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Fathima PA, Aiswarya RS, Shah HK, Ajithlal PM, Rajesh KR, Shubin C, Reena KJ, Kumar A, Saini P. Emergence of imported cutaneous leishmaniasis caused by Leishmania major: a case series from Kerala, India. Parasitol Res 2024; 123:278. [PMID: 39023835 DOI: 10.1007/s00436-024-08304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
Cutaneous leishmaniasis (CL) is often considered a 'great imitator' and is the most common form of leishmaniasis. The Leishmania species responsible for CL varies among countries, as these species exhibit specific distribution patterns. The increased mobility of people across countries has resulted in the imported incidences of leishmaniasis caused by non-endemic species of Leishmania. During 2023, we confirmed three CL cases caused by L. major from Kerala, India, and upon detailed investigation, these were identified to be imported from the Middle East and Kazakhstan regions. This is the first report of CL caused by L. major from Kerala. The lesion morphology, detection of anti-rK 39 antibody and Leishmania parasite DNA from the blood samples were the unique observations of these cases. Kerala, being an emerging endemic zone of visceral leishmaniasis (VL) and CL, the imported incidences of leishmaniasis by non-endemic species can pose a significant threat, potentially initiating new transmission cycles of leishmaniasis caused by non-endemic species.
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Affiliation(s)
- P A Fathima
- Indian Council of Medical Research-Vector Control Research Centre (Field Station), Kottayam, Kerala, India
| | - R S Aiswarya
- Indian Council of Medical Research-Vector Control Research Centre (Field Station), Kottayam, Kerala, India
| | - Harish Kumar Shah
- Indian Council of Medical Research-Vector Control Research Centre (Field Station), Kottayam, Kerala, India
| | - P M Ajithlal
- Indian Council of Medical Research-Vector Control Research Centre (Field Station), Kottayam, Kerala, India
| | - K R Rajesh
- Govt. Medical College, Thrissur, Kerala, India
| | - C Shubin
- District Surveillance Unit, Malappuram, Kerala, India
| | - K J Reena
- Directorate of Health Services, Thiruvananthapuram, Kerala, India
| | - Ashwani Kumar
- Indian Council of Medical Research-Vector Control Research Centre, Puducherry, India
| | - Prasanta Saini
- Indian Council of Medical Research-Vector Control Research Centre (Field Station), Kottayam, Kerala, India.
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Sosa L, Espinoza LC, Fuentes JM, Siwady JA, Rodríguez Rivas F, Rincón Díaz M. Polyene macrolide antibiotic nanoemulsion: a proposal for the treatment of cutaneous leishmaniasis. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.04.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Leishmaniasis is a neglected tropical disease that requires timely and inexpensive treatment. For this purpose, a nanoemulsion with a polyene macrolide antibiotic, or amphotericin B (NE-AmB), was developed. This study quantified the amount of drug permeated and retained in intact and lacerated human skin, simulating cutaneous leishmaniasis (CL) processes. Toxicity in macrophage and keratinocyte cell lines, activity against promastigotes and amastigotes of Leishmania tropica, in vivo irritant activity, and histological evidence was evaluated. Results. The amount of drug retained in intact and damaged skin was 750.18 ± 5.43 and 567.97 ± 8.64 µg/g/cm2, respectively. There was no permeation. No apparent toxic effect was observed in HaCaT cell lines. The IC50 of NE-AmB found for promastigotes and amastigotes was 0.26 ± 0.09 and 0.37 ± 0.05 µg/mL, respectively. NE without AmB did show antiparasitic activity. The formulation showed lower IC50 values on both parasite stages than the AmB solution. There was no skin irritation, and histology showed skin improvement with treatment. We suggest that this NE-AmB may be a candidate for in vivo studies in CL patients.
Keywords. Leishmaniasis, Amphotericin B, ex vivo permeation studies, in vitro cytotoxicity, in vitro leishmanicidal activity, Draize test, histology.
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Affiliation(s)
- Lilian Sosa
- Pharmaceutical Technology Research Group, Faculty of Chemistry and Pharmacy, National Autonomous University of Honduras (UNAH), Tegucigalpa, Honduras
| | - Lupe Carolina Espinoza
- Departamento de Química y Ciencias Exactas, Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador
| | | | - Jorge Alberto Siwady
- Department of Pharmaceutical Technology, Faculty of Chemical Sciences and Pharmacy, National Autonomous University of Honduras (UNAH), Tegucigalpa, Honduras
| | - Fredy Rodríguez Rivas
- Faculty of Chemical Sciences and Pharmacy, National Autonomous University of Honduras (UNAH), Tegucigalpa, Honduras
| | - María Rincón Díaz
- Department of Materials Science and Physical Chemistry, Faculty of Chemistry, University of Barcelona (UB), Barcelona
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Dixit KK, Ramesh V, Gupta R, Negi NS, Singh R, Salotra P. Real-Time Fluorimetry Loop-Mediated Isothermal Amplification for Diagnosis of Leishmaniasis and as a Tool for Assessment of Cure for Post-Kala-Azar Dermal Leishmaniasis. Am J Trop Med Hyg 2021; 104:2097-2107. [PMID: 33872204 DOI: 10.4269/ajtmh.20-1057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
Despite the dwindling number of visceral leishmaniasis (VL) cases in India, there is an urgent need for early and unequivocal diagnostics for controlling and preventing the reemergence of VL. Post-kala-azar dermal leishmaniasis (PKDL), a dermal sequela of VL, serves as a reservoir of the parasite. Diagnosis of PKDL, especially the macular variant, is challenging and poses impediment toward attainment of VL elimination. In this study, a real-time fluorimetry loop-mediated isothermal amplification (RealAmp) assay has been established for the detection of different clinical manifestations of leishmaniasis. The study included 150 leishmaniasis patients (25 VL, 25 cutaneous leishmaniasis [CL], and 100-PKDL) along with 120 controls. The assay demonstrated sensitivity of 100% (95% CI: 86.68-100) for diagnosis of VL and PKDL (95% CI: 79.61-100) and 96% (95% CI: 86.68-100) for CL with 100% specificity. Moreover, considering the cardinal role of PKDL, diagnosis using minimally invasive slit aspirate was explored, which demonstrated remarkable sensitivity of 96% (95% CI: 87.64-98.47). As a test of cure for PKDL, RealAmp successfully detected parasite in two of posttreatment cases who later reported relapse on follow-up. Also, direct sample lysis using slit aspirate was attempted in a small group that yielded sensitivity of 89% (95% CI: 67.20-96.90). RealAmp depicted excellent diagnostic accuracy in the diagnosis of leishmaniasis in concordance with the established SYBR Green I-based visual loop-mediated isothermal amplification (LAMP) and the reference comparator real-time PCR. The study endorsed the employment of LAMP either as visual-LAMP or RealAmp for an accurate and expeditious diagnosis of PKDL and as a tool for assessment of cure.
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Affiliation(s)
- Keerti Kaumudee Dixit
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India.,2Faculty of Health and Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - V Ramesh
- 3Department of Dermatology and STD, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Ratan Gupta
- 4Department of Paediatrics, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Narendra Singh Negi
- 5Department of Medicine, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Ruchi Singh
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India
| | - Poonam Salotra
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India
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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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Development and Characterization of a Semi-Solid Dosage Form of Meglumine Antimoniate for Topical Treatment of Cutaneous Leishmaniasis. Pharmaceutics 2019; 11:pharmaceutics11110613. [PMID: 31731660 PMCID: PMC6920791 DOI: 10.3390/pharmaceutics11110613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/12/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is treated with painful intralesional injections of meglumine antimoniate (MA). With the aim of developing an alternative topical treatment for CL, a gel-based formulation with 30% MA was prepared and its physicochemical properties, stability and rheological behavior were studied. The following were assessed: drug release on propylene hydrophilic membranes ex vivo human skin permeation, tolerance in healthy volunteers, cytotoxicity in three cell lines and anti-leishmanial activity against Leishmania infantum promastigotes and amastigotes. The MA gel formulation was found to have suitable pH, and good spreadability and stability. Low quantities of pentavalent antimony (SbV) were observed in release and permeation tests, whereas retention was high in both non-damaged and damaged skin (71,043.69 ± 10,641.57 and 10,728 ± 2254.61 µg/g/cm2 of SbV, respectively). The formulation did not have a toxic effect on the cell lines, and presented lower SbV IC50 values against amastigotes (15.76 ± 4.81 µg/mL) in comparison with the MA solution. The high amount of drug retained in the skin and the SbV IC50 values obtained suggest that this semi-solid dosage form has potential as an alternative treatment of CL.
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Parija SC. Microbial links to noninfectious diseases: The way forward. Trop Parasitol 2019; 9:69-70. [PMID: 31579658 PMCID: PMC6767794 DOI: 10.4103/tp.tp_57_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Subhash Chandra Parija
- Vice-Chancellor, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India. E-mail:
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