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Almazán MC, Cajal SP, Díaz-Fernández M, Juárez M, Quipildor M, Portal G, Tejerina V, Vargas C, Copa GN, Gil JF, Cimino RO, Krolewiecki AJ. Clinical Presentation of American Tegumentary Leishmaniasis in a Leishmania (Viannia) braziliensis Endemic Hotspot: A 35-Year History. Am J Trop Med Hyg 2023; 109:804-810. [PMID: 37604471 PMCID: PMC10551066 DOI: 10.4269/ajtmh.23-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/26/2023] [Indexed: 08/23/2023] Open
Abstract
American tegumentary leishmaniasis (ATL) is a neglected tropical disease affecting the skin and mucosa. American tegumentary leishmaniasis due to Leishmania (Viannia) braziliensis is endemic in Argentina, where the Department of Oran is a hyperendemic focus. All cases of ATL with laboratory confirmation evaluated at a referral center in Oran city between 1985 and 2019 were analyzed retrospectively. Information from cases included clinical form, lesion size and number, time of evolution, and anatomical location; sex, age, and geographic origin were also studied. The temporal distribution of cases was analyzed. A total of 3,573 cases were included in the analysis. The ratio of males to females was 3:1 and the median age was 33 years old. Eighty-seven percent of cases were from Oran city and its surroundings, highlighting the hyperendemic nature of the area. Regarding clinical forms, 92.5% of cases were cutaneous and 7.5% were mucosal, with a median evolution time until clinical evaluation of 30 days and 7 months, respectively. Single cutaneous lesions were more frequent, localized mainly on the exposed areas in the upper and lower limbs. Secondary events were observed and described in 140 (4%) cases, with a median interval of 3.8 years for the appearance of recurrent mucosal disease in previously cutaneous forms. This is the largest case series of ATL due to L. (V.) braziliensis. The most classic presentation is of adult males with single cutaneous ulcers in exposed body areas, with < 10% of cases with mucosal complications. This comprehensive clinical characterization serves as a basis for future studies of the care and control of this neglected tropical disease.
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Affiliation(s)
- María Cristina Almazán
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas, Salta, Argentina
| | - Silvana Pamela Cajal
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Melisa Díaz-Fernández
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Marisa Juárez
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Marcelo Quipildor
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
- División Infectología, Hospital San Vicente de Paul, Orán, Argentina
| | - Guillermo Portal
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas, Salta, Argentina
| | - Valeria Tejerina
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Carlos Vargas
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Griselda Noemí Copa
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas, Salta, Argentina
| | - José Fernando Gil
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas, Salta, Argentina
- Instituto de Investigaciones en Energía No Convencional, Universidad Nacional de Salta, Salta, Argentina
| | - Rubén Oscar Cimino
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas, Salta, Argentina
| | - Alejandro Javier Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas, Salta, Argentina
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Lopez Y, Arana B, Rizzo N, Duran E, Acosta-Serrano Á, Mendizabal-Cabrera R. A neglected among the neglected: a review of cutaneous leishmaniasis in Guatemala. Trans R Soc Trop Med Hyg 2023; 117:609-616. [PMID: 37103337 PMCID: PMC10472881 DOI: 10.1093/trstmh/trad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
Cutaneous leishmaniasis (CL) is a parasitic vector-borne disease affecting mostly low- and middle-income countries. CL is endemic in Guatemala, where an increase in the number of cases and incidence and a changing disease distribution in the past decade have been reported. Important research was conducted in Guatemala in the 1980s and 1990s to understand the epidemiology of CL and two Leishmania species were identified as the aetiologic agents. Several species of sand flies have been reported, five of which are naturally infected with Leishmania. Clinical trials conducted in the country evaluated different treatments against the disease and provided solid evidence for CL control strategies that are applicable worldwide. More recently, in the 2000s and 2010s, qualitative surveys were conducted to understand community perceptions of the disease and to highlight the challenges and enablers for disease control. However, limited recent data have been generated regarding the current CL situation in Guatemala, and key information necessary for effective disease control, such as incrimination of vectors and reservoirs, is still lacking. This review describes the current state of knowledge of CL in Guatemala, including the main parasite and sand fly species, disease reservoirs, diagnosis and control, as well as the perceptions of communities in endemic regions.
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Affiliation(s)
- Yaimie Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Byron Arana
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
| | - Nidia Rizzo
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
| | - Erick Duran
- Ministry of Health and Social Assistance, 3-45, 6a Avenida 3, Guatemala City 01011, Guatemala
| | | | - Renata Mendizabal-Cabrera
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11–95, Guatemala City 01015, Guatemala
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Almazán MC, Copa GN, Gil JF, López Quiroga I, Díaz Fernández ME, Uncos A, Hoyos CL, Nasser JR, Barroso PA, Marco JD. Parasitological and molecular search for Leishmania natural infection in phlebotomine sand flies in peri-urban and rural sites of an Argentinean area endemic for tegumentary leishmaniasis. Acta Trop 2021; 222:106064. [PMID: 34302769 DOI: 10.1016/j.actatropica.2021.106064] [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: 03/29/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
Leishmaniases are neglected tropical diseases caused by Leishmania spp. parasites transmitted by the bite of phlebotomine sand flies. In Argentina, the most endemic area of American tegumentary leishmaniasis (ATL) has been Orán department, Province of Salta, where Leishmania (Viannia) braziliensis prevails and Nyssomyia neivai is considered as its vector, although there is no accurate and sufficient information in this regard. The aim of this work was to search for natural infection by Leishmania spp. in sand flies from peri-urban and rural sites with ATL background in Orán department. For this, sand flies were caught at five sites; female sand flies captured with Shannon trap were dissected to microscopically examine their gut contents, while females captured with CDC traps were molecularly analyzed by duplex PCR with two primer pairs to simultaneously amplify kinetoplast DNA (kDNA) and mammalian actin. A total of 1921 females were captured, with Ny. neivai being the most abundant species (89%), followed by Migonemyia migonei (6%) and cortelezzii complex (3%). No natural infection was found in any of them neither by dissection nor by PCR, although the detection limit of kDNA PCR was up to 25 promastigotes. The absence of infected females in peri-urban sites suggest that the transmission did not take place in those environments during the study period. Future searches for natural infection should focus on rural settings to deepen knowledge and elucidate the role of the circulating sand fly species as all have been linked to ATL transmission at other sites.
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Affiliation(s)
- María Cristina Almazán
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
| | - Griselda Noemí Copa
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - José Fernando Gil
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Argentina; Instituto de Investigaciones en Energía No Convencional, CONICET, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Inés López Quiroga
- Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Argentina
| | | | - Alejandro Uncos
- Instituto de Patología Experimental, CONICET, Salta, Argentina
| | - Carlos Lorenzo Hoyos
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Instituto de Patología Experimental, CONICET, Salta, Argentina
| | - Julio Rubén Nasser
- Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Argentina
| | - Paola Andrea Barroso
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Instituto de Patología Experimental, CONICET, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
| | - Jorge Diego Marco
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Instituto de Patología Experimental, CONICET, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
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Aramayo LV, Copa GN, Hoyos CL, Almazán MC, Juarez M, Cajal SP, Krolewiecki AJ, Nasser JR, Gil JF. [Tegumentary leishmaniasis and sandflies in Colonia Santa Rosa locality in northern Argentina]. Rev Argent Microbiol 2021; 54:143-151. [PMID: 34503860 DOI: 10.1016/j.ram.2021.06.002] [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: 10/13/2020] [Revised: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022] Open
Abstract
Tegumentary leishmaniasis (TL) is caused by parasites of the genus Leishmania and transmitted by the sandfly species, insects belonging to the order Diptera, family Psychodidae. Historically, the most endemic area of TL in Argentina has been the northern region. The aim of this work was to analyze the presence and temporal variation of TL cases reported between 1985 and 2019 in Colonia Santa Rosa locality, northern Argentina. Furthermore, its clinical forms were characterized and sandflies were captured. Patients were diagnosed by smear and the Montenegro skin test. For sampling, CDC light traps were placed at 14 sites from 7pm to 7am. The correlation between vegetation cover and sandfly abundance was also studied. One hundred and twenty TL cases were diagnosed and the overall prevalence was 0.75% (≈16 000 inhabitants). Patients presented simple and multiple cutaneous leishmaniasis (88.79%) and the mucocutaneous form (10.83%). Skin lesions were more frequent on the lower extremities (46.73%). Of the total number of sandflies, Nyssomyia neivai (95%) was the predominant species followed by Migonemyia migonei (1.9%), cortelezzii complex (1.3%) and Evandromyia sallesi (0.09%). The persistent occurrence of cases and the presence of sandflies in the locality suggest the existence of endemic transmission in the area. This highlights the need to design prevention and control measures for TL in northern Argentina.
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Affiliation(s)
- Lorena V Aramayo
- Cátedra de Química Biológica de la Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta-Capital, Argentina
| | - Griselda N Copa
- Instituto de Investigaciones en Energía no Convencional (INENCO-CONICET), Universidad Nacional de Salta, Salta-Capital, Argentina; Cátedra de Química Biológica de la Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta-Capital, Argentina
| | - Carlos L Hoyos
- Instituto de Patología Experimental (IPE-CONICET), Universidad Nacional de Salta, Salta-Capital, Argentina
| | - María C Almazán
- Instituto de Investigaciones de Enfermedades Tropicales, Sede Orán, Universidad Nacional de Salta, San Ramón de la Nueva Orán, Salta, Argentina
| | - Marisa Juarez
- Instituto de Investigaciones de Enfermedades Tropicales, Sede Orán, Universidad Nacional de Salta, San Ramón de la Nueva Orán, Salta, Argentina
| | - Silvana P Cajal
- Instituto de Investigaciones de Enfermedades Tropicales, Sede Orán, Universidad Nacional de Salta, San Ramón de la Nueva Orán, Salta, Argentina
| | - Alejandro J Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales, Sede Orán, Universidad Nacional de Salta, San Ramón de la Nueva Orán, Salta, Argentina
| | - Julio R Nasser
- Cátedra de Química Biológica de la Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta-Capital, Argentina
| | - José F Gil
- Instituto de Investigaciones de Enfermedades Tropicales, Sede Orán, Universidad Nacional de Salta, San Ramón de la Nueva Orán, Salta, Argentina; Instituto de Investigaciones en Energía no Convencional (INENCO-CONICET), Universidad Nacional de Salta, Salta-Capital, Argentina; Cátedra de Química Biológica de la Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta-Capital, Argentina.
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Abstract
The leishmanin skin test (LST) has been used for decades to detect exposure and immunity to the parasite Leishmania, the causative agent of the neglected tropical disease leishmaniasis. In the LST, Leishmania antigen (leishmanin) is intradermally injected into the forearm. In an individual who has been previously infected, a delayed-type hypersensitivity (DTH) reaction results in a measurable induration at the site of the injection, indicating that previous exposure to Leishmania has resulted in the development of cell-mediated immunity. LST positivity is associated with long-lasting protective immunity against reinfection, most notably as reported for visceral leishmaniasis (VL). Despite efforts over the past few decades, leishmanin antigen is no longer produced under good manufacturing practice (GMP) conditions anywhere in the world. Consequently, the use of the LST in epidemiological studies has declined in favor of serological and molecular tests. In this review, we provide a historical overview of the LST and justification for the reintroduction of leishmanin. A GMP-grade leishmanin can be used to detect immunity in vivo by the LST and can be investigated for use in an interferon-γ release assay (IGRA), which may serve as an in vitro version of the LST. The LST will be a valuable tool for surveillance and epidemiological studies in support of the VL elimination programs and as a surrogate marker of immunity in vaccine clinical trials.
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Akuffo R, Wilson M, Sarfo B, Attram N, Mosore MT, Yeboah C, Cruz I, Ruiz-Postigo JA, Boakye D, Moreno J, Anto F. Prevalence of Leishmania infection in three communities of Oti Region, Ghana. PLoS Negl Trop Dis 2021; 15:e0009413. [PMID: 34043625 PMCID: PMC8158879 DOI: 10.1371/journal.pntd.0009413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leishmaniasis is a neglected tropical disease caused by parasites of the genus Leishmania and is transmitted by various species of female phlebotomine sand flies. The first report of cutaneous leishmaniasis (CL) in Ghana refer to a cluster of cases in 1999-2003 in the Ho municipality of the Volta Region. We conducted an epidemiological assessment in the Oti Region, encouraged by recent reports of potential cases of CL. METHODOLOGY/PRINCIPAL FINDINGS Using a cross-sectional study design, the exposure to Leishmania was investigated in three communities of the Oti Region based on the leishmanin skin test (LST). LST results for 3,071 participants comprising 1091, 848, and 1132 persons from the communities of Ashiabre, Keri, and Sibi Hilltop, indicated an overall prevalence of exposure to Leishmania infection of 41.8% and individual community prevalence of 39.4%, 55.1%, and 34.2% respectively. Being male [AOR = 1.27; CI: 1.09, 1.49], and living in Keri [AOR = 1.83; CI: 1.43, 2.34] were associated with an increase in the odds of exposure to Leishmania. Being 5-10 years old [AOR = 1.48; CI: 1.06, 2.05], 11-17 years old [AOR = 2.03; CI: 1.45, 2.85], 18-40 years old [AORR = 2.83; CI: 1.81, 4.43] and 41-65 years old [AOR = 5.08; CI: 2.98, 8.68] were also significantly associated with increased odds of being exposed to Leishmania. CONCLUSIONS/SIGNIFICANCE This study demonstrated exposure to Leishmania in the study communities and also identified associated factors. Future efforts aimed at reducing exposure to Leishmania infection in the study area should take the associated factors into consideration.
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Affiliation(s)
- Richard Akuffo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- School of Public Health, University of Ghana, Accra, Ghana
- * E-mail:
| | - Michael Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Bismark Sarfo
- School of Public Health, University of Ghana, Accra, Ghana
| | - Naiki Attram
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | | | - Clara Yeboah
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | - Israel Cruz
- National School of Public health, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose-Antonio Ruiz-Postigo
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Daniel Boakye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Javier Moreno
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Francis Anto
- School of Public Health, University of Ghana, Accra, Ghana
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Rostami MN, Khamesipour A. Potential biomarkers of immune protection in human leishmaniasis. Med Microbiol Immunol 2021; 210:81-100. [PMID: 33934238 PMCID: PMC8088758 DOI: 10.1007/s00430-021-00703-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/22/2021] [Indexed: 12/30/2022]
Abstract
Leishmaniasis is a vector-borne neglected tropical disease endemic in over 100 countries around the world. Available control measures are not always successful, therapeutic options are limited, and there is no vaccine available against human leishmaniasis, although several candidate antigens have been evaluated over the last decades. Plenty of studies have aimed to evaluate the immune response development and a diverse range of host immune factors have been described to be associated with protection or disease progression in leishmaniasis; however, to date, no comprehensive biomarker(s) have been identified as surrogate marker of protection or exacerbation, and lack of enough information remains a barrier for vaccine development. Most of the current understanding of the role of different markers of immune response in leishmaniasis has been collected from experimental animal models. Although the data generated from the animal models are crucial, it might not always be extrapolated to humans. Here, we briefly review the events during Leishmania invasion of host cells and the immune responses induced against Leishmania in animal models and humans and their potential role as a biomarker of protection against human leishmaniasis.
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Affiliation(s)
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, 14155-6383, Tehran, Iran.
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Almazán MC, Copa GN, Lauthier JJ, Gil JF, López Quiroga I, Hoyos CL, Díaz Fernández ME, Nasser JR, Korenaga M, Marco JD, Barroso PA. Sand fly typing: a simple and morphologically-supported method based on polymorphism of 18S rRNA gene in a Leishmaniasis endemic area of Argentina. Acta Trop 2020; 211:105609. [PMID: 32598918 DOI: 10.1016/j.actatropica.2020.105609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/27/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022]
Abstract
Leishmaniases are vector-borne diseases that in the Americas are distributed from southern United States to northern Argentina. The vectors for this disease are small dipterans known as sand flies that are usually identified morphologically by observing structures with taxonomic value; but it is time-consuming, laborious, and requires entomological expertise. Then, this work was aimed at identifying sand flies with molecular techniques, using the morphological identification as a reference technique, in an endemic area of American Tegumentary Leishmaniasis (ATL) located in northern Argentina. For this, sand flies were caught at two patches of vegetation adjacent to rural areas in Orán department, Salta Province. Females were dissected with sterile needles; the head and last abdominal segments were analyzed for morphological identification. The remaining thorax and abdominal segments were used to extract DNA, which was amplified by PCR of the small subunit (SSU), 18S rRNA gene. PCR products were digested with CviQI and DdeI enzymes to identify sand fly species by Restriction Fragment Length Polymorphism (RFLP) analysis. Thus, the restriction pattern of each caught species was defined according to morphological identification. A total of 1501 females, belonging to four sand fly species, were captured. Nyssomyia neivai (1347/1501) was the most abundant species, followed by Migonemyia migonei (90/1501). From the total, 801 females were morphologically and molecularly identified, while 700 females were characterized only molecularly. For those females analyzed by both methods, there was total coincidence in the achieved result. Besides, the 5% (38/801) of females that could not be determined morphologically due to inadequate mounting were molecularly identified. All the females characterized just by PCR-RFLP, were successfully identified. Our results indicate that the explored method is capable of identifying the sand fly species that circulate in an ATL endemic area. Since this method is based on the analysis of markedly different patterns, the identification process might be more easily reproduced, as the bias introduced by the technician's lack of experience is removed.
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Affiliation(s)
- María Cristina Almazán
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Griselda Noemí Copa
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Juan José Lauthier
- Parasitology Department, Kochi Medical School, Kochi University, Okocho Kohasu, Nankoku, Kochi Prefecture, Japan
| | - José Fernando Gil
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Instituto de Investigaciones en Energía No Convencional-CONICET, Universidad Nacional de Salta, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Inés López Quiroga
- Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina
| | - Carlos Lorenzo Hoyos
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Instituto de Patología Experimental-CONICET, Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina
| | | | - Julio Rubén Nasser
- Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina
| | - Masataka Korenaga
- Parasitology Department, Kochi Medical School, Kochi University, Okocho Kohasu, Nankoku, Kochi Prefecture, Japan; Faculty of Health Sciences, Kochi Gakuen University, Asahi-Tenjincho, Kochi, Kochi Prefecture, Japan
| | - Jorge Diego Marco
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Instituto de Patología Experimental-CONICET, Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Paola Andrea Barroso
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina; Instituto de Patología Experimental-CONICET, Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
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Bettaieb J, Toumi A, Ghawar W, Chlif S, Nouira M, Belhaj-Hamida N, Gharbi A, Ben-Alaya N, Laouini D, Louzir H, Dellagi K, Ben Salah A. A prospective cohort study of Cutaneous Leishmaniasis due to Leishmania major: Dynamics of the Leishmanin skin test and its predictive value for protection against infection and disease. PLoS Negl Trop Dis 2020; 14:e0008550. [PMID: 32841284 PMCID: PMC7473511 DOI: 10.1371/journal.pntd.0008550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 09/04/2020] [Accepted: 07/01/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Leishmanin Skin Test (LST) is considered as a useful indicator of past infection by Leishmania parasites. However, the temporal dynamics of a positive LST under different epidemiologic scenarios and whether it relates to the protection against the recurrence of an overt disease are not fully documented. METHODOLOGY/PRINCIPAL FINDINGS We report here on a population based prospective study conducted on 2686 individuals living in two foci located in Central Tunisia, to assess over a one-year epidemiologic season, the incidence of Leishmania (L.) major infection and disease and changes in LST reactivity. The two foci were both endemic for Cutaneous Leishmaniasis (CL) due to L. major, but contrasted in their history for this disease (ie: an old focus versus a recent focus). We found that most infections occurred in the new focus (290/1000; 95% CI: 265-315 person-years) with an incidence rate of CL lesions 2.4 times higher than in the old focus. Likewise, the rates of LST reactivity reversion and loss, in the new focus, were 99/1000[38-116] person-years and 14/1000[8-21] person-years, respectively. Loss of LST reactivity was not noticed in the old focus. Interestingly, the incidence rates of symptomatic infection did not differ significantly according to the LST status at enrolment (negative versus positive) between the combined foci and the new one. CONCLUSIONS/SIGNIFICANCE Our findings confirm LST as a good tool for assessing L. major cryptic infection. However, the instability of the LST positivity in new foci should be considered as an important confounder of the outcome of this infection when developing a research protocol for vaccine trial.
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Affiliation(s)
- Jihène Bettaieb
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Amine Toumi
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wissem Ghawar
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sadok Chlif
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mariem Nouira
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nabil Belhaj-Hamida
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Adel Gharbi
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nissaf Ben-Alaya
- Department of Epidemiology, Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
| | - Dhafer Laouini
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hechmi Louzir
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Koussay Dellagi
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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10
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Copa GN, Almazán MC, Aramayo LV, Krolewiecki AJ, Cajal SP, Juarez M, Lauthier JJ, Korenaga M, Barroso P, Nasser JR, Marco JD, Gil JF. Tegumentary leishmaniasis and sand flies in a border area between Argentina and Bolivia. Trans R Soc Trop Med Hyg 2020; 113:91-100. [PMID: 30418628 DOI: 10.1093/trstmh/try113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/21/2018] [Indexed: 11/12/2022] Open
Abstract
Background Some sand flies are of medical importance because they are vectors of Leishmania parasites that are responsible for leishmaniasis. The aim of this study was to make a retrospective epidemiological analysis of tegumentary leishmaniasis (TL), to identify Leishmania spp. from patient isolates and to describe the diversity of sand flies from a border area between Bolivia and Argentina. Methods TL cases included in the study were diagnosed in an endemic area of the north of Argentina from 1985 to 2017. The parasites isolated were characterized by the cytochrome B method. Sand flies were captured with Centers for Disease Control traps in Aguas Blancas and Media Luna-Algarrobito localities. Results A total of 118 cases of TL were analysed. Eight isolates were characterized as Leishmania (Viannia) braziliensis. A total of 1291 sand flies were captured, including Nyssomyia neivai, Cortelezzii complex, Evandromyia sallesi, Migonemyia migonei and Micropygomyia quinquefer. Within the area, sand flies were found in the backyards of houses. Conclusions In this region there exists the possibility of peridomestic transmission of TL in the neighbourhoods peripheral to the urban area and in rural environments as well as the risk of transmission to travellers that pass through the customs offices.
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Affiliation(s)
- Griselda N Copa
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Sede Regional Orán, Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Alvarado 751 - San Ramón de la Nueva Orán-C.P.4530.,Cátedra de Química Biológica y Biología Molecular, Facultad de Ciencias Naturales, Universidad Nacional de Salta. Universidad Nacional de Salta. Av. Bolivia 5150 - CP
| | - María C Almazán
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Sede Regional Orán, Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Alvarado 751 - San Ramón de la Nueva Orán-C.P.4530.,Cátedra de Química Biológica y Biología Molecular, Facultad de Ciencias Naturales, Universidad Nacional de Salta. Universidad Nacional de Salta. Av. Bolivia 5150 - CP
| | - Lorena V Aramayo
- Cátedra de Química Biológica y Biología Molecular, Facultad de Ciencias Naturales, Universidad Nacional de Salta. Universidad Nacional de Salta. Av. Bolivia 5150 - CP
| | - Alejandro J Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Sede Regional Orán, Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Alvarado 751 - San Ramón de la Nueva Orán-C.P.4530
| | - Silvana P Cajal
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Sede Regional Orán, Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Alvarado 751 - San Ramón de la Nueva Orán-C.P.4530
| | - Marisa Juarez
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Sede Regional Orán, Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Alvarado 751 - San Ramón de la Nueva Orán-C.P.4530
| | - Juan J Lauthier
- Parasitology Department, Kochi Medical School, Kochi University, Oko, Nankoku, Kochi, Japan
| | - Masataka Korenaga
- Parasitology Department, Kochi Medical School, Kochi University, Oko, Nankoku, Kochi, Japan
| | - Paola Barroso
- Instituto de Patología Experimental (IPE-CONICET), Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Av. Bolivia 5150 - CP
| | - Julio R Nasser
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Sede Regional Orán, Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Alvarado 751 - San Ramón de la Nueva Orán-C.P.4530.,Cátedra de Química Biológica y Biología Molecular, Facultad de Ciencias Naturales, Universidad Nacional de Salta. Universidad Nacional de Salta. Av. Bolivia 5150 - CP
| | - Jorge D Marco
- Instituto de Patología Experimental (IPE-CONICET), Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Av. Bolivia 5150 - CP
| | - José F Gil
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Sede Regional Orán, Facultad de Ciencias de la Salud, Universidad Nacional de Salta. Alvarado 751 - San Ramón de la Nueva Orán-C.P.4530.,Instituto de Investigación en Energía No Convencional (INENCO-CONICET), Departamento de Física, Universidad Nacional de Salta. Av. Bolivia 5150 - CP
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11
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Jayasena Kaluarachchi TD, Weerasekera MM, McBain AJ, Ranasinghe S, Wickremasinghe R, Yasawardene S, Jayanetti N, Wickremasinghe R. Diagnosing Cutaneous leishmaniasis using Fluorescence in Situ Hybridization: the Sri Lankan Perspective. Pathog Glob Health 2019; 113:180-190. [PMID: 31429388 DOI: 10.1080/20477724.2019.1650228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cutaneous leishmaniasis (CL) caused by Leishmania donovani MON-37 is becoming a major public health problem in Sri Lanka, with 100 new cases per month being reported in endemic regions. Diagnosis of CL is challenging for several reasons. Due to relative specificity and rapidity we propose Fluorescence in Situ Hybridization as a diagnostic tool for CL. The objective was to evaluate the potential of Fluorescence in Situ Hybridization as a diagnostic method for Cutaneous leishmaniasis in Sri Lanka. Literature on current laboratory tests used to diagnose Cutaneous leishmaniasis in Sri Lanka and globally was reviewed. Sri Lankan data were reviewed systematically following the PRISMA guidelines. A narrative of the results is presented. There is currently no gold standard diagnostic method for Cutaneous leishmaniasis. Fluorescence in Situ Hybridization has been previously applied to detect dermal pathologies including those involving infectious agents, and its use to detect the Leishmania parasite in human cutaneous lesions reported in small number of studies, generally with limited numbers of subjects. Advantages of FISH has been specificity, cost and ease-of-use compared to the alternatives. Based on the available literature and our current work, FISH has potential for diagnosing CL and should now be evaluated in larger cohorts in endemic regions. FISH for CL diagnosis could find application in countries such as Sri Lanka, where laboratory facilities may be limited in rural areas where the disease burden is highest.
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Affiliation(s)
| | - Manjula Manoji Weerasekera
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Nugegoda , Sri Lanka
| | - Andrew J McBain
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Nugegoda , Sri Lanka.,Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester
| | - Shalindra Ranasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Renu Wickremasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Surangi Yasawardene
- Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Nisal Jayanetti
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya , Kelaniya , Sri Lanka
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12
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Braz LMA. Tegumentary leishmaniasis diagnosis: what happened with MST (Montenegro Skin Test) in Brazil? Rev Inst Med Trop Sao Paulo 2019; 61:e17. [PMID: 30864622 PMCID: PMC6413772 DOI: 10.1590/s1678-9946201961017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/12/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
- Lucia Maria Almeida Braz
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Soroepidemiologia, São Paulo, São Paulo, Brazil
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13
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Almazán MC, Hoyos CL, Krolewiecki AJ, Cajal SP, Copa GN, Fleitas PE, Barroso PA, Marco JD, Nasser JR, Gil JF. Molecular Identification of Leishmania spp. DNA from Archived Giemsa-Stained Slides of Patients from Salta, Argentina. Am J Trop Med Hyg 2018; 99:1156-1161. [PMID: 30255828 DOI: 10.4269/ajtmh.18-0223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis is endemic in Salta province, which belongs to the northwest of Argentina. Leishmania spp. DNA from Giemsa-stained slides of up to 12 years in storage of patients from Salta was characterized through polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP). One hundred smears positive for microscopy, classified in a semiquantitative scale for amastigote density, were analyzed. Also, Leishmanin skin test (LST) results were included. DNA extraction was carried out applying lysis buffer with proteinase K, and then DNA was amplified with ribosomal internal transcribed spacer 1 primers. PCR products were digested with HaeIII enzyme. All PCR-positive smears (74/100) belonged to Viannia subgenus. A statistically significant, directly proportional relationship between semiquantitative microscopy and PCR results was detected. All patients had LST-positive results (induration ≥ 5 mm), and the smears of those with smaller induration (LST < 19 mm) gave a higher proportion of positive PCR results. This study determined that smear age did not affect PCR positivity, which allows retrospective analyzes and suggests smears might be useful for molecular complementary diagnosis. Because Leishmania (Viannia) braziliensis is the main circulating species in the study area, determining Viannia subgenus in all analyzed samples confirms previous findings. PCR positivity showed statistically significant differences according to semiquantitative microscopy, highlighting the importance of parasite burden in the diagnostic sensitivity of the method. Considering that smears of patients with smaller LST induration were more positive in PCR, a negative smear from patients with positive LST response, but < 19 mm, could actually represent a false-negative result.
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Affiliation(s)
- María Cristina Almazán
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.,Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Carlos Lorenzo Hoyos
- Instituto de Patología Experimental, CONICET, Salta, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Alejandro Javier Krolewiecki
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Silvana Pamela Cajal
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Griselda Noemí Copa
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.,Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Pedro Emanuel Fleitas
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.,Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Paola Andrea Barroso
- Instituto de Patología Experimental, CONICET, Salta, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Jorge Diego Marco
- Instituto de Patología Experimental, CONICET, Salta, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - Julio Rubén Nasser
- Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | - José Fernando Gil
- Instituto de Investigaciones en Energía No Convencional, CONICET, Salta, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina
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