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Sundar S, Chakravarty J. Recent Advances in the Treatment of Leishmaniasis. Pediatr Infect Dis J 2024:00006454-990000000-00911. [PMID: 38907629 DOI: 10.1097/inf.0000000000004429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Affiliation(s)
- Shyam Sundar
- From the Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Talimi H, Retmi K, Fissoune R, Lemrani M. Artificial Intelligence in Cutaneous Leishmaniasis Diagnosis: Current Developments and Future Perspectives. Diagnostics (Basel) 2024; 14:963. [PMID: 38732377 PMCID: PMC11083257 DOI: 10.3390/diagnostics14090963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Cutaneous Leishmaniasis (CL) is a major global health problem requiring appropriate diagnosis methods. Its diagnosis is challenging, particularly in resource-limited settings. The integration of Artificial Intelligence (AI) into medical diagnostics has shown promising results in various fields, including dermatology. In this systematic review, we aim to highlight the value of using AI for CL diagnosis and the AI-based algorithms that are employed in this process, and to identify gaps that need to be addressed. Our work highlights that only a limited number of studies are related to using AI algorithms for CL diagnosis. Among these studies, seven gaps were identified for future research. Addressing these considerations will pave the way for the development of robust AI systems and encourage more research in CL detection by AI. This could contribute to improving CL diagnosis and, ultimately, healthcare outcomes in CL-endemic regions.
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Affiliation(s)
- Hasnaa Talimi
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca 20360, Morocco;
- Systems and Data Engineering Team, National School of Applied Sciences, University Abdelmalek Essaadi, Tangier 93000, Morocco;
| | - Kawtar Retmi
- Institute of Biological Sciences (ISSB-P), Mohammed VI Polytechnique University, Ben Guerir 43150, Morocco;
| | - Rachida Fissoune
- Systems and Data Engineering Team, National School of Applied Sciences, University Abdelmalek Essaadi, Tangier 93000, Morocco;
| | - Meryem Lemrani
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca 20360, Morocco;
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De los Santos MB, Loyola S, Perez-Velez ES, Santos RDP, Ramírez IM, Valdivia HO. Sampling is decisive to determination of Leishmania (Viannia) species. PLoS Negl Trop Dis 2024; 18:e0012113. [PMID: 38662642 PMCID: PMC11045131 DOI: 10.1371/journal.pntd.0012113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Accuracy of molecular tools for the identification of parasites that cause human cutaneous leishmaniasis (CL) could largely depend on the sampling method. Non-invasive or less-invasive sampling methods such as filter paper imprints and cotton swabs are preferred over punch biopsies and lancet scrapings for detection methods of Leishmania based on polymerase chain reaction (PCR) because they are painless, simple, and inexpensive, and of benefit to military and civilian patients to ensure timely treatment. However, different types of samples can generate false negatives and there is a clear need to demonstrate which sample is more proper for molecular assays. METHODOLOGY Here, we compared the sensitivity of molecular identification of different Leishmania (Viannia) species from Peru, using three types of sampling: punch biopsy, filter paper imprint and lancet scraping. Different composite reference standards and latent class models allowed to evaluate the accuracy of the molecular tools. Additionally, a quantitative PCR assessed variations in the results and parasite load in each type of sample. PRINCIPAL FINDINGS Different composite reference standards and latent class models determined higher sensitivity when lancet scrapings were used for sampling in the identification and determination of Leishmania (Viannia) species through PCR-based assays. This was consistent for genus identification through kinetoplastid DNA-PCR and for the determination of species using FRET probes-based Nested Real-Time PCR. Lack of species identification in some samples correlated with the low intensity of the PCR electrophoretic band, which reflects the low parasite load in samples. CONCLUSIONS The type of clinical sample can directly influence the detection and identification of Leishmania (Viannia) species. Here, we demonstrated that lancet scraping samples consistently allowed the identification of more leishmaniasis cases compared to filter paper imprints or biopsies. This procedure is inexpensive, painless, and easy to implement at the point of care and avoids the need for anesthesia, surgery, and hospitalization and therefore could be used in resource limited settings for both military and civilian populations.
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Affiliation(s)
- Maxy B. De los Santos
- Department of Parasitology, U.S. Naval Medical Research Unit SOUTH (NAMRU SOUTH), Bellavista, Lima, Peru
| | - Steev Loyola
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Erika S. Perez-Velez
- Departamento Académico de Medicina Humana, Universidad Andina del Cusco, Cusco, Peru
| | | | - Ivonne Melissa Ramírez
- Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Cercado de Lima, Lima, Peru
| | - Hugo O. Valdivia
- Department of Parasitology, U.S. Naval Medical Research Unit SOUTH (NAMRU SOUTH), Bellavista, Lima, Peru
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Yadav P, Ramesh V, Avishek K, Kathuria S, Khunger N, Sharma S, Salotra P, Singh R. Application of CL Detect™ rapid test for diagnosis and liposomal amphotericin B for treatment of cutaneous leishmaniasis: A retrospective analysis from a tertiary care centre in a non-endemic area in India. Indian J Dermatol Venereol Leprol 2024; 90:78-84. [PMID: 37609737 DOI: 10.25259/ijdvl_1017_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/22/2023] [Indexed: 08/24/2023]
Abstract
Background Increasing urbanisation has led to the occurrence of cutaneous leishmaniasis (CL) in new areas, which was otherwise localised to endemic areas. Healthcare workers should be made aware of this entity to ensure clinical suspicion of CL and investigations needed to confirm CL. The article describes patients seen at a tertiary hospital in Delhi. Aims To establish the utility of the CL Detect Rapid test as a diagnostic tool and the efficacy of Liposomal Amphotericin B (LAmB) for the complete cure of CL patients. Methods Data of patients of CL (n = 16) was retrospectively analysed concerning diagnosis and treatment. Diagnosis rested on histopathology, real-time PCR, and CL Detect Rapid Test. Speciation of the parasite was based on the Internal transcribed spacer-I gene. Patients were treated with LAmB (i.v., 5 mg/kg up to three doses, five days apart). Results A positivity of 81.3% (95%CI, 54.4-96) was observed for CL Detect Rapid test in comparison with 100% (95%CI, 79.4-100.0) for real-time PCR and 43.8% (95%CI, 19.8-70.1) for microscopy/histopathological examination. L. tropica was the infective species in all cases. All the patients treated with LAmB responded to treatment, and 9/10 patients demonstrated complete regression of lesions, while one was lost to follow-up. Limitations It is a retrospective study, and the data includes only confirmed cases of CL at a single centre. Conclusion This study highlights the utility of CL Detect as a promising diagnostic tool and the efficacy of LAmB for the complete cure of CL.
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Affiliation(s)
- Priya Yadav
- Molecular Biology Laboratory, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - V Ramesh
- Department of Dermatology & STD, Safdarjang Hospital & VMMC, New Delhi, India
| | - Kumar Avishek
- Molecular Biology Laboratory, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Sushruta Kathuria
- Department of Dermatology & STD, Safdarjang Hospital & VMMC, New Delhi, India
| | - Niti Khunger
- Department of Dermatology & STD, Safdarjang Hospital & VMMC, New Delhi, India
| | - Shruti Sharma
- Department of Pathology, ICMR National Institute of Pathology, Safdardung Hospital Campus, New Delhi, India
| | - Poonam Salotra
- Molecular Biology Laboratory, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Ruchi Singh
- Molecular Biology Laboratory, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
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Bel Hadj Ali I, Saadi-Ben Aoun Y, Hammami Z, Rhouma O, Chakroun AS, Guizani I. Handheld Ultra-Fast Duplex Polymerase Chain Reaction Assays and Lateral Flow Detection and Identification of Leishmania Parasites for Cutaneous Leishmaniases Diagnosis. Pathogens 2023; 12:1292. [PMID: 38003756 PMCID: PMC10675497 DOI: 10.3390/pathogens12111292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Early and accurate detection of infectious diseases is a key step for surveillance, epidemiology and control, notably timely disease diagnosis, patient management and follow-up. In this study, we aimed to develop handheld ultra-fast duplex PCR assays coupled to amplicon detection by lateral flow (LF) immunoassay to deliver a rapid and simple molecular diagnostic test for concomitant detection and identification of the main Leishmania parasites encountered in Tunisia. We selected two DNA targets to amplify L. major/L. tropica and L. infantum/L. tropica groups of species DNAs, respectively. We optimized the experimental conditions of a duplex ultra-fast PCR. The amplification is performed using a portable Palm convection PCR machine within 18 min, and the products are detected using an LF cassette within 10 min. The test allows the identification of the infecting species according to the position and number of test lines revealed. Tested on a selection of DNAs of representative Leishmania strains of the three studied species (N = 37), the ultra-fast duplex PCR-LF showed consistent, stable and reproducible results. The analytical limit of detection of the test was 0.4 pg for L. major, 4 pg for L. infantum and 40 pg for L. tropica.
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Affiliation(s)
- Insaf Bel Hadj Ali
- Laboratory of Molecular Epidemiology and Experimental Pathology-LR16IPT04, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis 1002, Tunisia; (Y.S.-B.A.); (Z.H.); (O.R.); (A.S.C.); (I.G.)
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Piyasiri SB, Dewasurendra R, Samaranayake N, Karunaweera N. Diagnostic Tools for Cutaneous Leishmaniasis Caused by Leishmania donovani: A Narrative Review. Diagnostics (Basel) 2023; 13:2989. [PMID: 37761356 PMCID: PMC10529649 DOI: 10.3390/diagnostics13182989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Leishmaniasis, a neglected tropical disease, encompasses a spectrum of clinical conditions and poses a significant risk of infection to over one billion people worldwide. Visceral leishmaniasis (VL) in the Indian sub-continent (ISC), where the causative parasite is Leishmania donovani, is targeted for elimination by 2025, with some countries already reaching such targets. Other clinical phenotypes due to the same species could act as a reservoir of parasites and thus pose a challenge to successful control and elimination. Sri Lanka has consistently reported cutaneous leishmaniasis (CL) due to L. donovani as the primary disease presentation over several decades. Similar findings of atypical phenotypes of L. donovani have also been reported from several other countries/regions in the Old World. In this review, we discuss the applicability of different methods in diagnosing CL due to L. donovani and a comprehensive assessment of diagnostic methods spanning clinical, microscopic, molecular, and immunological approaches. By incorporating evidence from Sri Lanka and other regions on L. donovani-related CL, we thoroughly evaluate the accuracy, feasibility, and relevance of these diagnostic tools. We also discuss the challenges and complexities linked to diagnosing CL and review novel approaches and their applicability for detecting CL.
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Affiliation(s)
| | | | | | - Nadira Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 0800, Sri Lanka; (S.B.P.); (R.D.); (N.S.)
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Zamanpour M, Mohebali M, Khamesipour A, Mohammadi AMA, Akhoundi B. Diagnosis of Human Cutaneous Leishmaniasis: A Comparative Study Using CL Detect ™ Dipstick, Direct Smear and Polymerase Chain Reaction Methods. Acta Parasitol 2023:10.1007/s11686-023-00662-5. [PMID: 36913075 DOI: 10.1007/s11686-023-00662-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/12/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION In most of the endemic areas, the detection of CL is based on searching for amastigotes using the direct smear method. Since expert microscopists are not usually available in every laboratory, false diagnoses are a disaster that happens. Therefore, the aim of current research is to evaluate the validity of the CL Detect™ Rapid Test (CDRT) for diagnosis CL in comparison to direct smear and polymerase chain reaction (PCR) methods. METHODS A total of 70 patients with skin lesions suspected to be CL were recruited. Skin samples from the lesions were collected and used for direct microscopic examination and the PCR method. Furthermore, the skin sample was collected in accordance with the manufacturer's instructions for the CDRT-based rapid diagnostic test. RESULTS Of 70 samples, 51 and 35 samples were positive by direct smear examination and the CDRT, respectively. The PCR showed positive results in 59 samples; 50 and 9 samples were identified as Leishmania major and Leishmania tropica, respectively. The sensitivity and specificity were calculated to be 68.6% (95% CI 54.11-80.89%) and 100% (95% CI 82.35-100%). When the results of CDRT were compared to the microscopic examinations, an agreement of 77.14% was seen between the CDRT and microscopic examination. In addition, the sensitivity and specificity were 59.32% (95% CI 45.75-71.93%) and 100% (95% CI 71.5-100%) when the CDRT was compared to PCR assay (as gold standard) and an agreement (65.71%) was found between CDRT and PCR assay. CONCLUSION As the CDRT is simple, rapid, and does not require great proficiency, it is recommended for use in the detection of CL caused by L. major or L. tropica as a diagnostic method, especially in areas with limited access to expert microscopists.
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Affiliation(s)
- Maryam Zamanpour
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .,Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Akram Mir Amin Mohammadi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Akhoundi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Evaluation of a diagnostic device, CL Detect rapid test for the diagnosis of new world cutaneous leishmaniasis in Peru. PLoS Negl Trop Dis 2023; 17:e0011054. [PMID: 36913433 PMCID: PMC10010545 DOI: 10.1371/journal.pntd.0011054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/21/2022] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a neglected disease and a public health problem in Latin America. The diagnosis of CL in poor hyperendemic regions relies to large extent on the identification of amastigotes in Giemsa-stained smears. There is an urgent need for a rapid, sensitive and low cost diagnostic method for use in field conditions for CL as current modalities are not readily available. The primary objective of this study was to determine the sensitivity and specificity of the FDA-cleared CL Detect Rapid Test in Peru, using modified test procedures rather than the instructions-for-use, by 1) increasing the extraction time and 2) increasing the volume of the sample added to the test strip. CL Detect Rapid Test results were compared against microscopy and kDNA-PCR, for the diagnosis of CL in ulcerated lesions. In addition, we compared two collection methods the dental broach used and mentioned in the CL Detect insert and the standard less invasive and easier to conduct scrapping method. METHODOLOGY Participants were patients who presented for medical consultation due to a suspected CL lesion. Four samples from the index lesion were collected using a dental broach, per package insert, and lancet scraping and tested by the modified CL Detect Rapid Test, microscopy, and PCR. PRINCIPAL FINDINGS A total of 156 subjects were eligible and evaluated. The modified CL Detect sensitivity was higher in specimens obtained by scraping (83.3%) than those from dental broach (64.2%). The specificity was lower in scrapings (77.8%) with a false positive rate of 22.2% compared with dental broach samples (91.7%) with a false positive rate of 8.3%. However, molecular analysis showed that all 8 false negative microscopy scrapings (those positive by modified CL Detect and negative by microscopy) were positive by kDNA-PCR, meaning that the modified CL Detect was more sensitive than microscopy. CONCLUSIONS These modifications to the package insert that resulted in a diagnostic sensitivity (83.3%) comparable to microscopy for species found in Peru may enable earlier anti-leishmanial drug treatment decisions based on a positive result from the CL Detect Rapid Test alone until further diagnostic tests like microscopy and PCR can be performed. TRIAL REGISTRATION NCT03762070; Clinicaltrials.gov.
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Melkamu R, Berhane N, Jacobs BKM, Mohammed R, Kassa M, Yeshanew A, Fikre H, Atnafu S, van Henten S, van Griensven J, Pareyn M. PCR for detection of Leishmania donovani from microscopically negative tissue smears of suspected patients in Gondar, Ethiopia. PLoS Negl Trop Dis 2023; 17:e0011128. [PMID: 36780561 PMCID: PMC9956792 DOI: 10.1371/journal.pntd.0011128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/24/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND As untreated visceral leishmaniasis (VL) is fatal, reliable diagnostics are pivotal for accurate treatment allocation. The current diagnostic algorithm for VL in Ethiopia, which is based on the rK39 rapid diagnostic test and microscopy of tissue smears, lacks sensitivity. This probably leads to missed cases and patients not receiving treatment. METHODOLOGY We conducted a retrospective study on stored microscopically negative spleen and bone marrow smears from suspected VL patients collected at the Leishmaniasis Research and Treatment Center (LRTC) in Gondar, northern Ethiopia between June 2019 and November 2020. Sociodemographic, clinical and treatment data were collected and samples were tested by real-time PCR targeting kinetoplast DNA. PRINCIPLE FINDINGS Among the 191 eligible samples (135 spleen and 56 bone marrow) with a microscopically negative and valid PCR result, 119 (62.3%) were positive by PCR, although Ct values for some were high (median 33.0). Approximately three quarters of these undiagnosed primary VL (77.3%) and relapse (69.6%) patients did not receive antileishmanial treatment. Of the 56 microscopically negative bone marrow samples, 46 (82.1%) were PCR positive, which is considerably higher compared to the microscopically negative spleen samples, for which 73 out of 135 (54.1%) were PCR positive. The odds of being PCR positive were significantly higher for bone marrow aspirates and higher when white blood cell values were lower and splenomegaly (in cm) was more pronounced. CONCLUSIONS This study demonstrates that a lot of suspected VL patients remain undiagnosed and untreated. This indicates the urgent need for better diagnostics for VL in the East-African region. The outcomes of PCR positive should be closely monitored and treatment should be provided if the patient deteriorates. In resource limited settings, implementation of PCR on bone marrow aspirate smears of patients with low WBC values and splenomegaly could lead to considerable improvements in patient management.
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Affiliation(s)
- Roma Melkamu
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
- Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Nega Berhane
- Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Bart K. M. Jacobs
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
| | - Rezika Mohammed
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Mekibib Kassa
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Arega Yeshanew
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Saba Atnafu
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Saskia van Henten
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
| | - Myrthe Pareyn
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
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Recent advances on the piezoelectric, electrochemical, and optical biosensors for the detection of protozoan pathogens. Trends Analyt Chem 2022. [DOI: 10.1016/j.trac.2022.116803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cutaneous Leishmaniasis: A 2022 Updated Narrative Review into Diagnosis and Management Developments. Am J Clin Dermatol 2022; 23:823-840. [PMID: 36103050 PMCID: PMC9472198 DOI: 10.1007/s40257-022-00726-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/10/2023]
Abstract
This review is an update of an earlier narrative review published in 2015 on developments in the clinical management of cutaneous leishmaniasis (CL) including diagnosis, treatment, prevention and control measurements. CL is a vector-borne infection caused by the protozoan parasite Leishmania. The vector is the female sandfly. Globally, CL affects 12 million cases and annually 2 million new cases occur. CL is endemic in almost 100 countries and the total risk population is approximately 350 million people. WHO lists CL an emerging and uncontrolled disease and a neglected tropical disease. Local experience-based evidence remains the mainstay for the management of CL. Whereas intralesional therapeutic options are the first treatment option for most CL patients, those with mucocutaneous and disseminated involvement require a systemic therapeutic approach. Moreover, different Leishmania species can vary in their treatment outcomes. Therefore, species determination is critical for optimal CL clinical management. New DNA techniques allow for relatively easy Leishmania species determination, yet they are not easily implemented in resource-limited settings. There is a desperate need for novel, less toxic, and less painful treatment options, especially for children with CL. Yet, the large and well conducted studies required to provide the necessary evidence are lacking. To further control and potentially eliminate CL, we urgently need to improve vector control, and diagnostics, and we require efficient and safe vaccines. Alas, since CL primarily affects poor people, biotechnical companies dedicate little investment into the research programs that could lead to diagnostic, pharmaceutical, and vaccine innovations.
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Saïdi N, Galaï Y, Ben-Abid M, Boussoffara T, Ben-Sghaier I, Aoun K, Bouratbine A. Imaging Leishmania major Antigens in Experimentally Infected Macrophages and Dermal Scrapings from Cutaneous Leishmaniasis Lesions in Tunisia. Microorganisms 2022; 10:microorganisms10061157. [PMID: 35744675 PMCID: PMC9227018 DOI: 10.3390/microorganisms10061157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
Leishmania major cutaneous leishmaniasis (CL) lesions are characterized by an intense process of parasite destruction and antigen processing that could limit microscopic amastigote detection. The aim of our study was to develop a direct immunofluorescence (DIF) assay for in situ visualization of L. major antigens and access its reliability in the routine diagnosis of CL. The developed DIF assay used IgG polyclonal antibodies produced in rabbits by intravenous injections of live L. major metacyclic promastigotes chemically coupled to fluorescein isothiocyanate. Applied to L. major infected RAW macrophages, corresponding macrophage-derived amastigotes and dermal scrapings from CL lesions, the immunofluorescence assay stained specifically Leishmania amastigotes and showed a diffuse Leishmania antigen deposit into cytoplasm of phagocytic cells. Reliability of DIF in CL diagnosis was assessed on 101 methanol-fixed dermal smears from 59 positive and 42 negative CL lesions diagnosed by direct microscopy and/or kDNA real-time PCR. Sensitivity and specificity of DIF was 98.3% and 100%, respectively, being more sensitive than microscopy (p < 0.001) and as sensitive as ITS1-PCR. ITS1-PCR-RFLP allowed Leishmania species identification in 56 out of the 58 DIF-positive smears, identifying 52 L. major, two L. infantum and two L. tropica cases, which indicates antigenic cross-reactivity between Leishmania species.
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Affiliation(s)
- Nasreddine Saïdi
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
| | - Yousr Galaï
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
| | - Meriem Ben-Abid
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
| | - Thouraya Boussoffara
- Laboratoire de Recherche, Transmission, Contrôle et Immunobiologie des Infections, LR 20-IPT-02, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia;
| | - Ines Ben-Sghaier
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
- Service de Parasitologie-Mycologie, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Karim Aoun
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
- Service de Parasitologie-Mycologie, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Aïda Bouratbine
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
- Service de Parasitologie-Mycologie, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Correspondence:
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Özbel Y, Töz S, Muñoz C, Ortuño M, Jumakanova Z, Pérez-Cutillas P, Maia C, Conceição C, Baneth G, Pereira A, Van der Stede Y, Gossner CM, Berriatua E. The current epidemiology of leishmaniasis in Turkey, Azerbaijan and Georgia and implications for disease emergence in European countries. Zoonoses Public Health 2022; 69:395-407. [PMID: 35615899 PMCID: PMC9545164 DOI: 10.1111/zph.12977] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
Leishmania spp. are sand fly-borne protozoan parasites causing leishmaniasis in humans and animals. The aim of the study was to analyse the epidemiology of leishmaniasis in Turkey, Azerbaijan and Georgia from 2005 to 2020 and evaluate the associated risk for disease emergence in European countries. It is based on an analysis of WHO and OIE reported cases between 2005 and 2020, a review of scientific articles published in SCOPUS between 2009 and 2020 and a questionnaire survey to public health and veterinary authorities in these countries. Endemic Leishmania spp. include L. infantum in the three countries, L. major in Azerbaijan and Turkey and L. tropica and L. donovani in Turkey. Leishmaniasis is reported in humans, animals and sand flies and incidence is spatially and temporarily variable. In the southern Caucasus and particularly in Georgia, reported incidence of human visceral leishmaniasis by L. infantum remains high. However, whilst Georgia experienced a gradual decrease from >4.0 cases per 100,000 population in 2005-09 to 1.13 cases per 100,000 population in 2020, the period with highest incidence in Azerbaijan, which ranged between 0.40 and 0.61 cases per 100,000 population, was 2016-2019, and no cases have so far been reported for 2020. Visceral leishmaniasis in the Southern Caucasus affects mostly young children from deprived urban areas and its closely associated to canine leishmaniasis. Turkey reported cases of visceral leishmaniasis between 2005 and 2012 and in 2016 only, and incidence ranged between 0.02 and 0.05 per 100,000 population. In contrast, the reported annual incidence of cutaneous leishmaniasis in Turkey was much greater and peaked at 7.02 cases per 100,000 population in 2013, associated to imported cases from cutaneous leishmaniasis endemic Syria. Leishmaniasis by L. infantum in Azerbaijan and Georgia represents a regional public and animal health challenge that requires support to improve diagnosis, treatment and control. The unprecedented rise of cutaneous leishmaniasis and the spread of L. tropica and L. donovani in Turkey is an important risk factor for their emergence in Europe, especially in Mediterranean countries where competent vectors are widespread.
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Affiliation(s)
- Yusuf Özbel
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Seray Töz
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Clara Muñoz
- Departamento de Sanidad Animal, Facultad de Veterinaria, Campus Regional de Excelencia Internacional "Campus Mare Nostrum", Universidad de Murcia, Murcia, Spain
| | - Maria Ortuño
- Departamento de Sanidad Animal, Facultad de Veterinaria, Campus Regional de Excelencia Internacional "Campus Mare Nostrum", Universidad de Murcia, Murcia, Spain
| | - Zarima Jumakanova
- Departamento de Sanidad Animal, Facultad de Veterinaria, Campus Regional de Excelencia Internacional "Campus Mare Nostrum", Universidad de Murcia, Murcia, Spain
| | | | - Carla Maia
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Cláudia Conceição
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Gad Baneth
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - André Pereira
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Céline M Gossner
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Eduardo Berriatua
- Departamento de Sanidad Animal, Facultad de Veterinaria, Campus Regional de Excelencia Internacional "Campus Mare Nostrum", Universidad de Murcia, Murcia, Spain
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Freire ML, Rego FD, Lopes KF, Coutinho LA, Grenfell RFQ, Avelar DM, Cota G, Pascoal-Xavier MA, Oliveira E. Anti-mitochondrial Tryparedoxin Peroxidase Monoclonal Antibody-Based Immunohistochemistry for Diagnosis of Cutaneous Leishmaniasis. Front Microbiol 2022; 12:790906. [PMID: 35295679 PMCID: PMC8918995 DOI: 10.3389/fmicb.2021.790906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Cutaneous leishmaniasis (CL) remains a globally spreading public health problem. Among Latin America countries, Brazil has the greatest number of recorded CL cases with several Leishmania species being associated with human cases. Laboratory diagnosis is one of the major challenges to disease control due to the low accuracy of parasitological techniques, the restricted use of molecular techniques, and the importance of differential diagnosis with regard to several dermatological and systemic diseases. In response, we have developed and validated an immunohistochemistry (IHC) technique for CL diagnosis using anti-mTXNPx monoclonal antibody (mAb). Recombinant Leishmania–mTXNPx was produced and used as an immunogen for mAb production through the somatic hybridization technique. The viability of mAb labeling of Leishmania amastigotes was tested by IHC performed with skin biopsies from hamsters experimentally infected with Leishmania amazonensis, Leishmania braziliensis, and Leishmania guyanensis. The enzymes horseradish peroxidase (IHC-HRP) and alkaline phosphatase (IHC-AP), both biotin-free polymer detection systems, were used in the standardization step. The IHC was further validated with skin biopsies from 49 CL patients diagnosed by clinical examination and quantitative real-time polymerase chain reaction and from 37 patients presenting other dermatological infectious diseases. Other parasitological techniques, such as direct examination and culture, were also performed for confirmed CL patients. Histopathology and IHC were performed for all included patients. Overall, the highest sensitivity was observed for IHC-AP (85.7%), followed by IHC-HRP (79.6%), direct examination (77.6%), histopathological examination (HE; 65.3%), and in vitro culture (49%). Only IHC and HE presented specificity over 90% and were able to detect CL patients regardless of parasite burden (odds ratio > 1.94; 95%CI: 0.34–11.23). A significant increase in positivity rates was observed when IHC-AP was combined with direct examination (95.9%) and HE (93.9%). The IHC techniques evaluated in here detected the main Leishmania species causing CL in Brazil and can support diagnostic strategies for controlling this neglected disease, especially if used in combination with other approaches for an integrative laboratorial diagnosis.
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Affiliation(s)
| | - Felipe Dutra Rego
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | | | | | | | | | - Gláucia Cota
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Marcelo Antônio Pascoal-Xavier
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Edward Oliveira
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- *Correspondence: Edward Oliveira,
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van Henten S, Fikre H, Melkamu R, Dessie D, Mekonnen T, Kassa M, Bogale T, Mohammed R, Cnops L, Vogt F, Pareyn M, van Griensven J. Evaluation of the CL Detect Rapid Test in Ethiopian patients suspected for Cutaneous Leishmaniasis. PLoS Negl Trop Dis 2022; 16:e0010143. [PMID: 35041672 PMCID: PMC8797207 DOI: 10.1371/journal.pntd.0010143] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/28/2022] [Accepted: 01/04/2022] [Indexed: 01/01/2023] Open
Abstract
Background Cutaneous leishmaniasis (CL) is common in Ethiopia, mainly affecting impoverished populations in rural areas with poor access to health care. CL is routinely diagnosed using skin slit smear microscopy, which requires skilled staff and appropriately equipped laboratories. We evaluated the CL Detect Rapid Test (InBios, Washington, USA), which is supplied with a dental broach sampling device, as a diagnostic alternative which could be used in field settings. Methodology/Principal findings We evaluated the diagnostic accuracy of the CL Detect Rapid Test on skin slit and dental broach samples from suspected CL patients at the Leishmaniasis Research and Treatment Center in Gondar, Ethiopia. A combined reference test of microscopy and PCR on the skin slit sample was used, which was considered positive if one of the two tests was positive. We recruited 165 patients consecutively, of which 128 (77.6%) were confirmed as CL. All microscopy-positive results (n = 71) were also PCR-positive, and 57 patients were only positive for PCR. Sensitivity of the CL Detect Rapid Test on the skin slit was 31.3% (95% confidence interval (CI) 23.9–39.7), which was significantly higher (p = 0.010) than for the dental broach (22.7%, 95% CI 16.3–30.6). Sensitivity for both methods was significantly lower than for the routinely used microscopy, which had a sensitivity of 55.5% (IQR 46.8–63.8) compared to PCR as a reference. Conclusions/Significance The diagnostic accuracy of the CL Detect Rapid Test was low for skin slit and dental broach samples. Therefore, we do not recommend its use neither in hospital nor field settings. Trial registration This study is registered at ClinicalTrials.gov as NCT03837431. Cutaneous leishmaniasis (CL) is common in Ethiopia, and mainly affects rural areas with poor access to health care. CL is routinely diagnosed using microscopy on a skin slit sample, which requires skilled staff and appropriately equipped laboratories. We evaluated the diagnostic accuracy of the CL Detect Rapid Test as an alternative which could be used in field settings. In a population of 165 patients suspected to have CL, 78% was confirmed to have CL by PCR. We found that the CL Detect Rapid Test on the supplied dental broach had a sensitivity of only 23%; on a skin slit sample, the Rapid Test had a slightly higher sensitivity with 31%. The routine diagnostic test of microscopy on the skin slit had a significantly higher sensitivity with 56%. These findings show that the sensitivity of the CL Detect Rapid Test is low, and is much worse than that of the currently used diagnostic method. Therefore, we do not recommend it to be used for diagnosing CL in Ethiopia.
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Affiliation(s)
- Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Roma Melkamu
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Dilargachew Dessie
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Tigist Mekonnen
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Mekibib Kassa
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Tadfe Bogale
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Rezika Mohammed
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Myrthe Pareyn
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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El Idrissi Saik I, Benlabsir C, Fellah H, Lemrani M, Riyad M. Transmission patterns of Leishmania tropica around the Mediterranean basin: Could Morocco be impacted by a zoonotic spillover? PLoS Negl Trop Dis 2022; 16:e0010009. [PMID: 35025884 PMCID: PMC8757988 DOI: 10.1371/journal.pntd.0010009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cutaneous leishmaniasis (CL) due to Leishmania tropica is a neglected tropical disease characterized by a wide geographical distribution in the Mediterranean basin and is endemic in several of its countries. In addition, the vector Phlebotomus sergenti is abundantly present all around the basin. Its transmission cycle is still subject to debate. In some countries, the presence of an animal reservoir has been confirmed. In Morocco, CL due to L. tropica has risen since the 1980s and has spread widely to become the most abundant form of leishmaniasis in the territory. However, the anthroponotic transmission is so far the only recognized mode, despite recordings of L. tropica infection in animal hosts. In this review article, we assess the situation of CL due to L. tropica in the Mediterranean basin with a focus on Morocco and gather knowledge about any potential zoonotic transmission in the country. A concomitant zoonotic transmission could explain the persistence of the disease in areas where human protective measures combined with vector management did not help reduce the disease burden. Cutaneous leishmaniasis (CL) due to Leishmania tropica is a neglected tropical disease still considered to be anthroponotic in Morocco despite evidence of zoonotic transmission in other endemic countries of the Mediterranean basin. Its high incidence in the country makes it necessary to investigate whether or not a potential concomitant zoonotic transmission exists alongside the anthroponotic one. Moreover, several reports of natural animal infection have been noted in the country. In this paper, we review how CL due to L. tropica is present around the Mediterranean basin, with a particular focus on the Moroccan foci, and try to unveil the existence of a zoonotic transmission in the area. A deep understanding of the transmission patterns of L. tropica in the region is necessary for the implementation of effective control measures and a better assessment of the disease burden. In addition, the complexity of this neglected disease requires more fundamental and applied research to unveil potential factors involved in its spread.
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Affiliation(s)
- Imane El Idrissi Saik
- Laboratory of Cellular and Molecular Pathology, Research Team on Immunopathology of Infectious and Systemic Diseases, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Chaimaa Benlabsir
- Laboratory of Cellular and Molecular Pathology, Research Team on Immunopathology of Infectious and Systemic Diseases, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Hassan Fellah
- Laboratory of Cellular and Molecular Pathology, Research Team on Immunopathology of Infectious and Systemic Diseases, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Meryem Lemrani
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Myriam Riyad
- Laboratory of Cellular and Molecular Pathology, Research Team on Immunopathology of Infectious and Systemic Diseases, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
- * E-mail:
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Potential antigenic targets used in immunological tests for diagnosis of tegumentary leishmaniasis: A systematic review. PLoS One 2021; 16:e0251956. [PMID: 34043671 PMCID: PMC8158869 DOI: 10.1371/journal.pone.0251956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/06/2021] [Indexed: 01/14/2023] Open
Abstract
Immunological tests may represent valuable tools for the diagnosis of human tegumentary leishmaniasis (TL) due to their simple execution, less invasive nature and potential use as a point-of-care test. Indeed, several antigenic targets have been used with the aim of improving the restricted scenario for TL-diagnosis. We performed a worldwide systematic review to identify antigenic targets that have been evaluated for the main clinical forms of TL, such as cutaneous (CL) and mucosal (ML) leishmaniasis. Included were original studies evaluating the sensitivity and specificity of immunological tests for human-TL, CL and/or ML diagnosis using purified or recombinant proteins, synthetic peptides or polyclonal or monoclonal antibodies to detect Leishmania-specific antibodies or antigens. The review methodology followed PRISMA guidelines and all selected studies were evaluated in accordance with QUADAS-2. Thirty-eight original studies from four databases fulfilled the selection criteria. A total of 79 antigens were evaluated for the detection of antibodies as a diagnostic for TL, CL and/or ML by ELISA. Furthermore, three antibodies were evaluated for the detection of antigen by immunochromatographic test (ICT) and immunohistochemistry (IHC) for CL-diagnosis. Several antigenic targets showed 100% of sensitivity and specificity, suggesting potential use for TL-diagnosis in its different clinical manifestations. However, a high number of proof-of-concept studies reinforce the need for further analysis aimed at verifying true diagnostic accuracy in clinical practice.
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Diagnostic performance of a Recombinant Polymerase Amplification Test-Lateral Flow (RPA-LF) for cutaneous leishmaniasis in an endemic setting of Colombia. PLoS Negl Trop Dis 2021; 15:e0009291. [PMID: 33909619 PMCID: PMC8081229 DOI: 10.1371/journal.pntd.0009291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Control of cutaneous leishmaniasis by public health systems in the Americas relies on case identification and treatment. Point-of-care diagnostics that can be performed by health workers within or near affected communities could effectively bring the health system to the resource-limited sites providing early diagnosis and treatment, reducing morbidity and the burden of disease. Methodology/principal findings A cross-sectional study was undertaken to evaluate the diagnostic test performance of Isothermal Recombinase Polymerase Amplification (RPA) targeting Leishmania kinetoplast DNA, coupled with a lateral flow (LF) immunochromatographic strip, in a field setting and a laboratory reference center. Minimally invasive swab and FTA filter paper samples were obtained by community health workers and highly trained technicians from ulcerated lesions of > 2 weeks’ evolution from 118 patients’ ≥ 2 years of age in the municipality of Tumaco, Nariño. Extracted DNA was processed by RPA-LF at a reference center or in a primary health facility in the field. Evaluation was based on a composite “gold standard” that included microscopy, culture, biopsy and real-time polymerase chain reaction detection of Leishmania 18S rDNA. Standard of care routine diagnostic tests were explored as comparators. Sensitivity and specificity of RPA-LF in the reference lab scenario were 87% (95%CI 74–94) and 86% (95%CI 74–97), respectively. In the field scenario, the sensitivity was 75% (95%CI 65–84) and specificity 89% (95%CI 78–99). Positive likelihood ratios in both scenarios were higher than 6 while negative likelihood ratios ranged to 0.2–0.3 supporting the usefulness of RPA-LF to rule-in and potentially to rule-out infection. Conclusions/significance The low complexity requirements of RPA-LF combined with non-invasive sampling support the feasibility of its utilization by community health workers with the goal of strengthening the diagnostic capacity for cutaneous leishmaniasis in Colombia. Trial registration ClinicalTrials.gov NCT04500873. Limited access to diagnosis is a critical determinant of the “neglect” that defines the so-called Neglected Tropical Diseases (NTDs) including cutaneous leishmaniasis. Diagnostic tests that can be performed close to and involve the participation of the affected communities would improve access to treatment as well as diagnosis. Using non-invasive swab and filter paper samples obtained by Community Health Workers, we evaluated the diagnostic performance of an innovative and technically simple molecular test: Isothermal Recombinase Polymerase Amplification (RPA) to detect Leishmania DNA, coupled with a lateral flow (LF) strip to read the results with the naked eye. The RPA-LF test demonstrated high sensitivity and specificity and capacity to rule in or rule out a diagnosis of cutaneous leishmaniasis in both an endemic field setting and reference laboratory. The findings encourage the further optimization of the test format for Point-of-Care diagnosis by health personnel and rural health workers in endemic settings.
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Leishmaniasis immunopathology-impact on design and use of vaccines, diagnostics and drugs. Semin Immunopathol 2020; 42:247-264. [PMID: 32152715 DOI: 10.1007/s00281-020-00788-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
Leishmaniasis is a disease complex caused by 20 species of protozoan parasites belonging to the genus Leishmania. In humans, it has two main clinical forms, visceral leishmaniasis (VL) and cutaneous or tegumentary leishmaniasis (CL), as well as several other cutaneous manifestations in a minority of cases. In the mammalian host Leishmania parasites infect different populations of macrophages where they multiply and survive in the phagolysosomal compartment. The progression of both VL and CL depends on the maintenance of a parasite-specific immunosuppressive state based around this host macrophage infection. The complexity and variation of immune responses and immunopathology in humans and the different host interactions of the different Leishmania species has an impact upon the effectiveness of vaccines, diagnostics and drugs.
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Picado A, Nogaro S, Cruz I, Biéler S, Ruckstuhl L, Bastow J, Ndung’u JM. Access to prompt diagnosis: The missing link in preventing mental health disorders associated with neglected tropical diseases. PLoS Negl Trop Dis 2019; 13:e0007679. [PMID: 31622340 PMCID: PMC6797081 DOI: 10.1371/journal.pntd.0007679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- * E-mail:
| | - Sarah Nogaro
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Laura Ruckstuhl
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Jon Bastow
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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van Henten S, Adriaensen W, Fikre H, Akuffo H, Diro E, Hailu A, Van der Auwera G, van Griensven J. Cutaneous Leishmaniasis Due to Leishmania aethiopica. EClinicalMedicine 2018; 6:69-81. [PMID: 31193672 PMCID: PMC6537575 DOI: 10.1016/j.eclinm.2018.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 01/06/2023] Open
Abstract
Leishmania aethiopica is the main causative species for cutaneous leishmaniasis (CL) in Ethiopia. Despite its considerable burden, L. aethiopica has been one of the most neglected Leishmania species. In this review, published evidence on L. aethiopica history, geography, vector, reservoir, epidemiology, parasitology, and immunology is discussed and knowledge gaps are outlined. L. aethiopica endemic regions are limited to the highland areas, although nationwide studies on CL prevalence are lacking. Phlebotomus pedifer and P. longipes are the sandfly vectors and hyraxes are considered to be the main reservoir, but the role of other sandfly species and other potential reservoirs requires further investigation. Where and how transmission occurs exactly are also still unknown. Most CL patients in Ethiopia are children and young adults. Lesions are most commonly on the face, in contrast to CL caused by other Leishmania species which may more frequently affect other body parts. CL lesions caused by L. aethiopica seem atypical and more severe in their presentation as compared to other Leishmania species. Mucocutaneous leishmaniasis and diffuse cutaneous leishmaniasis are relatively common, and healing of lesions caused by L. aethiopica seems to take longer than that of other species. A thorough documentation of the natural evolution of L. aethiopica as well as in depth studies into the immunological and parasitological characteristics that underpin the atypical and severe clinical presentation are needed. Better understanding of CL caused by this parasite species will contribute to interventions related to transmission, prevention, and treatment.
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Affiliation(s)
- Saskia van Henten
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Corresponding author.
| | - Wim Adriaensen
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Helina Fikre
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Hannah Akuffo
- Swedish International Development Agency (Sida) and Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solna, Sweden
| | - Ermias Diro
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Asrat Hailu
- Addis Ababa University School of Medicine, Ethiopia
| | - Gert Van der Auwera
- Unit of Molecular Parasitology, Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium
| | - Johan van Griensven
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Vink MMT, Nahzat SM, Rahimi H, Buhler C, Ahmadi BA, Nader M, Zazai FR, Yousufzai AS, van Loenen M, Schallig HDFH, Picado A, Cruz I. Evaluation of point-of-care tests for cutaneous leishmaniasis diagnosis in Kabul, Afghanistan. EBioMedicine 2018; 37:453-460. [PMID: 30396855 PMCID: PMC6286266 DOI: 10.1016/j.ebiom.2018.10.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/01/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background Kabul (Afghanistan) is a major focus of cutaneous leishmaniasis (CL) caused by Leishmania tropica. Microscopy remains the reference test for diagnosis despite its low performance. We evaluated whether Loopamp™ Leishmania Detection Kit (Loopamp) and CL Detect™ Rapid Test (CL Detect), detecting Leishmania DNA and antigen, respectively could improve CL diagnosis. Methods A diagnostic accuracy study with prospective inclusion was conducted in a leishmaniasis reference clinic in Kabul. Slit skin samples from CL suspects were analysed by microscopy. Samples taken with a dental broach were tested with CL Detect, Loopamp, and PCR. All samples were transferred to the Academic Medical Center (AMC, the Netherlands) for PCR and Loopamp analyses. The diagnostic performance of the tests was evaluated against a reference combining microscopy and PCR. Findings 274 CL suspects were included in the study. In Kabul, CL Detect had a 65·4% sensitivity [95% Confidence Interval (CI): 59.2–71.2%] and a 100% specificity [95% CI: 80.5–100%], while these were 87.6% [95%CI: 82.9–91.3%] and 70.6% [95% CI: 44.0–89.7%] for Loopamp. At AMC the Loopamp's sensitivity (92.2% [95% CI: 88.2–95.2%]) and specificity (94.1% [95% CI: 71.3–99.8%]) were higher. An algorithm where CL Detect negative suspects would be tested by Loopamp yielded a 93.4% sensitivity [95% CI: 89.6–96.1%] and a 94.1% specificity [95% CI: 71.3–99.8%] when Loopamp's performance at AMC was used. Interpretation The high specificity of CL Detect and the performance of Loopamp allow their use in a diagnostic algorithm that would minimize the number of CL patients referred for confirmation. Fund Federal Ministry of Education and Research, Germany.
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Affiliation(s)
- Martijn M T Vink
- Health Works (Formerly HealthNet TPO), Lizzy Ansinghstraat 163, 1072 RG Amsterdam, The Netherlands
| | - Sami M Nahzat
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Habiburrahman Rahimi
- Health Protection and Research Organization, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Cyril Buhler
- ORDiagnostics SASU, 10Rue Irénée Blanc, 75020 Paris, France
| | - Bashir A Ahmadi
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Mohammad Nader
- Health Protection and Research Organization, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Fazal R Zazai
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | | | - Merlin van Loenen
- Amsterdam UMC, University of Amsterdam, Medical Microbiology, Parasitology Unit, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Amsterdam UMC, University of Amsterdam, Medical Microbiology, Parasitology Unit, Meibergdreef 9, Amsterdam, The Netherlands
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland.
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