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Maia C, Conceição C, Pereira A, Rocha R, Ortuño M, Muñoz C, Jumakanova Z, Pérez-Cutillas P, Özbel Y, Töz S, Baneth G, Monge-Maillo B, Gasimov E, Van der Stede Y, Torres G, Gossner CM, Berriatua E. The estimated distribution of autochthonous leishmaniasis by Leishmania infantum in Europe in 2005-2020. PLoS Negl Trop Dis 2023; 17:e0011497. [PMID: 37467280 PMCID: PMC10389729 DOI: 10.1371/journal.pntd.0011497] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/31/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND This study describes the spatial and temporal distribution between 2005 and 2020 of human and animal leishmaniasis by Leishmania infantum in European countries reporting autochthonous cases, and highlights potential activities to improve disease control. METHODOLOGY/PRINCIPAL FINDINGS It was based on a review of the scientific literature and data reported by the World Health Organization (WHO), the World Organization for Animal Health (WOAH) and the Ministries of Health, including hospital discharges in some countries. Autochthonous infections were reported in the scientific literature from 22 countries, including 13 and 21 countries reporting human and animal infections, respectively. In contrast, only 17 countries reported autochthonous human leishmaniasis cases to the WHO and 8 countries animal infections to the WOAH. The number of WOAH reported cases were 4,203, comprising 4,183 canine cases and 20 cases in wildlife. Of 8,367 WHO reported human cases, 69% were visceral leishmaniasis cases-of which 94% were autochthonous-and 31% cutaneous leishmaniasis cases-of which 53% were imported and mostly in France. The resulting cumulative incidence per 100,000 population of visceral leishmaniasis between 2005-2020, was highest in Albania (2.15 cases), followed by Montenegro, Malta, Greece, Spain and North Macedonia (0.53-0.42), Italy (0.16), Portugal (0.09) and lower in other endemic countries (0.07-0.002). However, according to hospital discharges, the estimated human leishmaniasis incidence was 0.70 in Italy and visceral leishmaniasis incidences were 0.67 in Spain and 0.41 in Portugal. CONCLUSIONS/SIGNIFICANCE Overall, there was no evidence of widespread increased incidence of autochthonous human leishmaniasis by L. infantum in European countries. Visceral leishmaniasis incidence followed a decreasing trend in Albania, Italy and Portugal, and peaked in Greece in 2013, 2014 and 2017, and in Spain in 2006-2007 and 2011-2013. Animal and human cutaneous leishmaniasis remain highly underreported. In humans, hospital discharge databases provide the most accurate information on visceral leishmaniasis and may be a valuable indirect source of information to identify hotspots of animal leishmaniasis. Integrated leishmaniasis surveillance and reporting following the One Health approach, needs to be enhanced in order to improve disease control.
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Affiliation(s)
- Carla Maia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Cláudia Conceição
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - André Pereira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rafael Rocha
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria Ortuño
- Departamento de Sanidad Animal, Facultad de Veterinaria, Regional Campus of International Excellence “Campus Mare Nostrum”, Universidad de Murcia, Murcia, Spain
| | - Clara Muñoz
- Departamento de Sanidad Animal, Facultad de Veterinaria, Regional Campus of International Excellence “Campus Mare Nostrum”, Universidad de Murcia, Murcia, Spain
- SaBio, Institute for Game and Wildlife Research, IREC (CSIC-UCLM-JCCM), Ciudad Real, Spain
| | - Zarima Jumakanova
- Departamento de Sanidad Animal, Facultad de Veterinaria, Regional Campus of International Excellence “Campus Mare Nostrum”, Universidad de Murcia, Murcia, Spain
| | | | - Yusuf Özbel
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Seray Töz
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gad Baneth
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Begoña Monge-Maillo
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Elkhan Gasimov
- Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Yves Van der Stede
- Biological Hazards, Animal Health and Welfare (BIOHAW) Unit, European Food Safety Authority, Parma, Italy
| | - Gregorio Torres
- Science Department, World Organisation for Animal Health (WOAH), Paris, France
| | - Céline M. Gossner
- Disease Programme Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Eduardo Berriatua
- Departamento de Sanidad Animal, Facultad de Veterinaria, Regional Campus of International Excellence “Campus Mare Nostrum”, Universidad de Murcia, Murcia, Spain
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Kumar A, Pandey SC, Samant M. A spotlight on the diagnostic methods of a fatal disease Visceral Leishmaniasis. Parasite Immunol 2020; 42:e12727. [PMID: 32378226 DOI: 10.1111/pim.12727] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/26/2023]
Abstract
Leishmania donovani (a causative agent of visceral leishmaniasis) poses a serious health threat to the human population which is fatal if left untreated. The life cycle of Leishmania alternates between vertebrate host and Phlebotomine fly as intermediate ones. Due to the difficulties linked to vector (sandfly) control and the lack of an effective vaccine, the control of leishmaniasis relies mostly on chemotherapy. Unfortunately, the prevalence of parasites becoming resistant to the first-line drug pentavalent antimonial (SbV )/sodium antimony gluconate (SAG) and some other anti-leishmanial drug is increasing in several parts of the world. With the alarming rise of drug resistance and other issues related to VL, there is an urgent need to focus on early detection and quick diagnosis of VL case. Therefore, we have reviewed most of the methods used in the diagnostic process of VL. Along with existing diagnostic methods, developing more effective and sensitive diagnostic methods and biomarkers is also vital for enhancing VL identification and control programs. This review gathers the comprehensive information on diagnostics methods of VL under a single umbrella that could be the prominent tools for the development of rapid, accurate and cost-effective diagnostic kits for VL which can be used in field conditions.
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Affiliation(s)
- Awanish Kumar
- Department of Biotechnology, National Institute of Technology, Raipur, India
| | - Satish Chandra Pandey
- Cell and Molecular Biology Laboratory, Department of Zoology, Kumaun University, Almora, India.,Department of Biotechnology, Kumaun University, Nainital, India
| | - Mukesh Samant
- Cell and Molecular Biology Laboratory, Department of Zoology, Kumaun University, Almora, India
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Toepp AJ, Monteiro GRG, Coutinho JFV, Lima AL, Larson M, Wilson G, Grinnage-Pulley T, Bennett C, Mahachi K, Anderson B, Ozanne MV, Anderson M, Fowler H, Parrish M, Willardson K, Saucier J, Tyrell P, Palmer Z, Buch J, Chandrashekar R, Brown GD, Oleson JJ, Jeronimo SMB, Petersen CA. Comorbid infections induce progression of visceral leishmaniasis. Parasit Vectors 2019; 12:54. [PMID: 30674329 PMCID: PMC6345068 DOI: 10.1186/s13071-019-3312-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a vector borne zoonotic disease endemic in humans and dogs in Brazil. Due to the increased risk of human infection secondary to the presence of infected dogs, public health measures in Brazil mandate testing and culling of infected dogs. Despite this important relationship between human and canine infection, little is known about what makes the dog reservoir progress to clinical illness, significantly tied to infectiousness to sand flies. Dogs in endemic areas of Brazil are exposed to many tick-borne pathogens, which are likely to alter the immune environment and thus control of L. infantum. RESULTS A cross-sectional study of 223 dogs from an area of Natal, in the Rio Grande do Norte, Brazil, were studied to determine the association between comorbid tick-borne disease and Leishmania infection in this endemic area. The risk of Leishmania seropositivity was 1.68× greater in dogs with tick-borne disease seropositivity compared to those without (Adjusted RR: 1.68, 95% CI: 1.09-2.61, P = 0.019). A longitudinal study of 214 hunting dogs in the USA was conducted to determine the causal relationship between infection with tick-borne diseases and progression of VL. Hunting dogs were evaluated three times across a full tick season to detect incident infection with tick-borne diseases. A logistic regression model with generalized estimating equations to estimate the parameters was used to determine how exposure to tick-borne disease altered VL progression over these three time points when controlling for other variables. Dogs infected with three or more tick-borne diseases were 11× more likely to be associated with progression to clinical VL than dogs with no tick-borne disease (Adjusted RR: 11.64, 95% CI: 1.22-110.99, P = 0.03). Dogs with exposure to both Leishmania spp. and tick-borne diseases were five times more likely to die during the study period (RR: 4.85, 95% CI: 1.65-14.24, P = 0.0051). CONCLUSIONS Comorbid tick-borne diseases dramatically increased the likelihood that a dog had clinical L. infantum infection, making them more likely to transmit infection to sand flies and people. As an important consequence, reduction of tick-borne disease exposure through topical or oral insecticides may be an important way to reduce progression and transmissibility of Leishmania infection from the canine reservoir to people.
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Affiliation(s)
- Angela J. Toepp
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Glória R. G. Monteiro
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, RN 59078-970 Brazil
| | - José F. V. Coutinho
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, RN 59078-970 Brazil
| | - Adam Leal Lima
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Mandy Larson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Geneva Wilson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Tara Grinnage-Pulley
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Carolyne Bennett
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Kurayi Mahachi
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Bryan Anderson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Marie V. Ozanne
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
| | - Michael Anderson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Hailie Fowler
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Immunology Program, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242 USA
| | - Molly Parrish
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Kelsey Willardson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
| | - Jill Saucier
- IDEXX Laboratories Inc., One IDEXX Drive, Westbrook, Maine 04092 USA
| | - Phyllis Tyrell
- IDEXX Laboratories Inc., One IDEXX Drive, Westbrook, Maine 04092 USA
| | - Zachary Palmer
- Department of Geographical and Sustainability Sciences, College of Liberal Arts & Sciences, University of Iowa, Iowa City, Iowa 52242 USA
| | - Jesse Buch
- IDEXX Laboratories Inc., One IDEXX Drive, Westbrook, Maine 04092 USA
| | | | - Grant D. Brown
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
| | - Jacob J. Oleson
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
| | - Selma M. B. Jeronimo
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, RN 59078-970 Brazil
| | - Christine A. Petersen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242 USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa 52241 USA
- Immunology Program, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242 USA
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Semi-quantitative measurement of asymptomatic L. infantum infection and symptomatic visceral leishmaniasis in dogs using Dual-Path Platform® CVL. Appl Microbiol Biotechnol 2016; 101:381-390. [PMID: 27796441 DOI: 10.1007/s00253-016-7925-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/24/2016] [Accepted: 10/04/2016] [Indexed: 12/21/2022]
Abstract
Infection with Leishmania causes diseases with variable presentation. The most severe form is visceral leishmaniasis (VL), caused by either L. donovani or L. infantum. Despite efforts to eliminate VL, to date, molecular detection in resource-poor settings have lacked the accuracy and rapidity that would enable widespread field use and the need for accurate, sensitive assays to detect asymptomatic Leishmania infection has become apparent. The domestic dog serves as the primary reservoir host of L. infantum. Study of this reservoir population provides an opportunity to evaluate the sensitivity and specificity of diagnostics for well-defined, symptomatic, canine visceral leishmaniasis (CVL) and asymptomatic L. infantum infection. Blood samples from an L. infantum-endemic population of US hunting dogs were evaluated with Dual-Path Platform (DPP®) CVL compared to those obtained via direct detection methods (culture- and Leishmania-specific quantitative polymerase chain reaction, qPCR) and immunofluorescence anti-Leishmania antibody test (IFAT). Statistically significant correlations were found between DPP® CVL development time and clinical status, culture status, circulating DNA levels, and IFAT titer. DPP® CVL results correlated with both clinical severity of disease and serological evidence of asymptomatic L. infantum infection. By precisely documenting the minimum time required for the development of a clear positive result in DPP® CVL, this test could be used in a rapid, semi-quantitative manner for the evaluation of asymptomatic and symptomatic CVL. Our results also indicate that a similar test could be used to improve our understanding of human VL.
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Banu SS, Ahmed BN, Shamsuzzaman AKM, Lee R. Evaluation of recombinant K39 antigen and various promastigote antigens in sero-diagnosis of visceral leishmaniasis in Bangladesh. Parasite Epidemiol Control 2016; 1:219-228. [PMID: 29988192 PMCID: PMC5991841 DOI: 10.1016/j.parepi.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 01/30/2023] Open
Abstract
Background Definitive diagnosis of visceral leishmaniasis (VL) by demonstrating parasites in tissue smears or by culture involves invasive procedures, technical expertise and adequate laboratory facilities. Endemic countries rely mainly on serological tests to diagnose VL. Currently, the immunochromatographic test incorporating the recombinant K39 antigen (rK39 ICT) is the reference test for rapid diagnosis of VL in the Indian subcontinent. The performance of serological tests using rK39 and other promastigote antigens can vary due to differences in antigen expression, the various hosts and environmental factors. To achieve elimination of VL, diagnostic accuracy will be necessary for active case detection especially in those who carry asymptomatic infections. We evaluated the performance of rK39 ICT, enzyme linked immunosorbent assay using mixed Leishmania promastigotes from different Leishmania species (p-ELISA) and indirect fluorescent antibody test (IFAT) utilizing whole promastigotes from the Leishmania donovani complex for sero-diagnosis of VL in Bangladesh. Methods The sensitivity of each serological test was evaluated on 155 patients who were diagnosed to have VL by microscopy and/or by culture methods. Test specificities were calculated on 706 healthy blood donors, 91 diagnostic sera from patients with a febrile illness and sera from patients positive for malaria (n = 91) and Chagas disease (n = 91). All statistical calculations were at 95% confidence intervals. Results The sensitivities of rK39 ICT, p-ELISA and IFAT were 100%, 86.5% and 92.3%, respectively. All three serological methods had a pooled sensitivity of 82.6%. The specificities of rK39 ICT, p-ELISA and IFAT from combined control groups were 100%, 93.1% and 99.9%, respectively. The respective positive and negative predictive values of the tests were both 100% for rK39 ICT, 66.3% and 97.8% for p-ELISA and 99.3% and 98.8% for IFAT. The p-ELISA showed cross reactivity with 36.3% of sera positive for malaria and 28.6% of sera positive for Chagas disease while rK39 ICT and IFAT showed no cross reactivity. Conclusion This study confirms the efficiency of rK39 ICT for rapid diagnosis of VL. The p-ELISA using mixed promastigote antigens did not perform well as a serological test for VL in Bangladesh. Due to high sensitivity and specificity of whole promastigote antigen of L. donovani complex utilized in IFAT, this test can be considered in combination with rK39 ICT to confirm VL diagnosis when clinical diagnosis cannot distinguish between other diseases.
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Affiliation(s)
- Sultana Shahana Banu
- Parasitology Department, Centre for Infectious Diseases and Microbiology (CIDM), ICPMR, Westmead Hospital, Westmead, NSW, Australia.,Discipline of Medicine, Sydney Medical School, University of Sydney, NSW, Australia.,Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MOHFW), Dhaka, Bangladesh
| | - Be-Nazir Ahmed
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MOHFW), Dhaka, Bangladesh
| | | | - Rogan Lee
- Parasitology Department, Centre for Infectious Diseases and Microbiology (CIDM), ICPMR, Westmead Hospital, Westmead, NSW, Australia.,Discipline of Medicine, Sydney Medical School, University of Sydney, NSW, Australia
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Developments in Diagnosis of Visceral Leishmaniasis in the Elimination Era. J Parasitol Res 2015; 2015:239469. [PMID: 26843964 PMCID: PMC4710934 DOI: 10.1155/2015/239469] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/06/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022] Open
Abstract
Visceral leishmaniasis (VL) is the most devastating parasitic infection worldwide causing high morbidity and mortality. Clinical presentation of VL ranges from asymptomatic or subclinical infection to severe and complicated symptomatic disease. A major challenge in the clinical management of VL is the weakness of health systems in disease endemic regions. People affected by VL mostly present to primary health care centers (PHCs), often late in their therapeutic itinerary. PHC physicians face a major challenge: they do not deal with a single disease issue but with patients presenting with complaints pointing to several diagnostic possibilities. Risk exists when some patients having less clinical manifestations are misdiagnosed. Therefore, field based accurate, sensitive, and cost effective rapid diagnostic tools that can detect disease in its mildest form are essential for effective control and reaching the goal of VL elimination. In this review, we discuss the current status and challenges of various diagnostic tools for the diagnosis of VL and assess their application in resource poor settings.
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Monge-Maillo B, Norman FF, Cruz I, Alvar J, López-Vélez R. Visceral leishmaniasis and HIV coinfection in the Mediterranean region. PLoS Negl Trop Dis 2014; 8:e3021. [PMID: 25144380 PMCID: PMC4140663 DOI: 10.1371/journal.pntd.0003021] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Visceral leishmaniasis is hypoendemic in Mediterranean countries, where it is caused by the flagellate protozoan Leishmania infantum. VL cases in this area account for 5%–6% of the global burden. Cases of Leishmania/HIV coinfection have been reported in the Mediterranean region, mainly in France, Italy, Portugal, and Spain. Since highly active antiretroviral therapy was introduced in 1997, a marked decrease in the number of coinfected cases in this region has been reported. The development of new diagnostic methods to accurately identify level of parasitemia and the risk of relapse is one of the main challenges in improving the treatment of coinfected patients. Clinical trials in the Mediterranean region are needed to determine the most adequate therapeutic options for Leishmania/HIV patients as well as the indications and regimes for secondary prophylaxis. This article reviews the epidemiological, diagnostic, clinical, and therapeutic aspects of Leishmania/HIV coinfection in the Mediterranean region.
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Affiliation(s)
- Begoña Monge-Maillo
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Francesca F. Norman
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Israel Cruz
- WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Jorge Alvar
- Visceral Leishmaniasis Program, Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Rogelio López-Vélez
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
- * E-mail:
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Boelaert M, Verdonck K, Menten J, Sunyoto T, van Griensven J, Chappuis F, Rijal S. Rapid tests for the diagnosis of visceral leishmaniasis in patients with suspected disease. Cochrane Database Syst Rev 2014; 2014:CD009135. [PMID: 24947503 PMCID: PMC4468926 DOI: 10.1002/14651858.cd009135.pub2] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The diagnosis of visceral leishmaniasis (VL) in patients with fever and a large spleen relies on showing Leishmania parasites in tissue samples and on serological tests. Parasitological techniques are invasive, require sophisticated laboratories, consume time, or lack accuracy. Recently, rapid diagnostic tests that are easy to perform have become available. OBJECTIVES To determine the diagnostic accuracy of rapid tests for diagnosing VL in patients with suspected disease presenting at health services in endemic areas. SEARCH METHODS We searched MEDLINE, EMBASE, LILACS, CIDG SR, CENTRAL, SCI-expanded, Medion, Arif, CCT, and the WHO trials register on 3 December 2013, without applying language or date limits. SELECTION CRITERIA This review includes original, phase III, diagnostic accuracy studies of rapid tests in patients clinically suspected to have VL. As reference standards, we accepted: (1) direct smear or culture of spleen aspirate; (2) composite reference standard based on one or more of the following: parasitology, serology, or response to treatment; and (3) latent class analysis. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed quality of included studies using the QUADAS-2 tool. Discrepancies were resolved by a third author. We carried out a meta-analysis to estimate sensitivity and specificity of rapid tests, using a bivariate normal model with a complementary log-log link function. We analysed each index test separately. As possible sources of heterogeneity, we explored: geographical area, commercial brand of index test, type of reference standard, disease prevalence, study size, and risk of bias (QUADAS-2). We also undertook a sensitivity analysis to assess the influence of imperfect reference standards. MAIN RESULTS Twenty-four studies containing information about five index tests (rK39 immunochromatographic test (ICT), KAtex latex agglutination test in urine, FAST agglutination test, rK26 ICT, and rKE16 ICT) recruiting 4271 participants (2605 with VL) were included. We carried out a meta-analysis for the rK39 ICT (including 18 studies; 3622 participants) and the latex agglutination test (six studies; 1374 participants). The results showed considerable heterogeneity. For the rK39 ICT, the overall sensitivity was 91.9% (95% confidence interval (95% CI) 84.8 to 96.5) and the specificity 92.4% (95% CI 85.6 to 96.8). The sensitivity was lower in East Africa (85.3%; 95% CI 74.5 to 93.2) than in the Indian subcontinent (97.0%; 95% CI 90.0 to 99.5). For the latex agglutination test, overall sensitivity was 63.6% (95% CI 40.9 to 85.6) and specificity 92.9% (95% CI 76.7 to 99.2). AUTHORS' CONCLUSIONS The rK39 ICT shows high sensitivity and specificity for the diagnosis of visceral leishmaniasis in patients with febrile splenomegaly and no previous history of the disease, but the sensitivity is notably lower in east Africa than in the Indian subcontinent. Other rapid tests lack accuracy, validation, or both.
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Affiliation(s)
| | | | | | | | | | - Francois Chappuis
- Geneva University HospitalsDivision of International and Humanitarian MedicineRue Gabrielle‐Perret‐Gentil, 61211GenevaSwitzerland14
| | - Suman Rijal
- BP Koirala Institute of Health SciencesDepartment of Internal MedicineGhopaDharanSunsariNepal056700
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Mondal S, Bhattacharya P, Ali N. Current diagnosis and treatment of visceral leishmaniasis. Expert Rev Anti Infect Ther 2010; 8:919-44. [PMID: 20695748 DOI: 10.1586/eri.10.78] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Human visceral leishmaniasis (VL), a potentially fatal disease, is most prevalent in the Indian subcontinent, East Africa and South America. Definite diagnosis and effective treatment are the primary needs for the control of VL. Diagnosis of VL has typically relied on microscopic examination of bone marrow/splenic aspirate, but serology and molecular methods are now better alternatives. The conventional drugs for treatment of VL have limitations including unresponsiveness, relapse, specific toxicities and parenteral administration lasting for long durations. Moreover, they are less effective in HIV-VL-coinfected patients. Registration of miltefosine and paromomycin, and preferential pricing of AmBisome has offered more choices for monotherapy and combination therapy for VL. Combination therapy will increase treatment efficacy and prevent the development of resistance. In addition, active case finding and vector control strategies will also have a positive impact in the control of VL. This article critically addresses the currently available diagnostic and treatment regimens for the control of VL.
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Affiliation(s)
- Smriti Mondal
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, Kolkata, India
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