation(s)
| | - Toby G Rossman
- Environmental Medicine, NYU Grossman School of Medicine, New York, USA
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14
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Yeshaw Y, Tsegaye AT, Nigatu SG. Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study. Infect Drug Resist 2020; 13:881-891. [PMID: 32273732 PMCID: PMC7102893 DOI: 10.2147/idr.s245991] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital. Methods Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients’ charts and registration books, and analyzed using Stata 14 software. Kaplan–Meier failure curve and Log rank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P≤ 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model. Results A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2–8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27–4.11)), relapse VL (AHR=3.03 (95% CI: 1.25–7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30–10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48–4.51)), jaundice (AHR=2.84 (95% CI: 1.57–5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86–5.73)). Conclusion The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.
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Affiliation(s)
- Yigizie Yeshaw
- Department of Medical Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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15
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Simão JC, Victória C, Fortaleza CMCB. Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil. Int J Infect Dis 2020; 95:44-49. [PMID: 32088340 DOI: 10.1016/j.ijid.2020.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Visceral leishmaniasis (VL) is a public health threat for several tropical countries, including Brazil. Therapy failures and relapses aggravate VL morbidity and mortality. Our study aimed at identifying predictors of relapse and thus contributes to directing therapeutic options and patient follow-up. METHODS A nonconcurrent cohort of 571 subjects who completed successful therapy for VL in the city of Bauru, São Paulo State, Brazil, was followed for 24 months in order to identify the incidence and predictors of relapse. Extensive review of medical charts and laboratory files was conducted. Univariate and multivariable Cox regression models were used to identify predictors for the outcome of interest. A hierarchical strategy was used for variable selection in multivariable models. RESULTS Relapses occurred in 6.8% of treated subjects, after a median of 6 months (interquartile range, 4-9). In a comprehensive multivariable model, relapse was associated with: HIV-coinfection (hazard ratio [HR], 7.47; 95% confidence interval [CI], 2.58-21.55); the presence of lower limb edema (HR, 6.06; 95%CI, 1.38-26.77) and low platelet count upon admission (HR for platelet count × 1000, 0.99; 95%CI, 0.98-0.99) ; and secondary pneumonia (HR, 5.49; 95%CI, 1.49-20.18). On the other hand, therapy with Liposomal Amphotericin (as opposed to Antimoniate) was not independently associated with relapse (HR, 5.97; 95%CI, 0.63-56.29). CONCLUSION Besides reinforcing the impact of HIV coinfection on the outcome of VL, our study points to clinical and laboratory findings that characterize patients who were more likely to relapse. Those groups should be more closely followed, and possibly could benefit from novel therapeutic options.
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Affiliation(s)
- José Cláudio Simão
- Postgraduate Program in Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Cassiano Victória
- Department of Veterinary Hygiene and Public Health, Veterinary Faculty, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Carlos Magno Castelo Branco Fortaleza
- Postgraduate Program in Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
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16
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Pekelharing JE, Gatluak F, Harrison T, Maldonado F, Siddiqui MR, Ritmeijer K. Outcomes of visceral leishmaniasis in pregnancy: A retrospective cohort study from South Sudan. PLoS Negl Trop Dis 2020; 14:e0007992. [PMID: 31978116 PMCID: PMC7001985 DOI: 10.1371/journal.pntd.0007992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/05/2020] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Visceral leishmaniasis (VL) is endemic in South Sudan, where outbreaks occur frequently. Because of changes in the immune system during pregnancy, pregnant women are considered particularly vulnerable for developing complications of VL disease, including opportunistic infections. There is limited evidence available about clinical aspects and treatment outcomes of VL in pregnancy. We describe characteristics, maternal and pregnancy outcomes from a cohort of pregnant women with VL. Methods We conducted a retrospective analysis using routine programme data from a MSF health facility in Lankien, Jonglei State, South Sudan, between Oct 2014 and April 2018. Records were extracted of women diagnosed with VL while pregnant, and those symptomatic during pregnancy but diagnosed during the first two weeks postpartum. Records were matched with a random sample of non-pregnant women of reproductive age (15–45 years) with VL from the same period. Results We included 113 women with VL in pregnancy, and 223 non-pregnant women with VL. Women with VL in pregnancy presented with more severe anaemia, were more likely to need blood transfusion (OR 9.3; 95%CI 2.5–34.2) and were more often prescribed antibiotics (OR 6.0; 95%CI 3.4–10.6), as compared to non-pregnant women with VL. Adverse pregnancy outcomes, including miscarriage and premature delivery, were reported in 20% (16/81) where VL was diagnosed in pregnancy, and 50% 13/26) where VL was diagnosed postpartum. Postpartum haemorrhage was common. Pregnant women were more likely to require extension of treatment to achieve cure (OR 10.0; 95%CI 4.8–20.9), as compared to non-pregnant women with VL. Nevertheless, overall initial cure rates were high (96.5%) and mortality was low (1.8%) in this cohort of pregnant women with VL. Conclusion This is the largest cohort in the literature of VL in pregnancy. Our data suggest that good maternal survival rates are possible in resource-limited settings, despite the high incidence of complications. Visceral leishmaniases (VL), also known as ‘Kala azar’, is a parasitic disease transmitted by sand flies. South Sudan is one of the countries in the world with the highest disease burden of VL. Existing evidence about treatment and outcomes of VL in pregnancy is limited. We described outcomes of pregnant women with VL and women diagnosed with VL in the first two weeks postpartum. Pregnant women with VL were treated with liposomal amphotericin B (AmBisome) in this cohort. Survival rates and initial cure rates of women with VL in pregnancy treated in this resource constrained setting were high. However, these patients often required extension of treatment to achieve cure after the initial standard dose of 30mg/kg AmBisome in six doses. Careful evaluation of patients is needed at the end of the standard treatment regimen, in order to ensure proper (parasitological) cure before discharge. We reported a high incidence of complications (including severe anaemia with a need for blood transfusion), adverse pregnancy outcomes (including miscarriage and premature delivery), and obstetric complications. This research adds to the existing body of knowledge concerning VL in pregnancy, although several questions about this condition remain unanswered. Topics for future research include the immunological response to leishmania infection in pregnancy, and maternal, pregnancy and neonatal outcomes after discharge from VL treatment.
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Affiliation(s)
| | | | - Tim Harrison
- Médecins Sans Frontières, Amsterdam, Netherlands
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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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