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Martins IML, de Paula AMB, Caldeira AP, Oliveira LB, Fernandes LF. Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil. Rev Soc Bras Med Trop 2024; 57:e004012024. [PMID: 38422344 PMCID: PMC10890824 DOI: 10.1590/0037-8682-0045-2024] [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: 04/07/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a public health problem and is a relevant cause of death in developing countries. This study aimed to evaluate the 20-year survival and predictors of worse prognosis in patients with VL admitted to a reference hospital for the treatment of infectious diseases between 1995 and 2016 in northern Minas Gerais, an area of high endemicity for VL. METHODS This retrospective cohort study was conducted at a hospital in northern Minas Gerais, Brazil. All patients with VL were evaluated over a 20-year period. The medical records were thoroughly analyzed. Cox regression analysis was performed to estimate factors associated with the probability of survival. RESULTS The cohort included 972 individuals, mostly male children <10 years old, from urban areas who presented at admission with the classic triad of fever, hepatosplenomegaly, and skin pallor. The mean hemoglobin level was 7.53 mg/dl. The mean interval between symptom onset and hospital admission was 40 days. The instituted therapies ranged from pentavalent antimonates to amphotericin, or both. The probability of survival was reduced to 78% one year after symptom onset. Hemoglobin levels and age were strongly associated with the probability of survival. CONCLUSIONS Regardless of the mechanism underlying the reduction in hemoglobin and the non-modifiable factors of age, early initiation of drug treatment is the most appropriate strategy for increasing survival in patients with VL, which challenges health systems to reduce the interval between the onset of symptoms and hospital admission.
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Affiliation(s)
- Igor Monteiro Lima Martins
- Universidades Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, MG, Brasil
- Centro Universitário UNIFIPMOC, Montes Claros, MG, Brasil
| | | | - Antônio Prates Caldeira
- Universidade Estadual de Montes Claros, Departamento de Saúde da Mulher e da Criança, Montes Claros, MG, Brasil
- Centro Universitário UNIFIPMOC, Montes Claros, MG, Brasil
| | - Lanuza Borges Oliveira
- Universidade Estadual de Montes Claros, Departamento de Enfermagem, Montes Claros, MG, Brasil
- Centro Universitário UNIFIPMOC, Montes Claros, MG, Brasil
| | - Luciano Freitas Fernandes
- Universidade Estadual de Montes Claros, Hospital Universitário Clemente Faria, Montes Claros, MG, Brasil
- Centro Universitário UNIFIPMOC, Montes Claros, MG, Brasil
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2
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Costa CHN, Chang KP, Costa DL, Cunha FVM. From Infection to Death: An Overview of the Pathogenesis of Visceral Leishmaniasis. Pathogens 2023; 12:969. [PMID: 37513817 PMCID: PMC10384967 DOI: 10.3390/pathogens12070969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/02/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Kala-azar, also known as visceral leishmaniasis (VL), is a disease caused by Leishmania infantum and L. donovani. Patients experience symptoms such as fever, weight loss, paleness, and enlarged liver and spleen. The disease also affects immunosuppressed individuals and has an overall mortality rate of up to 10%. This overview explores the literature on the pathogenesis of preclinical and clinical stages, including studies in vitro and in animal models, as well as complications and death. Asymptomatic infection can result in long-lasting immunity. VL develops in a minority of infected individuals when parasites overcome host defenses and multiply in tissues such as the spleen, liver, and bone marrow. Hepatosplenomegaly occurs due to hyperplasia, resulting from parasite proliferation. A systemic inflammation mediated by cytokines develops, triggering acute phase reactants from the liver. These cytokines can reach the brain, causing fever, cachexia and vomiting. Similar to sepsis, disseminated intravascular coagulation (DIC) occurs due to tissue factor overexpression. Anemia, hypergammaglobulinemia, and edema result from the acute phase response. A regulatory response and lymphocyte depletion increase the risk of bacterial superinfections, which, combined with DIC, are thought to cause death. Our understanding of VL's pathogenesis is limited, and further research is needed to elucidate the preclinical events and clinical manifestations in humans.
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Affiliation(s)
- Carlos H N Costa
- Centro de Investigações em Agravos Tropicais Emergentes e Negligenciados, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Rua Artur de Vasconcelos 151-Sul, Teresina 64002-510, PI, Brazil
| | - Kwang-Poo Chang
- Department of Microbiology/Immunology, Center for Cancer Cell Biology, Immunology & Infection, Chicago Medical School, Rosalind Franklin University, North Chicago, IL 60064, USA
| | - Dorcas L Costa
- Centro de Investigações em Agravos Tropicais Emergentes e Negligenciados, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Rua Artur de Vasconcelos 151-Sul, Teresina 64002-510, PI, Brazil
| | - Francisco Valmor M Cunha
- Departament of Physiotherapy, Centro Universitário Uninovafapi, Rua Vitorino Orthiges Fernandes, 6123-Uruguai, Teresina 64073-505, PI, Brazil
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3
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Goto Y, Mizobuchi H. Pathological roles of macrophages in Leishmania infections. Parasitol Int 2023; 94:102738. [PMID: 36738983 DOI: 10.1016/j.parint.2023.102738] [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: 10/27/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Macrophages are the major host cells for Leishmania parasites, and determine the fate of infection by either limiting or allowing growth of the parasites, resulting in development or control of leishmaniasis, respectively. They also play important roles in causing pathological outcomes during Leishmania infection. The pathophysiology is complex and include a wide variety of molecular and cellular responses including enhancement of inflammatory responses by releasing cytokines, causing damages to surrounding cells by reactive oxygen species, or disordered phagocytosis of other cells. It is of note that disease severity in leishmaniasis sometimes does not correlate with parasite burdens, indicating that pathological roles of macrophages are not necessarily linked to their parasite-killing activities that are often defined by M1/M2 status. Here, we review the roles of macrophages in leishmaniasis with a focus on their pathological mechanisms in disease development.
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Affiliation(s)
- Yasuyuki Goto
- Laboratory of Molecular Immunology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.
| | - Haruka Mizobuchi
- Laboratory of Molecular Immunology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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4
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Dachraoui K, Chelbi I, Labidi I, Ben Osman R, Sayadi A, Ben Said M, Cherni S, Abbas MAS, Charrel R, Zhioua E. The Role of the Leishmania infantum Infected Dogs as a Potential Reservoir Host for Toscana Virus in a Zoonotic Visceral Leishmaniasis Focus of Northern Tunisia. Viruses 2023; 15:v15041012. [PMID: 37112992 PMCID: PMC10143639 DOI: 10.3390/v15041012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
The role of dogs as reservoir hosts for Toscana virus (TOSV) remains undetermined. This study investigated TOSV and Leishmania infantum infections in one healthy and three infected dogs with Leishmania (A, B, C) following natural exposition to sandfly bites in a focus of zoonotic visceral leishmaniasis (ZVL) located in Northern Tunisia from June to October 2020. At the end of the exposition period, infected and healthy dogs were examined for TOSV and L. infantum infections by xenodiagnosis using a colony of Phlebotomus perniciosus. Pools of freshly engorged P. perniciosus at days 0 and those at days 7 post-feeding were screened for TOSV and L. infantum by nested PCR in the polymerase gene and kinetoplast minicircle DNA, respectively. In the exposure site, P. pernicious is the most abundant sandfly species. The infection rates of sandflies with TOSV and L. infantum were 0.10 and 0.05%, respectively. Leishmania infantum DNA and TOSV RNA were detected in P. perniciosus females fed on dog B and C, respectively. The isolation of TOSV in Vero cells was achieved from two pools containing P. perniciosus fed on dog C. No pathogens were detected in P. perniciosus females fed on dog A and on control dog. We report for the first time the reservoir competence of dog with ZVL in the transmission of TOSV to sandfly vectors in natural settings, in addition to its role as a main reservoir host of L. infantum.
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Affiliation(s)
- Khalil Dachraoui
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Laboratory of Transmission, Control and Immuno-Biology of Infections, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Ifhem Chelbi
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Laboratory of Transmission, Control and Immuno-Biology of Infections, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Imen Labidi
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Raja Ben Osman
- Vaccine Control Unit, National Drug Control Laboratory, Tunis 1002, Tunisia
| | - Aida Sayadi
- Vaccine Control Unit, National Drug Control Laboratory, Tunis 1002, Tunisia
| | - Mourad Ben Said
- Department of Basic Sciences, Higher Institute of Biotechnology of Sidi Thabet, University of Manouba, Manouba 2010, Tunisia
- Laboratory of Microbiology, National School of Veterinary Medicine of Sidi Thabet, University of Manouba, Manouba 2010, Tunisia
| | - Saifedine Cherni
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | | | - Rémi Charrel
- Unité des Virus Emergents, Aix-Marseille University, IRD 190, INSERM U1207, 13005 Marseille, France
- Laboratoire des Infections Virales Aigues et Tropicales, Pole des Maladies Infectieuses, AP-HM Hôpitaux Universitaires de Marseille, 13005 Marseille, France
| | - Elyes Zhioua
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Laboratory of Transmission, Control and Immuno-Biology of Infections, Institut Pasteur de Tunis, Tunis 1002, Tunisia
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5
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Carvalho AG, Kuhn ALM, Dias JVL, Luz JGG. Epidemiological patterns related to deaths caused by visceral leishmaniasis in the southern Amazon region of Brazil. Trans R Soc Trop Med Hyg 2022; 117:326-335. [PMID: 36479897 DOI: 10.1093/trstmh/trac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/07/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
ABSTRACT
Background
We analysed the spatial and spatiotemporal patterns of visceral leishmaniasis (VL) mortality at the municipality level in an endemic state in the southern Amazon region of Brazil. Individual-level factors associated with death due to VL were also investigated.
Methods
All VL cases and deaths reported between 2007 and 2018 were included. The global and local bivariate Moran's index assessed the space–time autocorrelation of smoothed triennial VL mortality. Kulldorff's scan statistics investigated spatial and spatiotemporal clusters. A multivariable logistic regression explored sociodemographic, diagnostic and clinical variables associated with death due to VL.
Results
We observed an overall VL mortality and lethality of 0.14 cases/100 000 inhabitants and 11.2%, respectively. A total of 14% of the municipalities registered at least one VL-related death. In the southeastern mesoregion of the state, we detected high-risk spatial (relative risk [RR] 14.14; p<0.001) and spatiotemporal (RR 15.91; p<0.001) clusters for VL mortality. Bivariate Moran's analysis suggested a high space–time autocorrelation of VL mortality. Death by VL was associated with age ≥48 y (odds ratio [OR] 7.2 [95% confidence interval {CI} 3.4 to 15.3]), displacement for notification (OR 3.3 [95% CI 1.5 to 7.2]) and occurrence of oedema (OR 2.8 [95% CI 1.3 to 6.1]) and bleeding (OR 5.8 [95% CI 2.6 to 12.8]).
Conclusions
VL mortality has a heterogeneous spatiotemporal distribution. The death-related factors suggest late diagnosis as an underlying cause of mortality.
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Affiliation(s)
- Amanda G Carvalho
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
| | - André Luiz M Kuhn
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
| | - João Victor L Dias
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys , 1 Cruzeiro St. Teófilo Otoni, Minas Gerais, 39803-371, Brazil
| | - João Gabriel G Luz
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
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Ness TE, Martin-Blais R, Weatherhead JE. How I Approach Leishmaniasis: Diagnosis and Treatment in the United States. J Pediatric Infect Dis Soc 2022; 11:525-532. [PMID: 36043874 PMCID: PMC9720369 DOI: 10.1093/jpids/piac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
Leishmaniasis is a vector-borne disease caused by over 20 species of obligate intracellular protozoa belonging to the genus Leishmania. Leishmaniasis has a global distribution, including in the United States, and can cause a spectrum of clinical syndromes, including cutaneous, mucosal, and visceral diseases depending on host factors and the infecting Leishmania spp. Accurate diagnosis, including Leishmania species identification, is an important step to guide the most appropriate therapeutic intervention. Antileishmanial therapy is dependent on the Leishmania spp. identified, the clinical syndrome, and the child's immune system. However, many treatment regimens for children have been extrapolated from adult clinical trials, which may lead to underdosing and subsequent poor outcomes in infected children. Additional research is urgently needed to help guide therapy for children and determine appropriate antileishmanial agents, doses, and treatment courses for children with leishmaniasis.
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Affiliation(s)
- Tara E Ness
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Rachel Martin-Blais
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jill E Weatherhead
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Division of Pediatric Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
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7
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Foinquinos J, Duarte MDC, Figueiroa JN, Correia JB, Cavalcanti NV. Temporal Validation of a Predictive Score for Death in Children with Visceral Leishmaniasis. J Trop Med 2021; 2021:6688444. [PMID: 34976072 PMCID: PMC8716242 DOI: 10.1155/2021/6688444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To perform a temporal validation of a predictive model for death in children with visceral leishmaniasis (VL). METHODS A temporal validation of a children-exclusive predictive model of death due to VL (Sampaio et al. 2010 model), using a retrospective cohort, hereby called validation cohort. The validation cohort convenience sample was made of 156 patients less than 15 years old hospitalized between 2008 and 2018 with VL. Patients included in the Sampaio et al. 2010 study are here denominated derivation cohort, which was composed of 546 patients hospitalized in the same hospital setting in the period from 1996 to 2006. The calibration and discriminative capacity of the model to predict death by VL in the validation cohort were then assessed through the procedure of logistic recalibration that readjusted its coefficients. The calibration of the updated model was tested using Hosmer-Lemeshow test and Spiegelhalter test. A ROC curve was built and the value of the area under this curve represented the model's discrimination. RESULTS The validation cohort found a lethality of 6.4%. The Sampaio et al. 2010 model demonstrated inadequate calibration in the validation cohort (Spiegelhalter test: p=0.007). It also presented unsatisfactory discriminative capacity, evaluated by the area under the ROC curve = 0.618. After the coefficient readjustment, the model showed adequate calibration (Spiegelhalter test, p=0.988) and better discrimination, becoming satisfactory (AUROC = 0.762). The score developed by Sampaio et al. 2010 attributed 1 point to the variables dyspnea, associated infections, and neutrophil count <500/mm3; 2 points to jaundice and mucosal bleeding; and 3 points to platelet count <50,000/mm3. In the recalibrated model, each one of the variables had a scoring of 1 point for each. CONCLUSION The temporally validated model, after coefficient readjustment, presented adequate calibration and discrimination to predict death in children hospitalized with VL.
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Affiliation(s)
| | | | | | - Jailson B. Correia
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
- Universidade de Pernambuco, Recife, Brazil
- Faculdade Pernambucana de Saúde, Recife, Brazil
| | - Nara Vasconcelos Cavalcanti
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
- Universidade de Pernambuco, Recife, Brazil
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8
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Shi Q, Huang M, Li X, Zheng X, Wang F, Zou Y, Wang L, Jia J. Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection. PLoS Negl Trop Dis 2021; 15:e0009944. [PMID: 34735436 PMCID: PMC8594843 DOI: 10.1371/journal.pntd.0009944] [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: 07/06/2021] [Revised: 11/16/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Visceral leishmaniasis (VL) could progress to secondary hemophagocytic lymphohistiocytosis (HLH), which is a rare but life-threatening condition with poor prognosis. So far, the clinical and laboratory characteristics of VL associated HLH have not been well elucidated. Method and findings In this study, we retrospectively analyzed the clinical and laboratory profiles between 17 patients with VL associated HLH and 27 patients with VL alone admitted at the Beijing Friendship Hospital, Capital Medical University from May 2016 to March 2021. In addition to the identification of Leishmania infection, hemophagocytosis was identified in bone marrow in the most cases of VL associated HLH (15/17). The patients with VL associated HLH had higher chances of bleeding, hepatomegaly, thrombocytopenia, hypertriglyceridemia, hyperferritinemia, hypofibrinogenemia, elevated secretion of soluble IL-2 receptor or lower NK cell activity compared to patients with VL only. Furthermore, patients with VL associated HLH had higher inflammation status associated with higher levels of Th1 (TNF-α, IFN-γ, IL-1beta, IL-6, IL-8, IL-12p70), Th2 (IL-4) and Th17 cytokines (IL-17, IL-23) in the peripheral blood, and higher parasite load (qPCR and parasite culture). All 27 VL cases were totally recovered after being treated with Sodium Stibogluconate, five of the 17 patients with VL associated HLH died even after timely treatment with anti-parasite and immunosuppressive chemotherapy. Conclusion Without appropriate treatment, visceral leishmaniosis could develop to secondary HLH. The parasite culturing and qPCR detection of bone marrow samples facilitates the diagnosis of VL associated HLH in addition to other findings of HLH. Prompt treatment with anti-Leishmania and immunosuppressive chemotherapy is critical to reduce the mortality of VL associated HLH. Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening syndrome characterized by pro-inflammatory cytokine secretion, hyperinflammatory and multiple organ damages. Visceral leishmaniasis (VL) is a well-known cause of infection associated HLH and result in fatal consequence. However, it is not well characterized for the clinical and laboratory features of the visceral leishmaniasis associated HLH. In this study, we presented that, compared to the VL alone, patients with VL associated HLH had higher chances of bleeding, hepatomegaly, thrombocytopenia, hypertriglyceridemia, hyperferritinemia, hypofibrinogenemia, elevated secretion of soluble IL-2 receptor or lower NK cell activity. Moreover, patients with VL associated HLH also had higher levels of Th1, Th2 and Th17 cytokines in the sera and had higher parasite load in the bone marrow specimen. More cases with VL associated HLH had hepatosplenomegaly with iron overload in the magnetic resonance imaging. In the therapeutic strategy, besides the anti-Leishmania treatment, anti-inflammatory therapy to reduce cytokine storm and excessive immune responses facilitated the remission in the VL associated HLH cases.
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Affiliation(s)
- Qi Shi
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Minjun Huang
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Xiaoli Li
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Xiaoyan Zheng
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Fei Wang
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Yang Zou
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Lei Wang
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
- * E-mail:
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, P.R. China
- National Clinical Research Center of Digestive Diseases, Beijing, P.R. China
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9
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Chelbi I, Maghraoui K, Zhioua S, Cherni S, Labidi I, Satoskar A, Hamilton JGC, Zhioua E. Enhanced attraction of sand fly vectors of Leishmania infantum to dogs infected with zoonotic visceral leishmaniasis. PLoS Negl Trop Dis 2021; 15:e0009647. [PMID: 34314425 PMCID: PMC8345872 DOI: 10.1371/journal.pntd.0009647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 08/06/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The sand fly Phlebotomus perniciosus is the main vector of Leishmania infantum, etiological agent of zoonotic visceral leishmaniasis in the Western Mediterranean basin. Dogs are the main reservoir host of this disease. The main objective of this study was to determine, under both laboratory and field conditions, if dogs infected with L. infantum, were more attractive to female P. perniciosus than uninfected dogs. METHODOLOGY/PRINCIPAL FINDINGS We carried out a series of host choice experiments and found that infected dogs were significantly more attractive to P. perniciosus than uninfected dogs in the laboratory as well as in the field. Significantly more P. perniciosus fed on infected dogs than on uninfected dogs. However, the fecundity of P. perniciosus fed on infected dogs was adversely impacted compared to uninfected dogs by lowering the number of laid eggs. Phlebotomus perfiliewi, the second most abundant sand fly species in the field site and a competent vector of L. infantum had similar trends of attractivity as P. perniciosus toward infected dogs under field conditions. CONCLUSIONS The results strongly suggest that L. infantum causes physiological changes in the reservoir host which lead to the host becoming more attractive to both male and female P. perniciosus. These changes are likely to improve the chance of successful transmission because of increased contact with infected hosts and therefore, infected dogs should be particularly targeted in the control of zoonotic visceral leishmaniasis in North Africa.
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Affiliation(s)
- Ifhem Chelbi
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis, Tunisia
| | | | - Sami Zhioua
- Laboratory of Bio-informatic, Mathematics, Statistic, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Saifedine Cherni
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Imen Labidi
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Abhay Satoskar
- Departments of Pathology and Microbiology, Ohio State University, Columbus, Ohio, United States of America
| | - James G. C. Hamilton
- Division of Biomedical and Life Sciences, Lancaster University, Lancaster, United Kingdom
| | - Elyes Zhioua
- Unit of Vector Ecology, Institut Pasteur de Tunis, Tunis, Tunisia
- * E-mail:
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10
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Ben-Ahmed K. Childhood visceral leishmaniasis in Tunisia: A cross-sectional study in local spatial analysis. Acta Trop 2021; 214:105793. [PMID: 33310075 DOI: 10.1016/j.actatropica.2020.105793] [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: 08/19/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
This paper describes spatial distribution of Visceral Leishmaniasis (VL) and determines its correlation with climatic factors in an endemic focus in northern and central Tunisia. Data on VL cases in children under five years of age were obtained by consulting medical reports from all Tunisian Pediatric Departments (TPD) during 2006-2016. Three key climatic factors, namely precipitation, continentality index and pluviometric coefficient of Emberger were used as predictor variables to model the VL geographical distribution. Data handling and statistical analysis were performed using R and Arcview GIS software systems. Bayesian local spatial model was employed to analyse the data. The results show a progressive increase in the VL incidence rates in regions with high levels of precipitation, but with low values of both continentality index and pluviometric coefficient of Emberger. A likely explanation of these findings arises from the opposite local effects of climatic factors which tend to cancel each other out in the calculation of the mean parameter estimate over the whole study area. We conclude that using non-local spatial analysis approach leads to misleading epidemiological interpretations, which in turn are of relevance for more efficient and cost-effective resource allocation for control and well manage the spread of VL in the study region and elsewhere in Tunisia.
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Affiliation(s)
- Kais Ben-Ahmed
- Department of Finance, College of Business, University of Jeddah, Saudi Arabia; Higher Institute of Management, ISG, University of Sousse, Tunisia.
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Fares W, Dachraoui K, Barhoumi W, Cherni S, Chelbi I, Zhioua E. Co-circulation of Toscana virus and Leishmania infantum in a focus of zoonotic visceral leishmaniasis from Central Tunisia. Acta Trop 2020; 204:105342. [PMID: 31954137 DOI: 10.1016/j.actatropica.2020.105342] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
In the Mediterranean basin, sand flies are vectors of Leishmania parasites and phleboviruses affecting humans and animals. In this study, we aimed to investigate phlebovirus and Leishmania parasites circulating in a focus of zoonotic visceral leishmaniasis (ZVL) located in a highly irrigated area within the arid Central Tunisia, known mainly to be endemic for zoonotic cutaenous leishmaniasis (ZCL) caused Leishmania major and transmitted by Phlebotomus papatasi. Sand flies were collected using CDC light traps in the village of Saddaguia, an emergent focus of ZVL located in Central Tunisia during September-October 2014, 2015, and 2016. Pools of live female sand flies were screened for phleboviruses and Leishmania by nested PCR in the polymerase gene and kinetoplast minicircle DNA, respectively. Dead sand flies were identified morphologically to species level. Sand flies of the subgenus Larroussius mainly Phlebotomus perfiliewi, Phlebotomus perniciosus, and Phlebotomus longicuspis were predominant in this ZVL focus compared to P. papatasi. A total of 1932, 1740, and 444 sand flies were tested in 2014, 2015 and 2016, respectively. Pathogen screening performed on 4116 sand flies distributed in 148 pools revealed the presence of Leishmania infantum and Toscana virus. The minimum infection rates of sand flies with TOSV in 2014, 2015, and 2016 were 0.05%, 011%, and 0.22%, respectively. The minimum infection rates of sand flies with L. infantum in 2014, 2015, and 2016 were 0.25%, 012%, and 0.79%, respectively. No L. major was detected during the 3-years investigation in this ZVL focus. Our results showed clearly the endemic co-circulation of TOSV and L. infantum in this emergent ZVL focus. However, no co-infection of TOSV and L. infantum was detected in any of the sand fly pools investigated during the three years period. TOSV was isolated from positive pools in 2015. Phylogenetic analysis showed that the Tunisian strains of TOSV belonged to the sublineage A. Based on the present findings, our results provided strong evidence that TOSV and L. infantum are transmitted by the same predominant sand fly species of the subgenus Larroussius, and subsequently, humans and dogs could be co-infected through co-infected or successive infected bites. Our results showed clearly that the development of irrigation in arid areas contributed significantly to the establishment of stable transmission cycles of L. infantum and TOSV and subsequently to the emergence of a ZVL focus within this arid bio-geographical area characterized by the presence of multiple foci of ZCL located outside the study site. Thus, more studies are needed to better understand the impact of RNA viruses shared by vectors and reservoir hosts of L. infantum on the development of zoonotic visceral leishmaniasis.
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Abstract
Visceral leishmaniasis, a fatal disease if not treated, is caused by Leishmania parasites. This disease might be overlooked in the Middle East because of limited awareness and low incidence. We report 5 patients who died of visceral leishmaniasis in Lebanon and make recommendations to improve faster diagnosis and treatment.
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