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Amahmid O, El Guamri Y, Zenjari K, Bouhout S, Ait Moh M, Boraam F, Ait Melloul A, Benfaida H, Bouhoum K, Belghyti D. Epidemiological features of cutaneous leishmaniasis in diagnosed patients from an endemic area (central Morocco). J Parasit Dis 2021; 45:762-768. [PMID: 34475658 DOI: 10.1007/s12639-021-01357-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/27/2021] [Indexed: 11/28/2022] Open
Abstract
Cutaneous leishmaniasis represents the most neglected tropical disease across the world. In Morocco, this disease is endemic and constitutes a major public health problem, with a national control program been implemented. The current study aimed to determine the pattern and epidemiological features of cutaneous leishmaniasis in affected patients in an area covered by the CL control and prevention program (Central Morocco). A total of 161 patients suspected for cutaneous leishmaniasis were diagnosed according to WHO laboratory methods, and 82 cases were confirmed positive for CL. The reports were analysed by patients' socio-geographic status, gender and age. The number and distribution of CL lesions by location, gender and age were investigated. Overall the confirmed cases, 89 % were infected by Leishmania tropica versus 21 % for Leishmania major. Females were significantly more affected than males (p < 0.01). Children (0-15 years), especially those ≤ 7 years of age, were the most affected. For the distribution of lesions, single lesion cases were largely preponderant (70.7 %) compared to multiple lesions. Face location was significantly more frequent (62.2 %) compared to limbs (26.8 %). Face lesions were found more prevalent in children than in adults while limb lesions were highly observed in adults. The pattern of the disease is affected by many factors (e.g. environment, gender, age, etc.) and has specifics to be considered in prevention and control programs in endemic areas.
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Affiliation(s)
- Omar Amahmid
- Biology Unit, Department of Life and Earth Sciences, Regional Centre for Careers of Education and Training, CRMEF-Marrakech-Safi, Avenue Mozdalifa, P.O. Box 797, 40090 Marrakesh, Morocco.,Laboratory of Water, Biodiversity and Climate Change, Parasitology and Aquatic Biodiversity, Department of Biology, Faculty of Sciences-Semlalia, University Cadi Ayyad, Marrakesh, Morocco.,Laboratory of Natural Resources and Sustainable Development, Department of Biology, Faculty of Sciences Kenitra, Ibn Tofaïl University, Kenitra, Morocco
| | - Youssef El Guamri
- Biology Unit, Department of Life and Earth Sciences, Regional Centre for Careers of Education and Training, CRMEF-Marrakech-Safi, Avenue Mozdalifa, P.O. Box 797, 40090 Marrakesh, Morocco.,Laboratory of Natural Resources and Sustainable Development, Department of Biology, Faculty of Sciences Kenitra, Ibn Tofaïl University, Kenitra, Morocco
| | - Khalid Zenjari
- Regional Direction of Health Marrakesh-Safi, Marrakesh, Morocco
| | - Souad Bouhout
- Service of Parasitic Diseases, Direction of Epidemiology and Diseases Control (DELM), Rabat, Morocco
| | - Mohamed Ait Moh
- Regional Direction of Health Marrakesh-Safi, Marrakesh, Morocco
| | - Fatima Boraam
- Regional Direction of Health Marrakesh-Safi, Marrakesh, Morocco
| | - Abdelaziz Ait Melloul
- Regional Laboratory of Epidemiological Diagnostic and Environmental Hygiene (LRDEHM), Marrakesh-Safi, Morocco
| | - Hilal Benfaida
- Regional Laboratory of Epidemiological Diagnostic and Environmental Hygiene (LRDEHM), Marrakesh-Safi, Morocco
| | - Khadija Bouhoum
- Laboratory of Water, Biodiversity and Climate Change, Parasitology and Aquatic Biodiversity, Department of Biology, Faculty of Sciences-Semlalia, University Cadi Ayyad, Marrakesh, Morocco
| | - Driss Belghyti
- Laboratory of Natural Resources and Sustainable Development, Department of Biology, Faculty of Sciences Kenitra, Ibn Tofaïl University, Kenitra, Morocco
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Karunaweera ND, Ginige S, Senanayake S, Silva H, Manamperi N, Samaranayake N, Siriwardana Y, Gamage D, Senerath U, Zhou G. Spatial Epidemiologic Trends and Hotspots of Leishmaniasis, Sri Lanka, 2001-2018. Emerg Infect Dis 2021; 26:1-10. [PMID: 31855147 PMCID: PMC6924882 DOI: 10.3201/eid2601.190971] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Leishmaniasis, a neglected tropical disease, is on the decline in South Asia. However, cases of cutaneous leishmaniasis have risen in Sri Lanka since 2001, and the lack of in-depth research on its epidemiologic characteristics hampers control efforts. We analyzed data collected from patients with cutaneous leishmaniasis in Sri Lanka during 2001-2018 to study temporal and geographic trends and identify and monitor disease hotspots. We noted a progression in case rates, including a sharp rise in 2018, showing temporal expansion of disease-prevalent areas and 2 persistent hotspots. The northern hotspot shifted and shrank over time, but the southern hotspot progressively expanded and remained spatially static. In addition, we noted regional incidence differences for age and sex. We provide evidence of temporally progressive and spatially expanding incidence of leishmaniasis in Sri Lanka with distinct geographic patterns and disease hotspots, signaling an urgent need for effective disease control interventions.
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Tharakan SJ, Peter Cv D, Karthik R, Rupa V, Rose W, Thomas M, Manuel M, Rupali P, Pulimood S, Rao Ajjampur SS. Case Report: A Single-Center Case Series on Skin Manifestations of Leishmaniasis from a Non-Endemic State in Southern India. Am J Trop Med Hyg 2020; 104:928-933. [PMID: 33377447 DOI: 10.4269/ajtmh.20-0938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/21/2020] [Indexed: 11/07/2022] Open
Abstract
Leishmaniasis is endemic in the Indian subcontinent with predominance of visceral leishmaniasis (VL) due to Leishmania donovani. Cutaneous leishmaniasis (CL) is uncommon, and mucocutaneous leishmaniasis (MCL) is rarely reported in this region. Recent reports reveal a changing epidemiology and atypical manifestations. A retrospective study of 52 suspected cases with cutaneous and mucosal involvement seen from January 2008 to December 2018 in a tertiary care setting in a non-endemic state in southern India is reported. Twelve patients were confirmed to have leishmaniasis; seven had MCL, two had CL, and three had post-kala-azar dermal leishmaniasis (PKDL). All cases were male, with a median age of 41.5 years (interquartile range, 30-55.5 years), and the median duration of the disease was 6 years (interquartile range, 1-9.5 years). Patients with MCL had mucosal involvement including destructive ulcero-proliferative lesions due to delayed diagnosis; none had a history of travel to countries endemic for MCL and all were attributable to L. donovani species. On the other hand, Leishmania major which was the causative species in both CL patients was associated with travel to the Middle East. Patients with PKDL presented with multiple plaques and hypopigmented patches; one had concomitant VLand all were from endemic areas. Hitherto uncommon MCL, caused by potentially atypical variants of L. donovani, has emerged as a new manifestation of leishmaniasis in this region. A high index of suspicion based on lesions seen and history of travel combined with PCR-based diagnostics are required to confirm diagnosis for the various skin manifestations of leishmaniasis.
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Affiliation(s)
| | - Dincy Peter Cv
- Departments of Dermatology Unit-II, Christian Medical College, Vellore, India
| | - Rajiv Karthik
- Infectious Diseases, Christian Medical College, Vellore, India
| | - Vedantam Rupa
- ENT Unit-III, Christian Medical College, Vellore, India
| | - Winsley Rose
- Child Health Unit-III, Christian Medical College, Vellore, India
| | - Meera Thomas
- Pathology, Christian Medical College, Vellore, India
| | - Malathi Manuel
- The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | | | - Susanne Pulimood
- Departments of Dermatology Unit-II, Christian Medical College, Vellore, India
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A Comprehensive Review of Cutaneous Leishmaniasis in Sri Lanka and Identification of Existing Knowledge Gaps. Acta Parasitol 2020; 65:300-309. [PMID: 32052240 PMCID: PMC7223001 DOI: 10.2478/s11686-020-00174-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
Purpose Sri Lanka is endemic to cutaneous leishmaniasis and reported as the latest focus of leishmaniasis in the Asian subcontinent. Annually, the number of leishmaniasis cases is increasing; therefore, more efficient diagnostic tools, treatment methods and effective prevention measures are indispensable. For this reason, many studies were conducted regarding leishmaniasis infections in Sri Lanka; however, some areas need more attention. Thus, in this review, we comprehensively discussed the studies on leishmaniasis carried out in Sri Lanka. Methods Published articles on leishmaniasis in Sri Lanka were searched on PubMed, Google Scholar and ResearchGate databases. Inclusion criteria for the articles were based on keyword searches including ‘Leishmaniasis in Sri Lanka’, ‘Leishmaniasis vector in Sri Lanka’, ‘Sandfly species in Sri Lanka’, ‘Leishmaniasis epidemiology in Sri Lanka’ which are publicly accessible as of 15th July 2019. Results In this study, we evaluated and summarized the leishmaniasis reports in Sri Lanka and mainly focused on clinical presentation of leishmaniasis infection, genetic characteristics of Leishmania donovani Sri Lankan strain, geographical distribution and associated environmental factors, immunological aspects of the infection, vector, reservoir host, risk factors, diagnosis and treatment, and prevention and control. Furthermore, we identified the areas where further research is needed to fill the essential knowledge gaps. Conclusions Leishmaniasis has become a critically important parasitic infection in Sri Lanka, whereas the significant clinical form is cutaneous leishmaniasis. Prevalence of the leishmaniasis infections is reported from all the districts of the country. Therefore, more studies are essential to be carried out to fill the existing knowledge gaps emphasized in this review.
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Gunathilaka N, Semege S, Pathirana N, Manamperi N, Udayanga L, Wijesinghe H, Premaratne P, Fernando D. Prevalence of cutaneous leishmaniasis infection and clinico-epidemiological patterns among military personnel in Mullaitivu and Kilinochchi districts of the Northern Province, early war-torn areas in Sri Lanka. Parasit Vectors 2020; 13:263. [PMID: 32430014 PMCID: PMC7236442 DOI: 10.1186/s13071-020-04137-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The 30-year-old armed conflict in Sri Lanka resulted in a general breakdown of civil administration in the Northern and Eastern provinces, leading to mobilisation of many armed forces personnel to assist with reconstruction and resettlement. This occupational group has been identified as a priority risk group for leishmaniasis. METHODS Individuals enlisted at all military establishments in Mullaitivu and Kilinochchi districts, Northern Province of Sri Lanka were included. Five thousand individuals were screened for skin lesions between September 2018 and August 2019. Persons with lesions suspected as cutaneous leishmaniasis (CL) were further investigated. Information on sociodemographic/other potential risk factors was obtained through an interviewer-administered structured questionnaire. The diagnosis was confirmed by microscopic visualization of parasitic stages from different samples obtained (skin scraping, lesion aspirate and tissue impression smears), histopathology and polymerase chain reaction DNA amplification. RESULTS Among 5000 individuals screened, 74 individuals were suspected of having CL. Of these, 67.6% (n = 50) patients were confirmed for CL by microscopy. Around two third of both males (67.6%; n = 48) and females (66.6%; n = 2) were positive for Leishmania. The soldiers belonging to 26-35-year age group reported the highest susceptibility (83.3%; OR: 4.83, 95% CI: 3.49-6.20%). Of the sociodemographic factors, age, wearing short-sleeved upper body clothing as the uniform and non-use of insect repellents were identified as significant risk factors. Most of the CL patients had a single lesion (86.0%; n = 43) of an ulcerative type (34.0%; n = 17), mostly on their upper limb (67.9%; n = 34). Lesions were mostly 5-10 mm diameter (59.9%; n = 30) in size with poorly defined margins (72.0%; n = 36). Amongst the diagnostic techniques, microscopic examination of slit skin smear and tissue impression smear were able to discriminate the majority of patients (92.1%; n = 46) for CL. CONCLUSIONS In order to highlight the true burden of leishmaniasis in the military personnel, cases of leishmaniasis from military institutes should be recognized as a different entity per say and be included in the national figures so as to depict the real magnitude of the disease burden amongst this high-risk group.
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Affiliation(s)
- Nayana Gunathilaka
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Saveen Semege
- Directorate of Army Preventive Medicine & Mental Health Services, Army Headquarters, Sri Jayawardenepura, Sri Lanka
| | | | - Nuwani Manamperi
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lahiru Udayanga
- Department of Biosystems Engineering, Faculty of Agriculture and Plantation Management, Wayamba University of Sri Lanka, Makandura, Sri Lanka
| | - Harshima Wijesinghe
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Prasad Premaratne
- Department of Parasitology, Faculty of Medicine, Kotalawela Defence University, Ratmalana, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Trends in Recently Emerged Leishmania donovani Induced Cutaneous Leishmaniasis, Sri Lanka, for the First 13 Years. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4093603. [PMID: 31111052 PMCID: PMC6487155 DOI: 10.1155/2019/4093603] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
Sri Lanka reports a large epidemic of cutaneous leishmaniasis (CL) caused by an atypical L. donovani while regional leishmaniasis elimination drive aims at achieving its targets in 2020. Visceralization, mucotrophism, and CL associated poor treatment response were recently reported. Long-term clinico-epidemiological trends (2001-2013) in this focus were examined for the first time. Both constant and changing features were observed. Sociodemographic patient characteristics that differ significantly from those of country profile, microchanges within CL profile, spatial expansion, constant biannual seasonal variation, and nondependency of clinical profile on age or gender were evident. Classical CL remains the main clinical entity without clinical evidence for subsequent visceralization indicating presence of parasite strain variation. These observations make a scientific platform for disease control preferably timed based on seasonal variation and highlights the importance of periodic and continued surveillance of clinic-epidemiological and other characteristics.
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The Economic Impact of Cutaneous Leishmaniasis in Sri Lanka. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3025185. [PMID: 30406132 PMCID: PMC6201334 DOI: 10.1155/2018/3025185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023]
Abstract
Cutaneous leishmaniasis (CL) is a neglected tropical disease which affects mainly the poorest communities in developing countries. Considering the limited published information on economic impact of CL in Sri Lanka, the current study was conducted with the objective of revealing the nature and magnitude of the economic impact of CL in three selected disease endemic regions in Kurunegala District, Sri Lanka. The patient records of CL notified of relevant Medical Officer of Health (MOH) office during 2013- 2016 were obtained. Patient households were visited and data collection was done using an interviewed administered questionnaire. The majority of patients (57%) were economically active at the time of infection. Of them, 65% were the only contributors to household economy. Total median costs including both direct and indirect costs were 66.85 USD (Rs. 10,831) (IQR = 57.26 - 86.78 USD), while total median economic loss to households was 61.27 USD (Rs. 9,927) (IQR= 49.61- 75.04 USD). From provider perspective, total median cost per patient was 22.83 USD (Rs. 3,696). The mean total economic loss was denoted as 65.26 USD (Rs. 10,572) which is about 5.4% of the annual household income and 20.9% of the mean annual per capita income of the study population. Although economic impact of CL infection is not catastrophic according to current interpretation, the infection may have significant economic impacts on households when considering the mean economic loss to household as a percentage of the mean annual per capita income of the population.
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Iddawela D, Vithana SMP, Atapattu D, Wijekoon L. Clinical and epidemiological characteristics of cutaneous leishmaniasis in Sri Lanka. BMC Infect Dis 2018; 18:108. [PMID: 29510669 PMCID: PMC5838877 DOI: 10.1186/s12879-018-2999-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/16/2018] [Indexed: 12/26/2022] Open
Abstract
Background Leishmaniasis, a vector borne tropical/subtropical disease caused by the protozoan Leishmania is transmitted to humans by sandfly vectors Phlebotomus and Lutzomyia. The principal form found in Sri Lanka is cutaneous leishmaniasis (CL) and is caused by Leishmania donovani. A rising trend in disease prevalence has been observed recently in Sri Lanka and the island is in fact the newest endemic focus in South Asia. Determining the prevalence of smear positivity among clinically suspected CL patients, identifying risk factors and specific clinical presentations of CL in order to implement preventive and early treatment strategies were the objectives of this study. Methods A sample of 509 clinically suspected cases of CL referred to the Department of Parasitology from all across Sri Lanka between 2005 and 2015 was selected consecutively. Diagnosis was confirmed by microscopic visualization of the Leishmania amastigote from the slit skin smear. A structured questionnaire was used to identify exposure related risk factors and a clinical examination was performed to identify lesion characteristics. Results Out of 509 clinical cases, 41.5% (n = 211) were smear positive. The study population ranged from ages 1 to 80 years (mean age = 34.76) and the most affected age group was 40–49. Of the smear positives, 58.85% were males. Majority (47.86%) were from the North Western region (Kurunegala) of the country and were exposed to scrub jungles. Sand fly exposure (p = 0.04) and positive contact history (p = 0.005) were significant risk factors for smear positivity. Erythema (p = 0.02), lack of pruritus (p = 0.02) and scaly appearance (p = 0.003) were significant lesion characteristics in smear positivity. Lesions were commonly found in the exposed areas and the commonest morphological type was papulo-nodular. Conclusions An increasing trend in the spread of cutaneous leishmaniasis from endemic to non-endemic areas has become evident. Positive contact history and sandfly exposure were significant risk factors for smear positivity which may indicate the possibility of human reservoir hosts in infection transmission. Lack of pruritus, scaly appearance and erythema were highly significant lesion characteristics associated with Leishmania positive smears which can be used for the clinical diagnosis of CL.
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Affiliation(s)
- Devika Iddawela
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Dhilma Atapattu
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Lanka Wijekoon
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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De Silva G, Somaratne V, Senaratne S, Vipuladasa M, Wickremasinghe R, Wickremasinghe R, Ranasinghe S. Efficacy of a new rapid diagnostic test kit to diagnose Sri Lankan cutaneous leishmaniasis caused by Leishmania donovani. PLoS One 2017; 12:e0187024. [PMID: 29135995 PMCID: PMC5685575 DOI: 10.1371/journal.pone.0187024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) in Sri Lanka is caused by Leishmania donovani. This study assessed the diagnostic value of a new rapid diagnostic immunochromatographic strip (CL-Detect™ IC-RDT), that captures the peroxidoxin antigen of Leishmania amastigotes. Methodology/Principal findings We sampled 74 clinically suspected CL lesions, of which 59 (79.7%) were positive by PCR, 43 (58.1%) by Giemsa stained slit skin smear (SSS) and 21 (28.4%) by the new IC-RDT. All samples which were positive either by SSS or IC-RDT or both were positive by PCR. The sensitivities of the IC-RDT and SSS compared to PCR were 36% and 73%, respectively. Fifteen patients from this endemic region were negative by all three tests. Twenty two clinically non-CL skin lesions from a CL non-endemic region were also negative by all three methods. Specificity and PPV of both IC-RDT and SSS compared to PCR were 100%; the NPVs of IC-RDT and SSS were 37% and 58%, respectively. The median parasite grading of the 59 PCR positive samples was 2+ (1–10 parasites/100 HPFs) and IC-RDT positive lesions was 3+ (1–10 parasites /10HPFs). The duration of the lesion was not associated with IC-RDT positivity. Conclusions/Significance The median parasite grade of Sri Lankan CL lesions is low. The low sensitivities of SSS and CL Detect™ IC-RDT may be due to low parasite counts or low expression of peroxidoxin antigen in amastigotes of the Sri Lankan L. donovani strain. Our results indicate that negative SSS has to be combined with PCR for confirmation of CL in Sri Lanka. The current commercially available IC-RDT is not suitable to diagnose CL in Sri Lanka; an IC-RDT with improved sensitivity to detect L. donovani would be a valuable addition in the diagnostic tool kit for Sri Lanka.
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Affiliation(s)
- Gayani De Silva
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Sujai Senaratne
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | | | - Renu Wickremasinghe
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Shalindra Ranasinghe
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- * E-mail:
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Datta S, Sherman JM, Tovar MA, Bravard MA, Valencia T, Montoya R, Quino W, D'Arcy N, Ramos ES, Gilman RH, Evans CA. Sputum Microscopy With Fluorescein Diacetate Predicts Tuberculosis Infectiousness. J Infect Dis 2017; 216:514-524. [PMID: 28510693 PMCID: PMC5853787 DOI: 10.1093/infdis/jix229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/11/2017] [Indexed: 01/03/2023] Open
Abstract
Background Sputum from patients with tuberculosis contains subpopulations of metabolically active and inactive Mycobacterium tuberculosis with unknown implications for infectiousness. Methods We assessed sputum microscopy with fluorescein diacetate (FDA, evaluating M. tuberculosis metabolic activity) for predicting infectiousness. Mycobacterium tuberculosis was quantified in pretreatment sputum of patients with pulmonary tuberculosis using FDA microscopy, culture, and acid-fast microscopy. These 35 patients’ 209 household contacts were followed with prevalence surveys for tuberculosis disease for 6 years. Results FDA microscopy was positive for a median of 119 (interquartile range [IQR], 47–386) bacteria/µL sputum, which was 5.1% (IQR, 2.4%–11%) the concentration of acid-fast microscopy–positive bacteria (2069 [IQR, 1358–3734] bacteria/μL). Tuberculosis was diagnosed during follow-up in 6.4% (13/209) of contacts. For patients with lower than median concentration of FDA microscopy–positive M. tuberculosis, 10% of their contacts developed tuberculosis. This was significantly more than 2.7% of the contacts of patients with higher than median FDA microscopy results (crude hazard ratio [HR], 3.8; P = .03). This association maintained statistical significance after adjusting for disease severity, chemoprophylaxis, drug resistance, and social determinants (adjusted HR, 3.9; P = .02). Conclusions Mycobacterium tuberculosis that was FDA microscopy negative was paradoxically associated with greater infectiousness. FDA microscopy–negative bacteria in these pretreatment samples may be a nonstaining, slowly metabolizing phenotype better adapted to airborne transmission.
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Affiliation(s)
- Sumona Datta
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Infectious Diseases and Immunity and Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Jonathan M Sherman
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marco A Tovar
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Marjory A Bravard
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Teresa Valencia
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosario Montoya
- Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Willi Quino
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Nikki D'Arcy
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Eric S Ramos
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carlton A Evans
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Infectious Diseases and Immunity and Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
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11
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Siriwardana HVYD, Karunanayake P, Goonerathne L, Karunaweera ND. Emergence of visceral leishmaniasis in Sri Lanka: a newly established health threat. Pathog Glob Health 2017; 111:317-326. [PMID: 28820339 DOI: 10.1080/20477724.2017.1361564] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Sri Lanka is a new focus of human cutaneous leishmaniasis caused by a genetic variant of usually visceralizing parasite Leishmania donovani. Over 3000 cases have been reported to our institution alone, during the past two decades. Recent emergence of visceral leishmaniasis is of concern. METHODS Patients suspected of having visceral leishmaniasis (n = 120) fulfilling at least two of six criteria (fever > 2 weeks, weight loss, tiredness affecting daily functions, splenomegaly, hepatomegaly and anemia) were studied using clinic-epidemiological, immunological and haematological parameters. Seven cases (four progressive, treated (group A) and 3 non- progressive, potentially asymptomatic and observed (group B) were identified. Clinical cases were treated with systemic sodium stibogluconate or amphotericin B and all were followed up at the leishmaniasis clinic of University of Colombo for 3 years with one case followed up for 9 years. RESULTS All treated cases responded well to anti leishmanial treatment. Relapses were not noticed. Clinical features subsided in all non-progressive cases and did not develop suggestive clinical features or change of laboratory parameters. Visceral leishmaniasis cases have been originated from different districts within the country. Majority had a travel history to identified local foci of cutaneous leishmaniasis. CONCLUSION Visceral leishmaniasis is recognized as an emerging health threat in Sri Lanka. At least a proportion of locally identified strains of L. donovani possess the ability to visceralize. Apparent anti leishmanial sensitivity is encouraging. Timely efforts in disease containment will be important in which accurate understanding of transmission characteristics, increased professional and community awareness, improved diagnostics and availability of appropriate treatment regimens.
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Affiliation(s)
- H V Y D Siriwardana
- a Department of Parasitology, Faculty of Medicine , University of Colombo , Sri Lanka
| | - P Karunanayake
- b Department of Clinical Medicine, Faculty of Medicine , University of Colombo , Sri Lanka
| | - L Goonerathne
- c Department of Pathology, Faculty of Medicine , University of Colombo , Sri Lanka
| | - N D Karunaweera
- a Department of Parasitology, Faculty of Medicine , University of Colombo , Sri Lanka
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Kahandawaarachchi ICI, Premawansa GS, Warnasuriya W, Dassanayake M, Corea E. A case report of co-infection of Melioidosis and cutaneous Leishmaniasis. BMC Infect Dis 2017; 17:533. [PMID: 28764662 PMCID: PMC5540292 DOI: 10.1186/s12879-017-2639-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/26/2017] [Indexed: 01/25/2023] Open
Abstract
Background Leishmaniasis and melioidosis are frequently reported from the North Central Province of Sri Lanka. However, only one case of co-infection of the two diseases has been reported to date over the world. This is a case report of a patient who had co-infection with cutaneous leishmaniasis and melioidosis and was successfully treated and recovered from the illness. Case presentation A 61 year old female patient with diabetes mellitus presented with fever for one month’s duration and was found to have hepatosplenomegaly and an ulcer over the left arm. She had elevated inflammatory markers and blood culture grew Burkholderia pseudomallei and serum was highly positive for melioidosis antibodies. A slit skin smear of the ulcer showed Leishmania amastigotes. Conclusion Melioidosis and leishmaniasis are emerging infectious diseases in endemic countries and can be severe. The high prevalence rates in Sri Lanka should keep the treating physicians’ threshold for suspicion low for these two diseases.
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Affiliation(s)
| | | | | | | | - Enoka Corea
- Department of Microbiology, Faculty of Medicine, University of Colombo, Ragama, Sri Lanka
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13
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Potential Challenges of Controlling Leishmaniasis in Sri Lanka at a Disease Outbreak. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28630867 PMCID: PMC5467302 DOI: 10.1155/2017/6931497] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present works reviewed the existing information on leishmaniasis in Sri Lanka and in other countries, focusing on challenges of controlling leishmaniasis in the country, in an outbreak. Evidence from recent studies suggests that there is a possibility of a leishmaniasis outbreak in Sri Lanka in the near future. Difficulty of early diagnosis due to lack of awareness and unavailability or inadequacy of sensitive tests are two of the main challenges for effective case management. Furthermore, the absence of a proper drug for treatment and lack of knowledge about vector biology, distribution, taxonomy and bionomics, and reservoir hosts make the problem serious. The evident potential for visceralization in the cutaneous variant of L. donovani in Sri Lanka may also complicate the issue. Lack of knowledge among local communities also reduces the effectiveness of vector and reservoir host control programs. Immediate actions need to be taken in order to increase scientific knowledge about the disease and a higher effectiveness of the patient management and control programs must be achieved through increased awareness about the disease among general public and active participation of local community in control activities.
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Galgamuwa LS, Sumanasena B, Yatawara L, Wickramasinghe S, Iddawela D. Clinico-Epidemiological Patterns of Cutaneous Leishmaniasis Patients Attending the Anuradhapura Teaching Hospital, Sri Lanka. THE KOREAN JOURNAL OF PARASITOLOGY 2017; 55:1-7. [PMID: 28285499 PMCID: PMC5365259 DOI: 10.3347/kjp.2017.55.1.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/31/2016] [Accepted: 01/08/2017] [Indexed: 11/23/2022]
Abstract
Cutaneous leishmaniasis (CL) caused by Leishmania donovani is an endemic vector-borne disease in Sri Lanka. Over 2,500 cases have been reported since 2000 and the number of CL cases has dramatically increased annually. Total 57 clinically suspected CL patients attending the dermatology clinic in Anuradhapura Teaching Hospital were recruited from January to June 2015. Slit skin smears and skin biopsies were taken from each of the subjects. Clinical and epidemiological data were obtained using interviewer administered questionnaire. Forty-three (75.4%) patients among 57 were confirmed positive for L. donovani. The majority of infected patients was males (P=0.005), and the most affected age group was 21–40 years. Soldiers in security forces, farmers, and housewives were identified as high risk groups. The presence of scrub jungles around the residence or places of occupation (P=0.003), the presence of sandflies (P=0.021), and working outsides more than 6 hr per day (P=0.001) were significantly associated with CL. The number of lesions ranged from 1–3, and the majority (76%) of the patients had a single lesion. Upper and lower extremities were the prominent places of lesions, while the wet type of lesions were more prevalent in females (P=0.022). A nodular-ulcerative type lesion was common in both sexes. The presence of sandflies, scrub jungles, and outdoor activities contributed to spread of Leishmania parasites in an endemic pattern. Implementation of vector control programs together with health education with regard to transmission and prevention of CL are necessary to control the spread of this infection.
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Affiliation(s)
- Lahiru Sandaruwan Galgamuwa
- Department of Basic Sciences, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka.,Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Lalani Yatawara
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Susiji Wickramasinghe
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Devika Iddawela
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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15
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Wingfield T, Tovar MA, Huff D, Boccia D, Saunders MJ, Datta S, Montoya R, Ramos E, Lewis JJ, Gilman RH, Evans C. Beyond pills and tests: addressing the social determinants of tuberculosis. Clin Med (Lond) 2016; 16:s79-s91. [PMID: 27956446 PMCID: PMC6329567 DOI: 10.7861/clinmedicine.16-6-s79] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Poverty drives tuberculosis (TB) rates but the approach to TB control has been disproportionately biomedical. In 2015, the World Health Organization's End TB Strategy explicitly identified the need to address the social determinants of TB through socio-economic interventions. However, evidence concerning poverty reduction and cost mitigation strategies is limited. The research described in this article, based on the 2016 Royal College of Physicians Linacre Lecture, aimed to address this knowledge gap. The research was divided into two phases: the first phase was an analysis of a cohort study identifying TB-related costs of TB-affected households and creating a clinically relevant threshold above which those costs became catastrophic; the second was the design, implementation and evaluation of a household randomised controlled evaluation of socio-economic support to improve access to preventive therapy, increase TB cure, and mitigate the effects of catastrophic costs. The first phase showed TB remains a disease of people living in poverty - 'free' TB care was unaffordable for impoverished TB-affected households and incurring catastrophic costs was associated with as many adverse TB treatment outcomes (including death, failure of treatment, lost to follow-up and TB recurrence) as multidrug resistant (MDR) TB. The second phase showed that, in TB-affected households receiving socio-economic support, household contacts were more likely to start and adhere to TB preventive therapy, TB patients were more likely to be cured and households were less likely to incur catastrophic costs. In impoverished Peruvian shantytowns, poverty remains inextricably linked with TB and incurring catastrophic costs predicted adverse TB treatment outcome. A novel socio-economic support intervention increased TB preventive therapy uptake, improved TB treatment success and reduced catastrophic costs. The impact of the intervention on TB control is currently being evaluated by the Community Randomized Evaluation of a Socio-economic Intervention to Prevent TB (CRESIPT) study.
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Affiliation(s)
- Tom Wingfield
- Address for correspondence: Dr T Wingfield, The Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
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16
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Wingfield T, Tovar MA, Huff D, Boccia D, Saunders MJ, Datta S, Montoya R, Ramos E, Lewis JJ, Gilman RH, Evans C. Beyond pills and tests: addressing the social determinants of tuberculosis. Clin Med (Lond) 2016; 16. [PMID: 27956446 PMCID: PMC6329567 DOI: 10.7861/clinmedicine.16-6s-s79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Poverty drives tuberculosis (TB) rates but the approach to TB control has been disproportionately biomedical. In 2015, the World Health Organization's End TB Strategy explicitly identified the need to address the social determinants of TB through socio-economic interventions. However, evidence concerning poverty reduction and cost mitigation strategies is limited. The research described in this article, based on the 2016 Royal College of Physicians Linacre Lecture, aimed to address this knowledge gap. The research was divided into two phases: the first phase was an analysis of a cohort study identifying TB-related costs of TB-affected households and creating a clinically relevant threshold above which those costs became catastrophic; the second was the design, implementation and evaluation of a household randomised controlled evaluation of socio-economic support to improve access to preventive therapy, increase TB cure, and mitigate the effects of catastrophic costs. The first phase showed TB remains a disease of people living in poverty - 'free' TB care was unaffordable for impoverished TB-affected households and incurring catastrophic costs was associated with as many adverse TB treatment outcomes (including death, failure of treatment, lost to follow-up and TB recurrence) as multidrug resistant (MDR) TB. The second phase showed that, in TB-affected households receiving socio-economic support, household contacts were more likely to start and adhere to TB preventive therapy, TB patients were more likely to be cured and households were less likely to incur catastrophic costs. In impoverished Peruvian shantytowns, poverty remains inextricably linked with TB and incurring catastrophic costs predicted adverse TB treatment outcome. A novel socio-economic support intervention increased TB preventive therapy uptake, improved TB treatment success and reduced catastrophic costs. The impact of the intervention on TB control is currently being evaluated by the Community Randomized Evaluation of a Socio-economic Intervention to Prevent TB (CRESIPT) study.
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Affiliation(s)
- Tom Wingfield
- Address for correspondence: Dr T Wingfield, The Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
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17
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Karunaweera ND. Leishmaniasis: Path toward elimination from the Indian subcontinent. Trop Parasitol 2016; 6:2-4. [PMID: 26998429 PMCID: PMC4778179 DOI: 10.4103/2229-5070.175023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nadira D Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka E-mail:
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18
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Kariyawasam KKGDUL, Edirisuriya CS, Senerath U, Hensmen D, Siriwardana HVYD, Karunaweera ND. Characterisation of cutaneous leishmaniasis in Matara district, southern Sri Lanka: evidence for case clustering. Pathog Glob Health 2015; 109:336-43. [PMID: 26345305 DOI: 10.1179/2047773215y.0000000032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Leishmaniasis is a neglected tropical disease transmitted by Phlebotomus spp. sand flies. Cutaneous leishmaniasis (CL) in Sri Lanka is caused by Leishmania donovani. Transmission patterns are different in Southern and Northern Sri Lanka. Current study examined the prevalence, risk factors and distribution of CL in Matara District, Southern Sri Lanka. Total of 2260 individuals from four District Secretariat divisions (DSDs) were screened by house to house surveys using an interviewer administered questionnaire. The study population had an age range of 1-90 years (median = 43 ± 17.31), low monthly income ( < 20 000 LKR, 52.8%) and a male to female ratio of 1 : 2. Thirty eight patients were diagnosed by light microscopy, culture and/or PCR with a disease prevalence of 1.68%. Spatial mapping provided evidence for significant case clustering, which tended to be more prominent with proximity to forest areas. The risk factors identified were un-plastered brick walls, absence or low usage of protective measures against insect bites, low income and excessive time (>4 hours/day) spent outdoors. However, exposure of limbs while outdoors, unawareness about the disease, type of occupation, common water source as the mode of water supply and presence of animal shelters within 200 m were not associated with the risk of acquiring the disease. Peri-domestic transmission is likely to contribute to the observed case clustering with all age groups at risk of acquiring the infection. Human behavioural habits coinciding with that of the vector, sand fly are likely to enable host-vector contact promoting its spread. Appropriate vector control measures, improvement of housing conditions, public education regarding preventive measures are required to contain the spread of disease.
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Turan E, Yeşilova Y, Sürücü HA, Ardic N, Doni N, Aksoy M, Yesilova A, Oghumu S, Varikuti S, Satoskar AR. A Comparison of Demographic and Clinical Characteristics of Syrian and Turkish Patients with Cutaneous Leishmaniasis. Am J Trop Med Hyg 2015; 93:559-63. [PMID: 26078315 DOI: 10.4269/ajtmh.15-0090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/06/2015] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is a significant public health problem with increasing incidence, especially in extreme circumstances. In this study, we compared the sociodemographic and clinical characteristics of 685 Syrian CL patients afflicted by the Syrian conflict and 685 Turkish CL patients in 2012. Patient age, gender, duration of disease, lesion size, type, and localization were evaluated. The duration of CL disease in Syrian CL patients (4.5 ± 4.3 weeks) was shorter than that of Turkish CL patients (11.9 ± 9.7 weeks). The number of lesions was greater in Syrian patients (2.46 ± 2.43) than in Turkish patients (1.93 ± 1.47). Lesion sizes were comparable between both groups (Syrian, 11.2 ± 8.7 mm; Turkish, 10.7 ± 7.7 mm). In Syrian CL patients, nodular type lesions were the most common (325 patients, 49.1%), whereas, in Turkish CL patients, ulcer type lesions were the most common (352 patients, 51.5%). Our results indicate variations in the clinicoepidemiological features of CL between Turkish and Syrian patients within Sanliurfa province. This highlights the impact of social unrest and environmental conditions on the epidemiology of CL within this region. Approaches to prevention, control, and treatment of CL in these areas should take into consideration the emerging changes in clinicoepidemiological parameters of the disease.
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Affiliation(s)
- Enver Turan
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Yavuz Yeşilova
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Hacer Altun Sürücü
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Nurittin Ardic
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Nebiye Doni
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Mustafa Aksoy
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Abdullah Yesilova
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Steve Oghumu
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Sanjay Varikuti
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
| | - Abhay R Satoskar
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Microbiology, Harran University School of Medicine, Sanliurfa, Turkey; Department of Dermatology, Special Middle East Hospital, Sanliurfa, Turkey; Department of Biostatistics, YuzuncuYıl University School of Medicine, Van, Turkey; Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
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20
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Abstract
Leishmania is an infectious protozoan parasite related to African and American trypanosomes. All Leishmania species that are pathogenic to humans can cause dermal disease. When one is confronted with cutaneous leishmaniasis, identification of the causative species is relevant in both clinical and epidemiological studies, case management, and control. This review gives an overview of the currently existing and most used assays for species discrimination, with a critical appraisal of the limitations of each technique. The consensus taxonomy for the genus is outlined, including debatable species designations. Finally, a numerical literature analysis is presented that describes which methods are most used in various countries and regions in the world, and for which purposes.
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Affiliation(s)
- Gert Van der Auwera
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium
| | - Jean-Claude Dujardin
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium Antwerp University, Department of Biomedical Sciences, Antwerp, Belgium
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21
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Wingfield T, Schumacher SG, Sandhu G, Tovar MA, Zevallos K, Baldwin MR, Montoya R, Ramos ES, Jongkaewwattana C, Lewis JJ, Gilman RH, Friedland JS, Evans CA. The seasonality of tuberculosis, sunlight, vitamin D, and household crowding. J Infect Dis 2014; 210:774-83. [PMID: 24596279 PMCID: PMC4130318 DOI: 10.1093/infdis/jiu121] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background. Unlike other respiratory infections, tuberculosis diagnoses increase in summer. We performed an ecological analysis of this paradoxical seasonality in a Peruvian shantytown over 4 years. Methods. Tuberculosis symptom-onset and diagnosis dates were recorded for 852 patients. Their tuberculosis-exposed cohabitants were tested for tuberculosis infection with the tuberculin skin test (n = 1389) and QuantiFERON assay (n = 576) and vitamin D concentrations (n = 195) quantified from randomly selected cohabitants. Crowding was calculated for all tuberculosis-affected households and daily sunlight records obtained. Results. Fifty-seven percent of vitamin D measurements revealed deficiency (<50 nmol/L). Risk of deficiency was increased 2.0-fold by female sex (P < .001) and 1.4-fold by winter (P < .05). During the weeks following peak crowding and trough sunlight, there was a midwinter peak in vitamin D deficiency (P < .02). Peak vitamin D deficiency was followed 6 weeks later by a late-winter peak in tuberculin skin test positivity and 12 weeks after that by an early-summer peak in QuantiFERON positivity (both P < .04). Twelve weeks after peak QuantiFERON positivity, there was a midsummer peak in tuberculosis symptom onset (P < .05) followed after 3 weeks by a late-summer peak in tuberculosis diagnoses (P < .001). Conclusions. The intervals from midwinter peak crowding and trough sunlight to sequential peaks in vitamin D deficiency, tuberculosis infection, symptom onset, and diagnosis may explain the enigmatic late-summer peak in tuberculosis.
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Affiliation(s)
- Tom Wingfield
- IFHAD: Innovation For Health and Development, United Kingdom Infectious Diseases and Immunity, Imperial College London Wellcome Trust Imperial College Centre for Global Health Research, London The Monsall Infectious Diseases Unit, North Manchester General Hospital, Manchester
| | - Samuel G Schumacher
- IFHAD: Innovation For Health and Development, United Kingdom Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Perú
| | - Gurjinder Sandhu
- Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Perú Infectious Diseases and Immunity, Imperial College London Wellcome Trust Imperial College Centre for Global Health Research, London
| | - Marco A Tovar
- IFHAD: Innovation For Health and Development, United Kingdom Asociación Benefica Prisma Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Perú
| | - Karine Zevallos
- IFHAD: Innovation For Health and Development, United Kingdom Asociación Benefica Prisma
| | - Matthew R Baldwin
- Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Perú
| | - Rosario Montoya
- IFHAD: Innovation For Health and Development, United Kingdom Asociación Benefica Prisma
| | - Eric S Ramos
- Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Perú
| | | | - James J Lewis
- IFHAD: Innovation For Health and Development, United Kingdom Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert H Gilman
- Asociación Benefica Prisma School of Public Health, Johns Hopkins Bloomberg School of Hygiene and Public Health, Baltimore, Maryland
| | - Jon S Friedland
- Infectious Diseases and Immunity, Imperial College London Wellcome Trust Imperial College Centre for Global Health Research, London
| | - Carlton A Evans
- IFHAD: Innovation For Health and Development, United Kingdom Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Perú Infectious Diseases and Immunity, Imperial College London Wellcome Trust Imperial College Centre for Global Health Research, London
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22
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Mukherjee A, Saini S, Kabra SK, Gupta N, Singh V, Singh S, Bhatnagar S, Saini D, Grewal HMS, Lodha R. Effect of micronutrient deficiency on QuantiFERON-TB Gold In-Tube test and tuberculin skin test in diagnosis of childhood intrathoracic tuberculosis. Eur J Clin Nutr 2014; 68:38-42. [PMID: 24169461 DOI: 10.1038/ejcn.2013.216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/11/2013] [Accepted: 09/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Data on performance of QuantiFERON-TB Gold In-Tube test (QFT) and tuberculin skin test (TST) in children with active tuberculosis from high burden countries in the context of micronutrient deficiency are scarce. The objective of this study was to evaluate the effect of micronutrient deficiency on the performance of TST and QFT in children with intrathoracic tuberculosis. SUBJECTS/METHODS Children with probable intrathoracic tuberculosis underwent TST, QFT, gastric lavages and induced sputum examination for AFB (Acid-Fast Bacilli) smear and culture. Zinc, copper, ferritin and vitamin D were measured on stored serum samples. The study used cross-sectional data at initiation of anti-tubercular therapy. RESULTS Three hundred and sixty-two children (median age 115.5 months (interquartile range: 73, 144), 200 (55.3%) girls) were enrolled in the study. Microbiological confirmation of tuberculosis could be obtained in 128 patients. TST and QFT were positive in 337 (93%) and 297 (82%) children, respectively. Performance of both the tests was unaffected by weight-for-age and height-for-age 'z-scores' or by serum copper levels. TST was not affected by serum zinc and ferritin levels. Children with negative QFT results had lower mean serum zinc level (P=0.01) and higher ferritin levels (P=0.007) as compared to those with positive test. Higher proportion of children with positive TST were vitamin D deficient/insufficient (P=0.003). CONCLUSION Micronutrient status, especially serum levels of zinc, may influence the performance of QFT in children with intrathoracic tuberculosis. Considering the high prevalence of zinc deficiency in developing countries, QFT should be used cautiously for diagnosing tuberculosis.
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Affiliation(s)
- A Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - S Saini
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - N Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - V Singh
- Department of Pediatrics, Kalawati Saran Children Hospital and Lady Hardinge Medical College, New Delhi, India
| | - S Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S Bhatnagar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - D Saini
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - H M S Grewal
- 1] Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway [2] Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - R Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Mazeris A, Soteriadou K, Dedet JP, Haralambous C, Tsatsaris A, Moschandreas J, Messaritakis I, Christodoulou V, Papadopoulos B, Ivovic V, Pratlong F, Loucaides F, Antoniou M. Leishmaniases and the Cyprus paradox. Am J Trop Med Hyg 2010; 82:441-8. [PMID: 20207870 DOI: 10.4269/ajtmh.2010.09-0282] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In Cyprus, leishmaniasis has been considered exclusively a veterinary problem. It was prevalent before 1945, and until its recent reemergence, it was nearly eradicated by 1996 as a consequence of the destruction of reservoir hosts and vectors. A survey carried out to provide an unbiased estimate of current transmission rates in dogs and humans showed a 9-fold increase in dog seroprevalence (reaching 14.9%) compared with 10 years ago. However, no human cases caused by Leishmania infantum were detected, although L. donovani cases were reported recently. The 62 strains isolated from dogs were typed as L. infantum MON-1 (98.4%), which is the predominating zymodeme in the Mediterranean region, and MON-98 (1.6%). The Phlebotomus species P. tobbi (vector of L. infantum in Cyprus), P. galilaeus, and P. papatasi were the predominant species captured. Two transmission cycles seem to run in parallel in Cyprus: in dogs with L. infantum and in humans with L. donovani.
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