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van Dijk NJ, Hagos DG, Huggins DM, Carrillo E, Ajala S, Chicharro C, Kiptanui D, Solana JC, Abner E, Wolday D, Schallig HDFH. Simplified molecular diagnosis of visceral leishmaniasis: Laboratory evaluation of miniature direct-on-blood PCR nucleic acid lateral flow immunoassay. PLoS Negl Trop Dis 2024; 18:e0011637. [PMID: 38713648 DOI: 10.1371/journal.pntd.0011637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/15/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Diagnosis of visceral leishmaniasis (VL) in resource-limited endemic regions is currently based on serological testing with rK39 immunochromatographic tests (ICTs). However, rK39 ICT frequently has suboptimal diagnostic accuracy. Furthermore, treatment monitoring and detection of VL relapses is reliant on insensitive and highly invasive tissue aspirate microscopy. Miniature direct-on-blood PCR nucleic acid lateral flow immunoassay (mini-dbPCR-NALFIA) is an innovative and user-friendly molecular tool which does not require DNA extraction and uses a lateral flow strip for result read-out. This assay could be an interesting candidate for more reliable VL diagnosis and safer test of cure at the point of care. METHODOLOGY/PRINCIPLE FINDINGS The performance of mini-dbPCR-NALFIA for diagnosis of VL in blood was assessed in a laboratory evaluation and compared with the accuracy of rK39 ICTs Kalazar Detect in Spain and IT LEISH in East Africa. Limit of detection of mini-dbPCR-NALFIA was 650 and 500 parasites per mL of blood for Leishmania donovani and Leishmania infantum, respectively. In 146 blood samples from VL-suspected patients from Spain, mini-dbPCR-NALFIA had a sensitivity of 95.8% and specificity 97.2%, while Kalazar Detect had a sensitivity of 71.2% and specificity of 94.5%, compared to a nested PCR reference. For a sample set from 58 VL patients, 10 malaria patients and 68 healthy controls from Ethiopia and Kenya, mini-dbPCR-NALFIA had a pooled sensitivity of 87.9% and pooled specificity of 100% using quantitative PCR as reference standard. IT LEISH sensitivity and specificity in the East African samples were 87.9% and 97.4%, respectively. CONCLUSIONS/SIGNIFICANCE Mini-dbPCR-NALFIA is a promising tool for simplified molecular diagnosis of VL and follow-up of treated patients in blood samples. Future studies should evaluate its use in endemic, resource-limited settings, where mini-dbPCR-NALFIA may provide an accurate and versatile alternative to rK39 ICTs and aspirate microscopy.
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Affiliation(s)
- Norbert J van Dijk
- Amsterdam University Medical Centre, Department of Medical Microbiology and Infection Prevention, Experimental Parasitology, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, the Netherlands
| | - Dawit Gebreegziabiher Hagos
- Amsterdam University Medical Centre, Department of Medical Microbiology and Infection Prevention, Experimental Parasitology, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, the Netherlands
- College of Health Sciences, School of Medicine, Department of Medical Microbiology and Immunology, Mekelle University, Mekelle, Ethiopia
| | - Daniela M Huggins
- Amsterdam University Medical Centre, Department of Medical Microbiology and Infection Prevention, Experimental Parasitology, Amsterdam, the Netherlands
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-ISCIII), Madrid, Spain
| | - Sophia Ajala
- Amsterdam University Medical Centre, Department of Medical Microbiology and Infection Prevention, Experimental Parasitology, Amsterdam, the Netherlands
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-ISCIII), Madrid, Spain
| | - David Kiptanui
- Kacheliba Sub-County Hospital, Kacheliba, West Pokot County, Kenya
| | - Jose Carlos Solana
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-ISCIII), Madrid, Spain
| | - Edwin Abner
- Kacheliba Sub-County Hospital, Kacheliba, West Pokot County, Kenya
| | - Dawit Wolday
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Henk D F H Schallig
- Amsterdam University Medical Centre, Department of Medical Microbiology and Infection Prevention, Experimental Parasitology, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, the Netherlands
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Chicharro C, Nieto J, Miguelañez S, Garcia E, Ortega S, Peña A, Rubio JM, Flores-Chavez M. Molecular Diagnosis of Leishmaniasis in Spain: Development and Validation of Ready-To-Use Gel-Form Nested and Real-Time PCRs To Detect Leishmania spp. Microbiol Spectr 2023; 11:e0335422. [PMID: 37014253 PMCID: PMC10269443 DOI: 10.1128/spectrum.03354-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/08/2023] [Indexed: 04/05/2023] Open
Abstract
Leishmaniasis is an endemic parasitic disease in at least 98 countries. In Spain, it is considered a zoonosis caused by Leishmania infantum, with an annual incidence of 0.62 cases/100,000 inhabitants. The predominant clinical manifestations are the cutaneous (CL) and visceral forms (VL), and the diagnosis is performed by parasitological, serological, and molecular tests. At the WHO Collaborating Center for Leishmaniasis (WHOCCLeish), routine diagnostic tests are based on a nested PCR (Ln-PCR), culture, and serological tests. To simplify our PCR protocol, we aimed to develop and validate a ready-to-use nested gel-form PCR (LeishGelPCR) and a duplex real-time PCR (qPCR) that allowed simultaneous detection of Leishmania and mammalian DNA as an internal control (Leish-qPCR). Clinical validation was performed in 200 samples from the WHOCCLeish collection; 92 and 85 out of 94 and 87 samples were positive by LeishGelPCR and Leish-qPCR, respectively, showing a sensitivity of 98% in both approaches. The specificity was 100% for LeishGelPCR and 98% for Leish-qPCR. The limits of detection of both protocols were similar (0.5 and 0.2 parasites/reaction). Parasite loads in VL and CL forms were similar, although high loads were observed when invasive samples were tested. In conclusion, LeishGelPCR and Leish-qPCR showed excellent performance in the diagnosis of leishmaniasis. These new forms of 18S rRNA gene PCR are equivalent to Ln-PCR and can be introduced in the algorithm for CL and VL diagnosis. IMPORTANCE Although the gold standard for diagnosis of leishmaniasis is the microscopic observation of amastigotes, molecular techniques are becoming a cost-efficient alternative. Currently, PCR is a routine resource that is used in many reference microbiology laboratories. In this article, we have described two ways to improve the reproducibility and usability of the molecular detection of Leishmania spp. These new approaches could be introduced even in middle- and low-resource laboratories; one is a ready-to-use gel-form system of a nested PCR and the other is a real-time PCR. We show why molecular diagnosis is the best methodology to confirm a clinical suspicion of leishmaniasis with higher sensitivity than traditional methods, thus facilitating early diagnosis and timely treatment of human leishmaniasis.
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Affiliation(s)
- Carmen Chicharro
- Reference and Research Laboratory for Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-ISCIII), Madrid, Spain
- WHO Collaborating Center for Leishmaniasis (WHOCCLeish), Madrid, Spain
| | - Javier Nieto
- Reference and Research Laboratory for Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-ISCIII), Madrid, Spain
- WHO Collaborating Center for Leishmaniasis (WHOCCLeish), Madrid, Spain
| | - Silvia Miguelañez
- Reference and Research Laboratory for Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- WHO Collaborating Center for Leishmaniasis (WHOCCLeish), Madrid, Spain
| | - Emilia Garcia
- Reference and Research Laboratory for Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- WHO Collaborating Center for Leishmaniasis (WHOCCLeish), Madrid, Spain
| | - Sheila Ortega
- Reference and Research Laboratory for Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Peña
- Reference and Research Laboratory for Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jose Miguel Rubio
- Reference and Research Laboratory for Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-ISCIII), Madrid, Spain
| | - Maria Flores-Chavez
- Reference and Research Laboratory for Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Fundación Mundo Sano, Madrid, Spain
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3
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Monge-Maillo B, Norman FF, Chamorro-Tojeiro S, Gioia F, Pérez-Molina JA, Chicharro C, Moreno J, López-Vélez R. Post-kala-azar dermal leishmaniasis due to Leishmania infantum in an HIV-negative patient treated with miltefosine. J Travel Med 2022; 29:6404465. [PMID: 34668558 DOI: 10.1093/jtm/taab169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/02/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022]
Abstract
Post-kala-azar dermal leishmaniasis due to Leishmania infantum in an HIV-negative patient is very infrequent and this case highlights how it can be associated to other types of immunosuppression. Moreover, this case reports an effective therapeutic option with miltefosine, which can be very useful due to the scarce experience reported.
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Affiliation(s)
- Begoña Monge-Maillo
- National Reference Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Ctra Colmenar Km 9,100, CP 28034, Madrid, Spain
| | - Francesca F Norman
- National Reference Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Ctra Colmenar Km 9,100, CP 28034, Madrid, Spain
| | - Sandra Chamorro-Tojeiro
- National Reference Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Ctra Colmenar Km 9,100, CP 28034, Madrid, Spain
| | - Francesca Gioia
- National Reference Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Ctra Colmenar Km 9,100, CP 28034, Madrid, Spain
| | - José-Antonio Pérez-Molina
- National Reference Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Ctra Colmenar Km 9,100, CP 28034, Madrid, Spain
| | - Carmen Chicharro
- National Centre for Microbiology, Instituto de Salud Carlos III, Ctra Majadahonda-Pozuelo Km 2,2, CP 28220 Majadahonda, Madrid, Spain
| | - Javier Moreno
- National Centre for Microbiology, Instituto de Salud Carlos III, Ctra Majadahonda-Pozuelo Km 2,2, CP 28220 Majadahonda, Madrid, Spain
| | - Rogelio López-Vélez
- National Reference Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Ctra Colmenar Km 9,100, CP 28034, Madrid, Spain
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4
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Vioque F, Dashti A, Santín M, Ruiz-Fons F, Köster PC, Hernández-Castro C, García JT, Bailo B, Ortega S, Olea PP, Arce F, Chicharro C, Nieto J, González F, Viñuela J, Carmena D, González-Barrio D. Wild micromammal host spectrum of zoonotic eukaryotic parasites in Spain. Occurrence and genetic characterisation. Transbound Emerg Dis 2022; 69:e2926-e2942. [PMID: 35752461 DOI: 10.1111/tbed.14643] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
Micromammals have historically been recognized as highly contentious species in terms of the maintenance and transmission of zoonotic pathogens to humans. Limited information is currently available on the epidemiology and potential public health significance of intestinal eukaryotes in wild micromammals. We examined 490 faecal samples, grouped into 155 pools, obtained from 11 micromammal species captured in 11 Spanish provinces for the presence of DNA from Cryptosporidium spp., Giardia duodenalis, Enterocytozoon bieneusi and Blastocystis sp. The presence of Leishmania spp. was investigated in individual spleen samples. All micromammal species investigated harboured infections by at least one eukaryotic parasite, except Apodemus flavicollis, Myodes glareolus, Sorex coronatus and Sciurus vulgaris, but the sample size for these host species was very low. Cryptosporidium spp. was the most prevalent species found (3.7%, 95% confidence interval [CI]: 2.2-5.7), followed by G. duodenalis (2.8%, 95% CI: 1.6-4.6) and E. bieneusi (2.6%, 95% CI: 1.4-4.3). All pooled faecal samples tested negative for Blastocystis sp. Leishmania infantum was identified in 0.41% (95% CI: 0.05-1.46) of the 490 individual spleen samples analysed. Sequence analyses allowed the identification of Cryptosporidium andersoni (5.9%), C. ditrichi (11.7%), C. muris (5.9%), C. parvum (5.9%), C. tyzzeri (5.9%), rat genotypes CR97 (5.9%) and W19 (5.9%), vole genotypes V (11.7%) and VII (5.9%) and Cryptosproridium spp. (35.3%) within Cryptosporidium (n = 17). Known genotypes C (66.7%) and Peru11 (25.0%) and a novel genotype (named MouseSpEb1, 8.3%) were detected within E. bieneusi (n = 12). None of the G. duodenalis-positive samples could be genotyped at the assemblage level. Molecular data indicate that wild micromammals were primarily infected by rodent-adapted species/genotypes of eukaryotic pathogens and thereby have a limited role as a source of human infections. The presence of ruminant-adapted species C. andersoni along with finding C. parvum is indicative of an overlap between domestic/peri-domestic and sylvatic transmission cycles of these agents.
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Affiliation(s)
- Fátima Vioque
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Alejandro Dashti
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Mónica Santín
- EnvironmentalMicrobial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, USA
| | - Francisco Ruiz-Fons
- Instituto de Investigación en Recursos Cinegéticos (IREC), (CSIC-UCLM-JCCM), Ciudad Real, Spain
| | - Pamela C Köster
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Carolina Hernández-Castro
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
- Parasitology Group, Faculty of Medicine, Academic Corporation for the Study of Tropical Pathologies, University of Antioquia, Medellín, Colombia
| | - Jesus T García
- Parasitology Group, Faculty of Medicine, Academic Corporation for the Study of Tropical Pathologies, University of Antioquia, Medellín, Colombia
| | - Begoña Bailo
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Sheila Ortega
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Pedro P Olea
- Department of Ecology, Autonomous University of Madrid (UAM), Campus de Cantoblanco, Madrid, Spain
- Center for Research on Biodiversity and Global Change (CIBC-UAM), Autonomous University of Madrid (UAM), Campus de Cantoblanco, Madrid, Spain
| | - Fernando Arce
- School of Natural Sciences, University of Tasmania, Hobart, TAS, Australia
| | - Carmen Chicharro
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Health Institute Carlos III, Madrid, Spain
| | - Javier Nieto
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Health Institute Carlos III, Madrid, Spain
| | - Fernando González
- Department of Pharmacology and Toxicology, Faculty of Veterinary, Complutense University of Madrid, Madrid, Spain
| | - Javier Viñuela
- Instituto de Investigación en Recursos Cinegéticos (IREC), (CSIC-UCLM-JCCM), Ciudad Real, Spain
| | - David Carmena
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Health Institute Carlos III, Madrid, Spain
| | - David González-Barrio
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
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Solana JC, Chicharro C, García E, Aguado B, Moreno J, Requena JM. Assembly of a Large Collection of Maxicircle Sequences and Their Usefulness for Leishmania Taxonomy and Strain Typing. Genes (Basel) 2022; 13:genes13061070. [PMID: 35741832 PMCID: PMC9222942 DOI: 10.3390/genes13061070] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022] Open
Abstract
Parasites of medical importance, such as Leishmania and Trypanosoma, are characterized by the presence of thousands of circular DNA molecules forming a structure known as kinetoplast, within the mitochondria. The maxicircles, which are equivalent to the mitochondrial genome in other eukaryotes, have been proposed as a promising phylogenetic marker. Using whole-DNA sequencing data, it is also possible to assemble maxicircle sequences as shown here and in previous works. In this study, based on data available in public databases and using a bioinformatics workflow previously reported by our group, we assembled the complete coding region of the maxicircles for 26 prototypical strains of trypanosomatid species. Phylogenetic analysis based on this dataset resulted in a robust tree showing an accurate taxonomy of kinetoplastids, which was also able to discern between closely related Leishmania species that are usually difficult to discriminate by classical methodologies. In addition, we provide a dataset of the maxicircle sequences of 60 Leishmania infantum field isolates from America, Western Europe, North Africa, and Eastern Europe. In agreement with previous studies, our data indicate that L. infantum parasites from Brazil are highly homogeneous and closely related to European strains, which were transferred there during the discovery of America. However, this study showed the existence of different L. infantum populations/clades within the Mediterranean region. A maxicircle signature for each clade has been established. Interestingly, two L. infantum clades were found coexisting in the same region of Spain, one similar to the American strains, represented by the Spanish JPCM5 reference strain, and the other, named “non-JPC like”, may be related to an important leishmaniasis outbreak that occurred in Madrid a few years ago. In conclusion, the maxicircle sequence emerges as a robust molecular marker for phylogenetic analysis and species typing within the kinetoplastids, which also has the potential to discriminate intraspecific variability.
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Affiliation(s)
- Jose Carlos Solana
- Centro de Biología Molecular Severo Ochoa (CSIC-UAM), Departamento de Biología Molecular, Instituto Universitario de Biología Molecular (IUBM), Universidad Autónoma de Madrid, 28049 Madrid, Spain;
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (C.C.); (E.G.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (C.C.); (E.G.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Emilia García
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (C.C.); (E.G.)
| | - Begoña Aguado
- Centro de Biología Molecular Severo Ochoa (CSIC-UAM), Genomic and NGS Facility (GENGS), 28049 Madrid, Spain;
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (C.C.); (E.G.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (J.M.); (J.M.R.)
| | - Jose M. Requena
- Centro de Biología Molecular Severo Ochoa (CSIC-UAM), Departamento de Biología Molecular, Instituto Universitario de Biología Molecular (IUBM), Universidad Autónoma de Madrid, 28049 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (J.M.); (J.M.R.)
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Van der Auwera G, Davidsson L, Buffet P, Ruf MT, Gramiccia M, Varani S, Chicharro C, Bart A, Harms G, Chiodini PL, Brekke H, Robert-Gangneux F, Cortes S, Verweij JJ, Scarabello A, Karlsson Söbirk S, Guéry R, van Henten S, Di Muccio T, Carra E, van Thiel P, Vandeputte M, Gaspari V, Blum J. Surveillance of leishmaniasis cases from 15 European centres, 2014 to 2019: a retrospective analysis. Euro Surveill 2022; 27. [PMID: 35086613 PMCID: PMC8796293 DOI: 10.2807/1560-7917.es.2022.27.4.2002028] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Surveillance of human leishmaniasis in Europe is mostly limited to country-specific information from autochthonous infections in the southern part. As at the end of 2021, no integrated analysis has been performed for cases seen across centres in different European countries. Aim To provide a broad perspective on autochthonous and imported leishmaniasis cases in endemic and non-endemic countries in Europe. Methods We retrospectively collected records from cutaneous, mucosal and visceral leishmaniasis cases diagnosed in 15 centres between 2014 and 2019. Centres were located in 11 countries: Belgium, France, Germany, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom. Data on country of infection, reason for travelling, infecting species, age and sex were analysed. Results We obtained diagnostic files from 1,142 cases, of which 76%, 21% and 3% had cutaneous, visceral, and mucosal disease, respectively. Of these, 68% were men, and 32% women, with the median age of 37 years (range: 0–90) at diagnosis. Visceral leishmaniasis was mainly acquired in Europe (88%; 167/190), while cutaneous leishmaniasis was primarily imported from outside Europe (77%; 575/749). Sixty-two percent of cutaneous leishmaniasis cases from outside Europe were from the Old World, and 38% from the New World. Geographic species distribution largely confirmed known epidemiology, with notable exceptions. Conclusions Our study confirms previous reports regarding geographic origin, species, and traveller subgroups importing leishmaniasis into Europe. We demonstrate the importance of pooling species typing data from many centres, even from areas where the aetiology is presumably known, to monitor changing epidemiology.
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Affiliation(s)
| | | | - Pierre Buffet
- Service des maladies infectieuses et tropicales, AP-HP, Hopital Necker, Paris, France
| | - Marie-Thérèse Ruf
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Stefania Varani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Aldert Bart
- Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany
| | | | | | | | - Sofia Cortes
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jaco J Verweij
- Microvida Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | | | | | | | | | - Elena Carra
- Istituto Zooprofilattico Sperimentale della Lombardia e dell' Emilia-Romagna 'Bruno Ubertini', Brescia, Italy
| | | | | | - Valeria Gaspari
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Johannes Blum
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
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- The members of the network are listed under Investigators
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Silgado A, Armas M, Sánchez-Montalvá A, Goterris L, Ubals M, Temprana-Salvador J, Aparicio G, Chicharro C, Serre-Delcor N, Ferrer B, Molina I, García-Patos V, Pumarola T, Sulleiro E. Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona. PLoS Negl Trop Dis 2021; 15:e0009884. [PMID: 34758023 PMCID: PMC8580242 DOI: 10.1371/journal.pntd.0009884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Leishmania (L.) infantum is the only endemic species, but imported cases are often diagnosed. Different classical parasitological methods can be performed for cutaneous leishmaniasis (CL) diagnosis; but currently molecular techniques serve as a relevant tool for the detection and characterization of Leishmania parasites. We aimed to evaluate clinical and epidemiological characteristics of CL diagnosed patients by real-time PCR in a tertiary hospital over a six-year period. Methodology/Principal findings Clinical, epidemiological and microbiological data were retrospectively collected and analyzed. In our study, CL was confirmed in 59 (31.4%) out of 188 patients by real-time PCR, showing an increase over recent years: 11 cases of CL between 2014 and 2016 and 48 between 2017 and 2019. Real-time PCR was performed on skin swabs and/or biopsies samples, with a positivity of 38.5% and 26.5%, respectively. Results were 100% concordant when biopsy and skin swab were performed simultaneously. L. (L.) infantum was the most frequent species detected (50%), followed by L. (L.) major (45%) and Viannia subgenus (5%), which were detected only in imported cases. L. (L.) major was almost entirely detected in travelers/migrants from Morocco. Multiple and atypical skin lesions were more common in imported cases than in autochthonous cases (44.4% vs. 21.8%). Conclusions/Significance An increase in both autochthonous and imported CL cases has been observed in past years in our hospital. Molecular techniques assist in improving CL diagnosis and characterization of the Leishmania species, mainly in imported cases. Leishmaniasis is a neglected disease caused by different species of the genus Leishmania. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, the only endemic species is L. (L) infantum, although there are cases of imported leishmaniasis due to travel and migration of people from other endemic areas. Cutaneous lesions are the most common clinical form, but L. (L) infantum can also cause mucosal or visceral involvement. Although microscopic diagnosis and skin biopsy specimens are still used in routine diagnosis for cutaneous leishmaniasis, they are time-consuming and invasive, respectively. Currently, molecular techniques, such as real-time PCR, are very sensitive tools for the detection and identification of Leishmania parasites. In addition, the skin swab sample seems to be a non-invasive alternative for the diagnosis of cutaneous leishmaniasis. In the present work, we describe the clinical characteristics of 59 patients diagnosed by real-time PCR of cutaneous leishmaniasis, as well as the molecular epidemiology of the causative species. We show that there has been an increase in cutaneous leishmaniasis cases, both autochthonous and imported cases, over the study period. The presence of Leishmania species other than L. (L) infantum is also highlighted.
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Affiliation(s)
- Aroa Silgado
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Mayuli Armas
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases-Drassanes, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Lidia Goterris
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Maria Ubals
- Department of Dermatology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Temprana-Salvador
- Department of Pathology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gloria Aparicio
- Department of Dermatology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Núria Serre-Delcor
- Department of Infectious Diseases-Drassanes, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Berta Ferrer
- Department of Pathology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases-Drassanes, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Vicenç García-Patos
- Department of Dermatology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomas Pumarola
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
- * E-mail:
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Akuffo R, Sanchez C, Chicharro C, Carrillo E, Attram N, Mosore MT, Yeboah C, Kotey NK, Boakye D, Ruiz-Postigo JA, Moreno J, Wilson M, Sarfo B, Anto F. Detection of cutaneous leishmaniasis in three communities of Oti Region, Ghana. PLoS Negl Trop Dis 2021; 15:e0009416. [PMID: 34029326 PMCID: PMC8177633 DOI: 10.1371/journal.pntd.0009416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/04/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) is the most common type of leishmaniasis, a neglected tropical disease caused by parasites of the genus Leishmania. In Ghana, some studies in the Volta region have detected Leishmania parasites among persons with skin ulcers. Methodology/Principal findings Using a cross-sectional study design, the prevalence of CL in three communities of the Oti Region of Ghana was investigated. Demographic and epidemiological data were obtained by a structured interviewer administered questionnaire. A total of 426 (12.4%) out of 3,440 participants screened had at least one skin ulcer. Of 595 skin ulcers sampled and tested by PCR for Leishmania infection, 150 (25.2%) ulcers from 136 individuals tested positive, accounting for an overall CL prevalence of 31.9% among persons with skin ulcers. Individual community CL prevalence of 23.2%, 29.8%, and 36.8% was observed in Ashiabre, Keri, and Sibi Hilltop respectively among persons with skin ulcers. Conclusions/Significance Confirmation of CL in the study area suggests an active cycle of transmission of Leishmania infection. The observation of skin ulcers which tested negative to Leishmania infection suggests a need to test for additional causes of skin ulcers such as Treponema pallidum pertenue and Mycobacterium ulcerans in the study area. Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by parasites of the genus Leishmania and is transmitted by various species of female sandflies. CL usually begins as painless nodules and is usually characterized by skin ulcers which may be single or multiple. Although ulcers due to CL are often self-healing, they may become painful and result in scarring after healing. Typically, CL occurs on exposed parts of the body such as the neck, limbs, and face, which may be easily accessible to sandflies. Although cases of CL had previously been reported in some parts of the Volta region of Ghana, no previous case of CL had been reported in the Oti region. This study was initiated following reports of skin ulcers which were suggestive of CL in some communities of the Oti region. This study confirmed Leishmania infection in 150(25.5%) out of 595 skin ulcer samples obtained from 426 study participants. Given that 445(74,8%) of the skin ulcers tested negative for Leishmania parasite suggests a need for investigation of additional causes of skin ulcers such as yaws and Buruli ulcer in the study area.
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Affiliation(s)
- Richard Akuffo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- School of Public Health, University of Ghana, Accra, Ghana
| | - Carmen Sanchez
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Chicharro
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Naiki Attram
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | | | - Clara Yeboah
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | | | - Daniel Boakye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jose-Antonio Ruiz-Postigo
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Javier Moreno
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Michael Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Bismark Sarfo
- School of Public Health, University of Ghana, Accra, Ghana
| | - Francis Anto
- School of Public Health, University of Ghana, Accra, Ghana
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9
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Ibarra-Meneses AV, Chicharro C, Sánchez C, García E, Ortega S, Ndung’u JM, Moreno J, Cruz I, Carrillo E. Loop-Mediated Isothermal Amplification Allows Rapid, Simple and Accurate Molecular Diagnosis of Human Cutaneous and Visceral Leishmaniasis Caused by Leishmania infantum When Compared to PCR. Microorganisms 2021; 9:microorganisms9030610. [PMID: 33809454 PMCID: PMC7999953 DOI: 10.3390/microorganisms9030610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Loop-mediated isothermal amplification allows the rapid, sensitive and specific amplification of DNA without complex and expensive equipment. We compared the diagnostic performance of Loopamp™ Leishmania Detection Kit (Eiken Chemical Co., Ltd., Tokyo, Japan) with conventional and real-time polymerase chain reaction (PCR) for human cutaneous and visceral leishmaniasis caused by L. infantum. A total of 230 DNA samples from cutaneous (CL) and visceral (VL) leishmaniasis cases and controls from Spain, characterized by Leishmania nested PCR (LnPCR) were tested by: (i) the Loopamp™ Leishmania Detection Kit (Loopamp), run on Genie III real-time fluorimeter (OptiGene, UK); and (ii) real-time quantitative PCR (qPCR). The Loopamp test returned 98.8% (95% confidence interval—CI: 96.0–100.00) sensitivity and specificity of 97.7% (95% CI: 92.2–100) on VL samples, and 100% (95% CI: 99.1–100) sensitivity and 100.0% (95% CI: 98.8–100.0) specificity on CL samples. The Loopamp time-to-positivity (Tp) obtained by real-time fluorimetry showed excellent concordance (C = 97.91%) and strong correlation (r = 0.799) with qPCR’s cycle threshold (Ct). The performance of Loopamp is comparable to that of LnPCR and qPCR in the diagnosis of cutaneous and visceral leishmaniasis due to L. infantum. The excellent correlation between the Tp and Ct should be further investigated to determine the accuracy of Loopamp to quantify parasite load in tissues.
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Affiliation(s)
- Ana Victoria Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Emilia García
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Sheila Ortega
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | | | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, 1202 Geneva, Switzerland;
- National School of Public Health, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
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10
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Köster PC, Dashti A, Bailo B, Muadica AS, Maloney JG, Santín M, Chicharro C, Migueláñez S, Nieto FJ, Cano-Terriza D, García-Bocanegra I, Guerra R, Ponce-Gordo F, Calero-Bernal R, González-Barrio D, Carmena D. Occurrence and Genetic Diversity of Protist Parasites in Captive Non-Human Primates, Zookeepers, and Free-Living Sympatric Rats in the Córdoba Zoo Conservation Centre, Southern Spain. Animals (Basel) 2021; 11:700. [PMID: 33807707 PMCID: PMC8035673 DOI: 10.3390/ani11030700] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 12/19/2022] Open
Abstract
Little information is currently available on the epidemiology of parasitic and commensal protist species in captive non-human primates (NHP) and their zoonotic potential. This study investigates the occurrence, molecular diversity, and potential transmission dynamics of parasitic and commensal protist species in a zoological garden in southern Spain. The prevalence and genotypes of the main enteric protist species were investigated in faecal samples from NHP (n = 51), zookeepers (n = 19) and free-living rats (n = 64) by molecular (PCR and sequencing) methods between 2018 and 2019. The presence of Leishmania spp. was also investigated in tissues from sympatric rats using PCR. Blastocystis sp. (45.1%), Entamoeba dispar (27.5%), Giardia duodenalis (21.6%), Balantioides coli (3.9%), and Enterocytozoon bieneusi (2.0%) (but not Troglodytella spp.) were detected in NHP. Giardia duodenalis (10.5%) and Blastocystis sp. (10.5%) were identified in zookeepers, while Cryptosporidium spp. (45.3%), G. duodenalis (14.1%), and Blastocystis sp. (6.25%) (but not Leishmania spp.) were detected in rats. Blastocystis ST1, ST3, and ST8 and G. duodenalis sub-assemblage AII were identified in NHP, and Blastocystis ST1 in zookeepers. Giardia duodenalis isolates failed to be genotyped in human samples. In rats, four Cryptosporidium (C. muris, C. ratti, and rat genotypes IV and V), one G. duodenalis (assemblage G), and three Blastocystis (ST4) genetic variants were detected. Our results indicate high exposure of NHP to zoonotic protist species. Zoonotic transmission of Blastocysts ST1 was highly suspected between captive NHP and zookeepers.
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Affiliation(s)
- Pamela C. Köster
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
| | - Alejandro Dashti
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
| | - Begoña Bailo
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
| | - Aly S. Muadica
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
- Departamento de Ciências e Tecnologia, Universidade Licungo, Quelimane 106, Zambézia, Mozambique
| | - Jenny G. Maloney
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD 20705-2350, USA; (J.G.M.); (M.S.)
| | - Mónica Santín
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD 20705-2350, USA; (J.G.M.); (M.S.)
| | - Carmen Chicharro
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
| | - Silvia Migueláñez
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
| | - Francisco J. Nieto
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
| | - David Cano-Terriza
- Animal Health and Zoonosis Research Group (GISAZ), Department of Animal Health, University of Córdoba, 14071 Córdoba, Spain; (D.C.-T.); (I.G.-B.)
| | - Ignacio García-Bocanegra
- Animal Health and Zoonosis Research Group (GISAZ), Department of Animal Health, University of Córdoba, 14071 Córdoba, Spain; (D.C.-T.); (I.G.-B.)
| | - Rafael Guerra
- Veterinary Services, Córdoba Zoo Conservation Centre, 14071 Córdoba, Spain;
| | - Francisco Ponce-Gordo
- Department of Microbiology and Parasitology, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Rafael Calero-Bernal
- SALUVET, Department of Animal Health, Faculty of Veterinary, Complutense University of Madrid, 28040 Madrid, Spain;
| | - David González-Barrio
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
- SALUVET, Department of Animal Health, Faculty of Veterinary, Complutense University of Madrid, 28040 Madrid, Spain;
| | - David Carmena
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, 28220 Madrid, Spain; (P.C.K.); (A.D.); (B.B.); (A.S.M.); (C.C.); (S.M.); (F.J.N.)
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Cardozo RS, García-Montero PP, Chicharro C, Tardío JC. Cutaneous leishmaniasis: A pathological study of 360 cases with special emphasis on the contribution of immunohistochemistry and polymerase chain reaction to diagnosis. J Cutan Pathol 2020; 47:1018-1025. [PMID: 32578232 DOI: 10.1111/cup.13785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 05/23/2020] [Accepted: 06/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Traditional methods for the diagnosis of leishmaniasis yield poor sensitivity, which limits its effectiveness in lesions with a low parasite burden. METHODS Retrospective pathologic study of 360 cases of cutaneous leishmaniasis and analysis of the different diagnostic methods used. RESULTS In 93% of the lesions, histopathology showed a dense and diffuse inflammatory infiltrate, consisting of lymphocytes, histiocytes and plasma cells, which occupied the superficial and mid dermis and variably extended to deep dermis and superficial subcutis (standard pattern). The remaining cases exhibited atypical features, such as perivascular, interstitial or perifollicular inflammatory patterns, folliculitis or panniculitis. Granulomas were identified in 84% of biopsies, most of them as small, poorly formed, non-necrotizing histiocytic aggregates. Amastigotes were visualized by routine histopathologic exam in 36% of biopsies. Immunohistochemistry stained 17 of 26 lesions (65%) negative by conventional stains. PCR provided the correct diagnosis in 218 cases (58% of the series) negative for Leishmania by other techniques. CONCLUSIONS Biopsies negative for Leishmania by traditional diagnostic methods that show the histopathologic standard pattern, those with atypical features from patients with clinical suspicion of cutaneous leishmaniasis in endemic areas, should be studied by immunohistochemistry and/or PCR for Leishmania in order to reach the definitive diagnosis.
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Affiliation(s)
- Rocío S Cardozo
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Carmen Chicharro
- Leishmaniasis and Chagas Disease Unit, Reference and Research Laboratory in Parasitology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan C Tardío
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Basic Medical Sciences, Universidad Rey Juan Carlos, Madrid, Spain
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12
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Gálvez R, Montoya A, Cruz I, Fernández C, Martín O, Checa R, Chicharro C, Migueláñez S, Marino V, Miró G. Latest trends in Leishmania infantum infection in dogs in Spain, Part I: mapped seroprevalence and sand fly distributions. Parasit Vectors 2020; 13:204. [PMID: 32317026 PMCID: PMC7171843 DOI: 10.1186/s13071-020-04081-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/11/2020] [Indexed: 12/03/2022] Open
Abstract
Background This report describes L. infantum infection seroprevalence in dogs in Spain through data obtained from peer-reviewed literature and a cross-sectional serological survey assessing epidemiological and habitat variables as risk factors for infection. The study also provides preliminary sand fly species distribution data and indicates factors affecting their distribution and density. Methods Three different studies were conducted in Spain: (i) a peer-reviewed literature seroprevalence survey (1985–2019); (ii) a cross-sectional serological survey (2011–2016); and (iii) a preliminary entomological survey (2013–2014). In the cross-sectional serological survey, 1739 dogs from 74 different locations including 25 Spanish provinces were tested for L. infantum by indirect immunofluorescence antibody test (IFAT) (antibody titre ≥ 1:100). Seroprevalence of L. infantum infection was analysed by province and bioclimatic zone. Statistics were used to analyse relationships between several dog- and environment-related variables and L. infantum seroprevalence. In parallel, during 2013–2014, sand flies were collected across the Iberian Peninsula and the Balearic Islands using CDC light traps to examine relationships between habitat-related factors and sand fly species densities (number of sand flies per trap per hour). Results The literature review revealed that the provinces showing the highest seroprevalence were Balearic Islands (57.1%), Ourense (35.6%), Málaga (34.6%) and Cáceres (34.2%), and those showing the lowest seroprevalence were Vizcaya (0%), Cantabria (2.0%) and Álava (3.3%). In our survey, anti-Leishmania IgG antibodies were detected in 176 of the 1739 dogs rendering a seroprevalence of 10.12%. Percentage seroprevalence distributions significantly varied among bioclimatic belts. Seropositivity for L. infantum was related to size (large breed dogs versus small) and were significantly higher in younger dogs (≤ 1 years-old). In the entomological survey, 676 sand flies of five species were captured: 562 (83.13%) Phlebotomus perniciosus; 64 (9.47%) Sergentomyia minuta; 38 (5.62%) P. ariasi: 6 (0.89%) P. sergenti; and 6 (0.89%) P. papatasi. Phlebotomus perniciosus showed a greater density in the thermo-Mediterranean than in the meso-Mediterranean zone. Densities of S. minuta and P. ariasi were significantly higher in rural habitats. Conclusions This updated seroprevalence map of L. infantum infection in dogs in Spain defines non-endemic, hypoendemic, endemic and hyperendemic areas, and confirms P. perniciosus as the most abundant sand fly vector in Spain.![]()
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Affiliation(s)
- Rosa Gálvez
- Grupo de Investigación Epicontrol-Carnívoros, Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Montoya
- Grupo de Investigación Epicontrol-Carnívoros, Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Israel Cruz
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Fernández
- Grupo de Investigación Epicontrol-Carnívoros, Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Oihane Martín
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rocío Checa
- Grupo de Investigación Epicontrol-Carnívoros, Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Chicharro
- Parasitology Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Silvia Migueláñez
- Parasitology Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Valentina Marino
- Grupo de Investigación Epicontrol-Carnívoros, Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Guadalupe Miró
- Grupo de Investigación Epicontrol-Carnívoros, Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain.
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Echchakery M, Chicharro C, Boussaa S, Nieto J, Ortega S, Carrillo E, Moreno J, Boumezzough A. Molecular identification of Leishmania tropica and L. infantum isolated from cutaneous human leishmaniasis samples in central Morocco. J Vector Borne Dis 2020; 57:71-77. [PMID: 33818459 DOI: 10.4103/0972-9062.308804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Cutaneous leishmaniasis (CL) in Marrakesh-Safi region located in the central-south part of Morocco is a public health problem. This study assessed the efficiency of a microscopic examination method in establishing the diagnosis of CL and PCR for the characterization and identification of the circulating Leishmania strains in different CL foci of the study area. METHODS A total of 297 smears obtained from cutaneous lesions of suspected patients with CL were stained with May-Grünwald Giemsa (MGG) for microscopic examination. For each positive smear, genomic DNA was extracted and PCR-analysed, targeting the small subunit ribosomal ribonucleic acid (ssu rRNA) gene to detect Leishmania DNA. Then, the internal transcribed spacer 1 (ITS1) was amplified and sequenced in order to identify the Leishmania species. The sensitivity and specificity of the conventional microscopy with ssu rRNA gene were compared by Leishmania nested PCR (LnPCR) and ITS1 gene by ITS-PCR. RESULTS A total of 257 smears were positive in the microscopic examination, i.e. the detection rate of amastigotes by optical microscopy was 86.53% (257/297). The LnPCR was found to have a specificity and a sensitivity of 100%, each. Interestingly, the sequencing results showed that 99.61% (256/257) of the isolates had Leishmania tropica and 0.39% (1/257) had L. infantum infection. INTERPRETATION & CONCLUSION Though, classical microscopic examination is useful and economical, it is not sensitive enough, especially in endemic regions where several Leishmania species coexist. In such situations, PCR constitutes a complementary method for the identification of the causal species. The results indicate that both the L. tropica (dominant) and L. infantum are the causative agents of CL in the Marrakesh-Safi region. The rate of CL infection is high in Imintanout, and Chichaoua provinces. Hence, early diagnosis and prompt treatment of CL patients is necessary to prevent its extension to neighboring localities.
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Affiliation(s)
- M Echchakery
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - C Chicharro
- National Center of Microbiology, Institute of Health Carlos III (WHO Collaborating Centre for Leishmaniasis, Parasitology Service), Majadahonda, Madrid, Spain
| | - S Boussaa
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University; ISPITS-Higher Institute of Nursing and Technical Health Occupations, Marrakesh, Morocco
| | - J Nieto
- National Center of Microbiology, Institute of Health Carlos III (WHO Collaborating Centre for Leishmaniasis, Parasitology Service), Majadahonda, Madrid, Spain
| | - S Ortega
- National Center of Microbiology, Institute of Health Carlos III (WHO Collaborating Centre for Leishmaniasis, Parasitology Service), Majadahonda, Madrid, Spain
| | - E Carrillo
- National Center of Microbiology, Institute of Health Carlos III (WHO Collaborating Centre for Leishmaniasis, Parasitology Service), Majadahonda, Madrid, Spain
| | - J Moreno
- National Center of Microbiology, Institute of Health Carlos III (WHO Collaborating Centre for Leishmaniasis, Parasitology Service), Majadahonda, Madrid, Spain
| | - A Boumezzough
- Microbial Biotechnologies, Agrosciences and Environment Laboratory (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
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Torrellas A, Ferrer E, Cruz I, Lima HD, Delgado O, Rangel JC, Bravo JA, Chicharro C, Llanes-Acevedo IP, Miles MA, Feliciangeli MD. Molecular typing reveals the co-existence of two transmission cycles of American cutaneous leishmaniasis in the Andean Region of Venezuela with Lutzomyia migonei as the vector. Mem Inst Oswaldo Cruz 2018; 113:e180323. [PMID: 30540021 PMCID: PMC6282108 DOI: 10.1590/0074-02760180323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/30/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The transmission routes for American cutaneous leishmaniasis (ACL) are in flux, so studies examining its transmission in humans, mammalian hosts, and sand fly vectors are urgently needed. OBJECTIVES The aim of this work was understand the epidemiological cycles of Leishmania spp., which causes ACL in the Andean Region of Venezuela, by identifying the Leishmania and the sand fly species involved in human and dog infections. METHODS Thirty-one biopsies from patients in Mérida and Táchira states with suspected ACL were studied by both parasitological tests (cultures and hamster inoculation) and a molecular test [Internal transcribed spacer 1 (ITS1) nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)]. We also conducted a survey to detect Leishmania infection in dogs (Immunifluorescence antibody test and ITS1 nested PCR-RFLP) and sand flies (ITS1 nested PCR-RFLP) from El Carrizal, a highly endemic focus of ACL in Venezuela. FINDINGS Three different Leishmania species were identified in the clinical samples from humans (Leishmania braziliensis, L. guyanensis, and L. mexicana) and dogs (L. guyanensis and L. mexicana). The predominant sand fly species found were those from the Verrucarum group (infected with L. mexicana) and Lutzomyia migonei (infected with L. guyanensis and L. mexicana). MAIN CONCLUSIONS We show that Lu. migonei may be the putative vector in two ACL epidemiological cycles, involving L. guyanensis and L. mexicana. We also report for the first time the presence of L. guyanensis in domestic animals.
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Affiliation(s)
- Annhymariet Torrellas
- Universidad de Carabobo, Facultad de Ciencias de la Salud, Centro Nacional de Referencia de Flebotomos y otros Vectores, Instituto de Investigaciones Biomédicas Dr Francisco J Triana-Alonso, Maracay, Venezuela
| | - Elizabeth Ferrer
- Universidad de Carabobo, Facultad de Ciencias de la Salud, Instituto de Investigaciones Biomédicas Dr Francisco J Triana-Alonso, Maracay, Venezuela
| | - Israel Cruz
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Héctor de Lima
- Ministerio del Poder Popular para la Salud, Servicio Autónomo, Instituto de Biomedicina, Caracas, Venezuela
| | - Olinda Delgado
- Universidad Central de Venezuela, Instituto de Medicina Tropical, Caracas, Venezuela
| | | | - José Arturo Bravo
- Universidad de Carabobo, Facultad de Ciencias de la Salud, Centro Nacional de Referencia de Flebotomos y otros Vectores, Instituto de Investigaciones Biomédicas Dr Francisco J Triana-Alonso, Maracay, Venezuela
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ivonne Pamela Llanes-Acevedo
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael A Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Department of Pathogen Molecular Biology, London, United Kingdom
| | - María Dora Feliciangeli
- Universidad de Carabobo, Facultad de Ciencias de la Salud, Centro Nacional de Referencia de Flebotomos y otros Vectores, Instituto de Investigaciones Biomédicas Dr Francisco J Triana-Alonso, Maracay, Venezuela
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15
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Botana L, Matía B, San Martin JV, Romero-Maté A, Castro A, Molina L, Fernandez L, Ibarra-Meneses A, Aguado M, Sánchez C, Horrillo L, Chicharro C, Nieto J, Ortega S, Ruiz-Giardin JM, Carrillo E, Moreno J. Cellular Markers of Active Disease and Cure in Different Forms of Leishmania infantum-Induced Disease. Front Cell Infect Microbiol 2018; 8:381. [PMID: 30483480 PMCID: PMC6243388 DOI: 10.3389/fcimb.2018.00381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/09/2018] [Indexed: 11/13/2022] Open
Abstract
Increased numbers of peripheral blood mononucleocytes (PBMC) and increased IFN-γ secretion following in vitro challenge of blood samples with soluble Leishmania antigen (SLA), have been proposed as biomarkers of specific cell-mediated immunity, indicating that treatment of visceral leishmaniasis (VL) has been successful. However, Leishmania infantum infection may manifest as cutaneous leishmaniasis (CL), and less commonly as localized leishmanial lymphadenopathy (LLL) or mucosal leishmaniasis (ML). The present work examines the value of these biomarkers as indicators of cured leishmaniasis presenting in these different forms. Blood samples were collected before and after treatment from patients living in Fuenlabrada (Madrid, Spain), an L. infantum-endemic area recently the center of a leishmaniasis outbreak. All samples were subjected to Leishmania-specific PCR, serological tests (IFAT and rK39-ICT), and the SLA-cell proliferation assay (SLA-CPA), recording PBMC proliferation and the associated changes in IFN-γ production. Differences in the results recorded for the active and cured conditions were only significant for VL. PCR returned positive results in 67% of patients with active VL and in 3% of those with cured leishmaniasis. Similarly, rK39-ICT returned a positive result in 77% of active VL samples vs. 52% in cured VL samples, and IFAT in 90% vs. 56%; in the SLA-CPA, PBMC proliferation was seen in 16% vs. 90%, and an associated increase in IFN-γ production of 14 and 84%, respectively. The present findings reinforce the idea that PBMC proliferation and increased IFN-γ production in SLA-stimulated PBMC provide biomarkers of clinical cure in VL. Other tests are urgently needed to distinguish between the cured and active forms of the other types of clinical leishmaniasis caused by L. infantum.
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Affiliation(s)
- Laura Botana
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Matía
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.,Programa de Doctorado en Ciencias de la Salud, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Mostoles, Spain
| | | | | | - Alicia Castro
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Laura Molina
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Laura Fernandez
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Aguado
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Horrillo
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Nieto
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Sheila Ortega
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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16
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Ibarra-Meneses AV, Cruz I, Chicharro C, Sánchez C, Biéler S, Broger T, Moreno J, Carrillo E. Evaluation of fluorimetry and direct visualization to interpret results of a loop-mediated isothermal amplification kit to detect Leishmania DNA. Parasit Vectors 2018; 11:250. [PMID: 29665825 PMCID: PMC5905109 DOI: 10.1186/s13071-018-2836-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background Nucleic acid amplification tests (NAATs) have proven to be advantageous in the diagnosis of leishmaniases, allowing sensitive diagnosis of: (i) cutaneous leishmaniasis in long duration lesions and (ii) visceral leishmaniasis using a less-invasive sample like peripheral blood, in opposition to tissue aspiration required for parasite demonstration by microscopy. Despite their benefits, the implementation of NAATs for leishmaniasis diagnosis at the point-of-care has not been achieved yet, mostly due to the complexity and logistical issues associated with PCR-based methods. Methods In this work, we have evaluated the performance of a ready-to-use loop-mediated isothermal amplification (LAMP) kit using two real time fluorimeters to amplify leishmanial DNA obtained by silica column-based and Boil & Spin protocols. Results The different approaches used to run and interpret the LAMP reactions showed a performance equivalent to PCR and real-time PCR, using spiked and clinical samples. The time to positivity obtained with real-time fluorimetry showed an excellent correlation with both Ct values and parasite load from real-time quantitative PCR. Conclusions The results obtained open the possibility of using a highly stable, ready-to-use LAMP kit for the accurate diagnosis of leishmaniasis at the point-of-care. Furthermore, the feasibility of relating time to positivity, determined with a portable real-time fluorimeter, with the parasite burden could have a wider application in the management of leishmaniasis, such as in treatment efficacy monitoring or as a pharmacodynamics tool in clinical trials.
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Affiliation(s)
- Ana V Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Tobias Broger
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
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17
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Echchakery M, Nieto J, Boussaa S, El Fajali N, Ortega S, Souhail K, Aajly H, Chicharro C, Carrillo E, Moreno J, Boumezzough A. Asymptomatic carriers of Leishmania infantum in patients infected with human immunodeficiency virus (HIV) in Morocco. Parasitol Res 2018; 117:1237-1244. [PMID: 29478175 DOI: 10.1007/s00436-018-5805-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/08/2018] [Indexed: 02/02/2023]
Abstract
In Morocco, visceral leishmaniasis (VL) is a parasitic disease caused by the flagellated protozoan parasite Leishmania infantum. L. infantum is transmitted by the bite of female phlebotomine sandflies, and its main reservoir hosts are domestic dogs. Asymptomatic infection with L. infantum is more frequent than clinically apparent disease. In HIV-infected patients, the risk of clinical VL is increased due to immunosuppression that may reactivate latent infections. However, coinfected subjects do not necessarily develop VL and may remain as asymptomatic carriers depending on their immune status. The present study investigates the asymptomatic carriers of L. infantum in HIV-infected patients in central Morocco, where human cases of visceral leishmaniasis by L. infantum have been reported. A total of 200 HIV-infected patients attending the Infectious Diseases Unit of the Ibn Zohar Hospital of Marrakech participated in the study. Parasitological and serological blood analyses included a direct microscopic examination (DME), culture in Novy-McNeal-Nicolle (NNN) medium, and serology by indirect immunofluorescence (IFI). We found prevalence rates of 5% (10/200) by IFI, 3% (6/200) by DME, and 2.5% (5/200) by culture. The parasite was identified as L. infantum by PCR from positive cultures.
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Affiliation(s)
- M Echchakery
- Laboratory of Medical Analysis, Ibn Zohr Regional Hospital Center, Marrakech, Morocco.,Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - J Nieto
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - S Boussaa
- Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco. .,ISPITS-Higher Institute of Nursing and Health Technology, Marrakech, Morocco.
| | - N El Fajali
- Department of Infectious Diseases, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - S Ortega
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - K Souhail
- Laboratory of Medical Analysis, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - H Aajly
- Department of Infectious Diseases, Ibn Zohr Regional Hospital Center, Marrakech, Morocco
| | - C Chicharro
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - E Carrillo
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - J Moreno
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Ctra Pozuelo-Majadahonda, km 2, Majadahonda, 28220, Madrid, Spain
| | - A Boumezzough
- Ecology and the Environment Laboratory L2E (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
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18
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Montoya A, García M, Gálvez R, Checa R, Marino V, Sarquis J, Barrera J, Rupérez C, Caballero L, Chicharro C, Cruz I, Miró G. Implications of zoonotic and vector-borne parasites to free-roaming cats in central Spain. Vet Parasitol 2018; 251:125-130. [DOI: 10.1016/j.vetpar.2018.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
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Echchakery M, Chicharro C, Boussaa S, Nieto J, Carrillo E, Sheila O, Moreno J, Boumezzough A. Molecular detection of Leishmania infantum and Leishmania tropica in rodent species from endemic cutaneous leishmaniasis areas in Morocco. Parasit Vectors 2017; 10:454. [PMID: 28969710 PMCID: PMC5625640 DOI: 10.1186/s13071-017-2398-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 09/21/2017] [Indexed: 01/10/2023] Open
Abstract
Background Leishmaniasis remains a major public health problem in African nations, including Morocco, where little is known about the vertebrate reservoirs involved in the causal parasites’ transmission cycles. The present study investigates the role of rodent species as potential reservoirs of Leishmania spp. in central Morocco, where both L. tropica and L. infantum have been reported. Methods Rodents were caught from 22 sites in central Morocco, by using Sherman metal traps, and identified morphologically. For each specimen, genomic DNA was extracted from different tissues using the Speed Tools DNA extraction Kit. Then, samples were PCR-analyzed, targeting the SSU rRNA gene to detect Leishmania spp. DNA, followed by amplification of the internal transcribed spacer 1 (ITS1) and its sequencing to identify the species. Results A total of 197 rodents belonging to ten species were captured and identified: Rattus rattus (40.61%), Mus musculus (25.38%), Apodemus sylvaticus (8.63%), Mus spretus (7.11%), Meriones shawi (5.58%), Rattus norvegicus (4.57%), Meriones libycus (3.05%), Mastomys erythroleucus (2.03%), Gerbillus campestris (2.03%) and Lemniscomys barbarus (1.01%). Molecular analysis revealed the presence of Leishmania species in 18 specimens: six R. rattus (out of 80 captured; 7.5%), 11 M. musculus (out of 50 captured; 22%), and one R. norvegicus (out of 9 captured; 11.11%). Conclusions To the best of our knowledge, L. infantum and L. tropica were identified in rodent species for the first time in Morocco. These findings suggest that rodent species may be involved in L. infantum and L. tropica transmission cycles in this country but that further studies are needed to confirm their role as reservoirs of Leishmania species in Morocco. Electronic supplementary material The online version of this article (10.1186/s13071-017-2398-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohamed Echchakery
- Ecology and the Environment Laboratory L2E, (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco.
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Samia Boussaa
- Ecology and the Environment Laboratory L2E, (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco.,ISPITS-Higher Institute of Nursing and Technical Health Occupations, Ministry of Health, Marrakesh, Morocco
| | - Javier Nieto
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Ortega Sheila
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Parasitology Service, National Center of Microbiology Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Ali Boumezzough
- Ecology and the Environment Laboratory L2E, (URAC 32, CNRST ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
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20
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Van der Auwera G, Bart A, Chicharro C, Cortes S, Davidsson L, Di Muccio T, Dujardin JC, Felger I, Paglia MG, Grimm F, Harms G, Jaffe CL, Manser M, Ravel C, Robert-Gangneux F, Roelfsema J, Töz S, Verweij JJ, Chiodini PL. Comparison of Leishmania typing results obtained from 16 European clinical laboratories in 2014. ACTA ACUST UNITED AC 2017; 21:30418. [PMID: 27983510 PMCID: PMC5291127 DOI: 10.2807/1560-7917.es.2016.21.49.30418] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/13/2016] [Indexed: 11/20/2022]
Abstract
Leishmaniasis is endemic in southern Europe, and in other European countries cases are diagnosed in travellers who have visited affected areas both within the continent and beyond. Prompt and accurate diagnosis poses a challenge in clinical practice in Europe. Different methods exist for identification of the infecting Leishmania species. Sixteen clinical laboratories in 10 European countries, plus Israel and Turkey, conducted a study to assess their genotyping performance. DNA from 21 promastigote cultures of 13 species was analysed blindly by the routinely used typing method. Five different molecular targets were used, which were analysed with PCR-based methods. Different levels of identification were achieved, and either the Leishmania subgenus, species complex, or actual species were reported. The overall error rate of strains placed in the wrong complex or species was 8.5%. Various reasons for incorrect typing were identified. The study shows there is considerable room for improvement and standardisation of Leishmania typing. The use of well validated standard operating procedures is recommended, covering testing, interpretation, and reporting guidelines. Application of the internal transcribed spacer 1 of the rDNA array should be restricted to Old World samples, while the heat-shock protein 70 gene and the mini-exon can be applied globally.
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Affiliation(s)
| | - Aldert Bart
- Academic Medical Center, Amsterdam, The Netherlands
| | | | - Sofia Cortes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, UNL, Lisbon, Portugal
| | | | | | - Jean-Claude Dujardin
- Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Biomedical Sciences, Antwerp University, Antwerp, Belgium
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Maria Grazia Paglia
- National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Felix Grimm
- Institute of Parasitology, University of Zürich, Zürich, Switzerland
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Charles L Jaffe
- Hebrew University, Hadassah Medical Centre, Jerusalem, Israel
| | - Monika Manser
- United Kingdom National External Quality Assessment Service, London, United Kingdom
| | | | | | - Jeroen Roelfsema
- National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands
| | - Seray Töz
- Ege University, Faculty of Medicine, Department of Parasitology, Izmir, Turkey
| | | | - Peter L Chiodini
- Hospital for Tropical Diseases, London, United Kingdom.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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Llanes-Acevedo IP, Arcones C, Gálvez R, Martin O, Checa R, Montoya A, Chicharro C, Cruz S, Miró G, Cruz I. DNA sequence analysis suggests that cytb-nd1 PCR-RFLP may not be applicable to sandfly species identification throughout the Mediterranean region. Parasitol Res 2016; 115:1287-95. [PMID: 26755361 PMCID: PMC4759228 DOI: 10.1007/s00436-015-4865-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/30/2015] [Indexed: 12/04/2022]
Abstract
Molecular methods are increasingly used for both species identification of sandflies and assessment of their population structure. In general, they are based on DNA sequence analysis of targets previously amplified by PCR. However, this approach requires access to DNA sequence facilities, and in some circumstances, it is time-consuming. Though DNA sequencing provides the most reliable information, other downstream PCR applications are explored to assist in species identification. Thus, it has been recently proposed that the amplification of a DNA region encompassing partially both the cytochrome-B (cytb) and the NADH dehydrogenase 1 (nd1) genes followed by RFLP analysis with the restriction enzyme Ase I allows the rapid identification of the most prevalent species of phlebotomine sandflies in the Mediterranean region. In order to confirm the suitability of this method, we collected, processed, and molecularly analyzed a total of 155 sandflies belonging to four species including Phlebotomus ariasi, P. papatasi, P. perniciosus, and Sergentomyia minuta from different regions in Spain. This data set was completed with DNA sequences available at the GenBank for species prevalent in the Mediterranean basin and the Middle East. Additionally, DNA sequences from 13 different phlebotomine species (P. ariasi, P. balcanicus, P. caucasicus, P. chabaudi, P. chadlii, P. longicuspis, P. neglectus, P. papatasi, P. perfiliewi, P. perniciosus, P. riouxi, P. sergenti, and S. minuta), from 19 countries, were added to the data set. Overall, our molecular data revealed that this PCR-RFLP method does not provide a unique and specific profile for each phlebotomine species tested. Intraspecific variability and similar RFLP patterns were frequently observed among the species tested. Our data suggest that this method may not be applicable throughout the Mediterranean region as previously proposed. Other molecular approaches like DNA barcoding or phylogenetic analyses would allow a more precise molecular species identification.
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Affiliation(s)
- Ivonne Pamela Llanes-Acevedo
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, World Health Organization Collaborating Center for Leishmaniasis, Ctra. Majadahonda-Pozuelo Km2, Majadahonda, 28220, Madrid, Spain.
| | - Carolina Arcones
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, World Health Organization Collaborating Center for Leishmaniasis, Ctra. Majadahonda-Pozuelo Km2, Majadahonda, 28220, Madrid, Spain.
| | - Rosa Gálvez
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040, Madrid, Spain.
| | - Oihane Martin
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040, Madrid, Spain.
| | - Rocío Checa
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040, Madrid, Spain.
| | - Ana Montoya
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040, Madrid, Spain.
| | - Carmen Chicharro
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, World Health Organization Collaborating Center for Leishmaniasis, Ctra. Majadahonda-Pozuelo Km2, Majadahonda, 28220, Madrid, Spain.
| | - Susana Cruz
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, World Health Organization Collaborating Center for Leishmaniasis, Ctra. Majadahonda-Pozuelo Km2, Majadahonda, 28220, Madrid, Spain.
| | - Guadalupe Miró
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040, Madrid, Spain.
| | - Israel Cruz
- Neglected Tropical Diseases Programme, Foundation for Innovative New Diagnostics-FIND, Chemin des Mines 9, Campus Biotech, 1202, Geneva, Switzerland.
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Ramos A, Múñez E, García-Domínguez J, Martinez-Ruiz R, Chicharro C, Baños I, Suarez-Massa D, Cuervas-Mons V. Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient. Transpl Infect Dis 2015; 17:488-92. [PMID: 25816835 DOI: 10.1111/tid.12380] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/26/2014] [Accepted: 02/22/2015] [Indexed: 11/29/2022]
Abstract
Organ transplant recipients living in endemic regions are at increased risk of Leishmania infections. Visceral leishmaniasis is the most common kind of presentation in the Mediterranean basin. Rarely, Leishmania infantum may cause localized mucosal disease. We present the first case, to our knowledge, of a liver transplant recipient with localized mucosal leishmaniasis. Twenty-two years after transplantation, a painless, very slow growing ulcer appeared on the inner side of the patient's upper lip. A biopsy performed in the community hospital showed non-specific chronic inflammation without neoplastic signs. Because of a high suspicion of malignancy, the patient was transferred to the referral hospital to consider complete excision. The excisional biopsy revealed a granulomatous inflammatory reaction together with intracellular Leishmania amastigotes within macrophages. Leishmaniasis was confirmed by the nested polymerase chain reaction assay. The clinical and laboratory findings did not suggest visceral involvement. The patient received meglumine antimoniate for 21 days without relevant adverse effects.
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Affiliation(s)
- A Ramos
- Infectious Diseases Unit (Internal Medicine), Universidad Autónoma de Madrid, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E Múñez
- Infectious Diseases Unit (Internal Medicine), Universidad Autónoma de Madrid, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J García-Domínguez
- Plastic Surgery Department, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - R Martinez-Ruiz
- Microbiology Department, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - C Chicharro
- Parasitology Department, Instituto Nacional de Salud "Carlos III", Majadahonda, Madrid, Spain
| | - I Baños
- Liver Transplantation Unit (Internal Medicine), Universidad Autónoma de Madrid, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - D Suarez-Massa
- Pathology Department, HU Puerta de Hierro, Majadahonda, Madrid, Spain
| | - V Cuervas-Mons
- Liver Transplantation Unit (Internal Medicine), Universidad Autónoma de Madrid, HU Puerta de Hierro, Majadahonda, Madrid, Spain
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Lombardo G, Pennisi MG, Lupo T, Chicharro C, Solano-Gallego L. Papular dermatitis due to Leishmania infantum infection in seventeen dogs: diagnostic features, extent of the infection and treatment outcome. Parasit Vectors 2014; 7:120. [PMID: 24661822 PMCID: PMC3987822 DOI: 10.1186/1756-3305-7-120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/10/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | | | - Laia Solano-Gallego
- Departament de Medicina i Cirurgia Animal, Facultat de Veterinaria, Universitat Autònoma de Barcelona, Cerdanyola 08193 Barcelona, Spain.
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Chicharro C, Llanes-Acevedo IP, García E, Nieto J, Moreno J, Cruz I. Molecular typing of Leishmania infantum isolates from a leishmaniasis outbreak in Madrid, Spain, 2009 to 2012. ACTA ACUST UNITED AC 2013; 18:20545. [PMID: 23929179 DOI: 10.2807/1560-7917.es2013.18.30.20545] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Leishmaniasis is endemic in south-west Europe. Recent data point to the spread and (re-)emergence of this disease in previously endemic and non-endemic European countries. A recent example is the urban community outbreak of cutaneous and visceral leishmaniasis in the south-west of Madrid autonomous community, Spain, which began on 1 July 2009. A total of 446 cases associated to this outbreak were reported up to 31 December 2012. We show molecular typing data for 73 Leishmania infantum isolates obtained from January 2008 to July 2012 from different areas of Madrid, including those affected by the outbreak. Seven different genotypes were identified by combining data from two targets: the ribosomal internal transcribed spacers (ITS)-1 and -2 and the haspb (k26) gene. The results contribute to a better understanding of the parasite population circulating in the region, and indicate that most of the outbreak-associated isolates (22/31) were infected by parasites with the same combined genotype. Additional data from 82 L. infantum isolates typed as either MON-1 or MON-24 by isoenzyme analysis indicate that far from concluding that the outbreak was caused by a 'new' emerging genotype, further molecular typing-based surveillance studies are required to better understand the epidemiology of leishmaniasis in the region.
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Affiliation(s)
- C Chicharro
- WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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Custodio E, Gadisa E, Sordo L, Cruz I, Moreno J, Nieto J, Chicharro C, Aseffa A, Abraham Z, Hailu T, Cañavate C. Factors associated with Leishmania asymptomatic infection: results from a cross-sectional survey in highland northern Ethiopia. PLoS Negl Trop Dis 2012; 6:e1813. [PMID: 23029576 PMCID: PMC3459849 DOI: 10.1371/journal.pntd.0001813] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 07/27/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In northern Ethiopia the prevalence of visceral leishmaniasis is steadily rising posing an increasing public health concern. In order to develop effective control strategies on the transmission of the disease it is important to generate knowledge on the epidemiological determinants of the infection. METHODOLOGY/PRINCIPAL FINDINGS We conducted a cross-sectional survey on children 4-15 years of age using a multi staged stratified cluster sampling on high incidence sub-districts of Amhara regional state, Ethiopia. The survey included a socio-demographic, health and dietary questionnaire, and anthropometric measurements. We performed rK39-ICT and DAT serological tests in order to detect anti-Leishmania antibodies and carried out Leishmanin Skin Test (LST) using L.major antigen. Logistic regression models were used. Of the 565 children surveyed 56 children were positive to infection (9.9%). The individual variables that showed a positive association with infection were increasing age, being male and sleeping outside [adjusted odds ratios (95% CI): 1.15 (1.03, 1.29), 2.56 (1.19, 5.48) and 2.21 (1.03, 4.71) respectively] and in relation to the household: past history of VL in the family, living in a straw roofed house and if the family owned sheep [adjusted OR (95% CI): 2.92 (1.25, 6.81), 2.71 (1.21, 6.07) and 4.16 (1.41, 12.31) respectively]. CONCLUSIONS/SIGNIFICANCE A behavioural pattern like sleeping outside is determinant in the transmission of the infection in this area. Protective measures should be implemented against this identified risk activity. Results also suggest a geographical clustering and a household focalization of the infection. The behaviour of the vector in the area needs to be clarified in order to establish the role of domestic animals and house materials in the transmission of the infection.
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Affiliation(s)
- Estefanía Custodio
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.
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26
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Sordo L, Gadisa E, Custodio E, Cruz I, Simón F, Abraham Z, Moreno J, Aseffa A, Tsegaye H, Nieto J, Chicharro C, Cañavate C. Low prevalence of Leishmania infection in post-epidemic areas of Libo Kemkem, Ethiopia. Am J Trop Med Hyg 2012; 86:955-8. [PMID: 22665599 DOI: 10.4269/ajtmh.2012.11-0436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In Libo Kemkem (a district of Amhara region, Ethiopia), no cases of kala-azar had ever been reported until 2005 when an outbreak occurred. Over one-third of those cases were children under 15 years of age. The aim of the present study was to determine the prevalence of Leishmania infection in children aged 4-15 years. A cross-sectional survey was conducted in 2009. Children participating in the survey were selected using a three-stage cluster sampling method. A total of 386 children were included in the study. The overall prevalence of Leishmania infection (direct agglutination test- and/or rK39 immunochromatographic test- and/or leishmanin skin test-positive subjects) in this population was 1.02% (95% confidence interval = 0-4.54), and prevalence was higher in boys and children older than 12 years. Only one case of active disease was encountered. The results suggest that the conditions responsible for the outbreak no longer reign. However, active surveillance remains necessary.
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Affiliation(s)
- Luis Sordo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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27
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Gadisa E, Custodio E, Cañavate C, Sordo L, Abebe Z, Nieto J, Chicharro C, Aseffa A, Yamuah L, Engers H, Moreno J, Cruz I. Usefulness of the rK39-immunochromatographic test, direct agglutination test, and leishmanin skin test for detecting asymptomatic Leishmania infection in children in a new visceral leishmaniasis focus in Amhara State, Ethiopia. Am J Trop Med Hyg 2012; 86:792-8. [PMID: 22556076 DOI: 10.4269/ajtmh.2012.11-0196] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In areas where visceral leishmaniasis is anthroponotic, asymptomatically infected patients may play a role in transmission. Additionally, the number of asymptomatic patients in a disease-endemic area will also provide information on transmission dynamics. Libo Kemkem and Fogera districts (Amhara State, Ethiopia) are now considered newly established areas to which visceral leishmaniasis is endemic. In selected villages in these districts, we conducted a study to assess the usefulness of different approaches to estimate the asymptomatic infection rate. Of 605 participants, the rK39 immunochromatographic test was able to detect asymptomatic infection in 1.5% (9 of 605), direct agglutination test in 5.3% (32 of 605), and leishmanin skin test in 5.6% (33 of 589); the combined use of serologic methods and leishmanin skin test enabled detecting asymptomatic infection in 10.1% (61 of 605). We conclude that the best option to detect asymptomatic infection in this new visceral leishmaniasis-endemic focus is the combined use of the direct agglutination test and the leishmanin skin test.
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28
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Requena JM, Chicharro C, García L, Parrado R, Puerta CJ, Cañavate C. Sequence analysis of the 3'-untranslated region of HSP70 (type I) genes in the genus Leishmania: its usefulness as a molecular marker for species identification. Parasit Vectors 2012; 5:87. [PMID: 22541251 PMCID: PMC3425316 DOI: 10.1186/1756-3305-5-87] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/08/2012] [Indexed: 12/18/2022] Open
Abstract
Background The Leishmaniases are a group of clinically diverse diseases caused by parasites of the genus Leishmania. To distinguish between species is crucial for correct diagnosis and prognosis as well as for treatment decisions. Recently, sequencing of the HSP70 coding region has been applied in phylogenetic studies and for identifying of Leishmania species with excellent results. Methods In the present study, we analyzed the 3’-untranslated region (UTR) of Leishmania HSP70-type I gene from 24 strains representing eleven Leishmania species in the belief that this non-coding region would have a better discriminatory capacity for species typing than coding regions. Results It was observed that there was a remarkable degree of sequence conservation in this region, even between species of the subgenus Leishmania and Viannia. In addition, the presence of many microsatellites was a common feature of the 3´-UTR of HSP70-I genes in the Leishmania genus. Finally, we constructed dendrograms based on global sequence alignments of the analyzed Leishmania species and strains, the results indicated that this particular region of HSP70 genes might be useful for species (or species complex) typing, improving for particular species the discrimination capacity of phylogenetic trees based on HSP70 coding sequences. Given the large size variation of the analyzed region between the Leishmania and Viannia subgenera, direct visualization of the PCR amplification product would allow discrimination between subgenera, and a HaeIII-PCR-RFLP analysis might be used for differentiating some species within each subgenera. Conclusions Sequence and phylogenetic analyses indicated that this region, which is readily amplified using a single pair of primers from both Old and New World Leishmania species, might be useful as a molecular marker for species discrimination.
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Affiliation(s)
- Jose M Requena
- Centro de Biología Molecular Severo Ochoa (CSIC-UAM), Universidad Autonoma de Madrid, 28049 Madrid, Spain.
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Cañavate C, Herrero M, Nieto J, Cruz I, Chicharro C, Aparicio P, Mulugeta A, Argaw D, Blackstock AJ, Alvar J, Bern C. Evaluation of two rK39 dipstick tests, direct agglutination test, and indirect fluorescent antibody test for diagnosis of visceral leishmaniasis in a new epidemic site in highland Ethiopia. Am J Trop Med Hyg 2011; 84:102-6. [PMID: 21212210 DOI: 10.4269/ajtmh.2011.10-0229] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We assessed the performance characteristics of two rK39 immunochromatographic tests, a direct agglutination test (DAT), and an indirect immunofluorescent antibody test (IFAT) in the site of a new epidemic of visceral leishmaniasis (VL) in northwestern Ethiopia. The study population was composed of 179 patients with suspected VL and 67 controls. The sensitivities of Kalazar Detect(®), DiaMed-IT Leish(®), DAT, and IFAT in 35 polymerase chain reaction-confirmed VL cases were 94.3%, 91.4%, 91.4%, and 100%, respectively, and the specificities were 98.5%, 94%, 98.5%, and 98.5%, respectively. In a Bayesian latent class analysis of all 246 specimens, the estimated sensitivities were 90.5%, 89%, 88.8%, and 96% for Kalazar Detect(®), DiaMed-IT Leish(®), DAT, and IFAT, respectively; DAT showed the highest estimated specificity (97.4%). Both rK39 immunochromatographic tests perform as well as DAT, and are suitable for VL diagnosis in first-level health centers in this area of Ethiopia.
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Affiliation(s)
- Carmen Cañavate
- World Health Organization Collaborating Center for Leishmaniasis, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
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Cortes S, Chicharro C, Cruz I, Cristovão JM, Cañavate C, Campino L. Genetic diversity of human zoonotic leishmaniasis in Iberian Peninsula. Zoonoses Public Health 2010; 58:234-7. [PMID: 21040506 DOI: 10.1111/j.1863-2378.2010.01374.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leishmaniasis caused by Leishmania (Leishmania) infantum is a zoonotic disease endemic in South Europe, from Portugal to the Middle East. The aim of the present study was to investigate the genetic diversity of L. infantum parasites in Iberian Peninsula. Twenty-four L. infantum strains isolated from immunocompetent patients with leishmaniasis from several localities of Portugal and Spain were studied. The use of kinetoplast DNA-PCR-restriction fragment length polymorphism as a molecular marker revealed intra-specific variation. No association was found between genotype and clinical form of the disease or patients age group. Two main clusters were identified with this marker: (i) zymodeme MON-1 strains and (ii) non-MON-1 strains. However, no association was found between strains variability and geographical distribution suggesting that parasite populations of different regions in the Iberian Peninsula are homogenous.
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Affiliation(s)
- S Cortes
- Unidade de Leishmanioses, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
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Bashaye S, Nombela N, Argaw D, Mulugeta A, Herrero M, Nieto J, Chicharro C, Cañavate C, Aparicio P, Vélez ID, Alvar J, Bern C. Risk factors for visceral leishmaniasis in a new epidemic site in Amhara Region, Ethiopia. Am J Trop Med Hyg 2009; 81:34-39. [PMID: 19556563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We conducted a case-control study to evaluate risk factors for visceral leishmaniasis during an epidemic in a previously unaffected district of Ethiopia. We also collected blood and bone marrow specimens from dogs in the outbreak villages. In multivariable analyses of 171 matched case-control pairs, dog ownership, sleeping under an acacia tree during the day, and habitually sleeping outside at night were associated with significantly increased risk. Specimens from 7 (3.8%) dogs were positive by immunofluorescent antibody test (IFAT) and both enzyme-linked immunosorbent assays (ELISAs), whereas Leishmania DNA was detected in 5 (2.8%) bone marrow aspirates (from 3 seropositive and 2 seronegative dogs). Insecticide-treated nets may only protect a portion of those at risk. Further research on the vectors, the role of the dog in the transmission cycle, and the effect of candidate interventions are needed to design the best strategy for control.
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Affiliation(s)
- Seife Bashaye
- Malaria & Other Vector Borne Diseases, Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
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Bashaye S, Herrero M, Cañavate C, Vélez ID, Nieto J, Alvar J, Argaw D, Mulugeta A, Nombela N, Aparicio P, Bern C, Chicharro C. Risk Factors for Visceral Leishmaniasis in a New Epidemic Site in Amhara Region, Ethiopia. Am J Trop Med Hyg 2009. [DOI: 10.4269/ajtmh.2009.81.34] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kuhls K, Chicharro C, Cañavate C, Cortes S, Campino L, Haralambous C, Soteriadou K, Pratlong F, Dedet JP, Mauricio I, Miles M, Schaar M, Ochsenreither S, Radtke OA, Schönian G. Differentiation and gene flow among European populations of Leishmania infantum MON-1. PLoS Negl Trop Dis 2008; 2:e261. [PMID: 18612461 PMCID: PMC2438616 DOI: 10.1371/journal.pntd.0000261] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 06/12/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leishmania infantum is the causative agent of visceral and cutaneous leishmaniasis in the Mediterranean region, South America, and China. MON-1 L. infantum is the predominating zymodeme in all endemic regions, both in humans and dogs, the reservoir host. In order to answer important epidemiological questions it is essential to discriminate strains of MON-1. METHODOLOGY/PRINCIPAL FINDINGS We have used a set of 14 microsatellite markers to analyse 141 strains of L. infantum mainly from Spain, Portugal, and Greece of which 107 strains were typed by MLEE as MON-1. The highly variable microsatellites have the potential to discriminate MON-1 strains from other L. infantum zymodemes and even within MON-1 strains. Model- and distance-based analysis detected a considerable amount of structure within European L. infantum. Two major monophyletic groups-MON-1 and non-MON-1-could be distinguished, with non-MON-1 being more polymorphic. Strains of MON-98, 77, and 108 were always part of the MON-1 group. Among MON-1, three geographically determined and genetically differentiated populations could be identified: (1) Greece; (2) Spain islands-Majorca/Ibiza; (3) mainland Portugal/Spain. All four populations showed a predominantly clonal structure; however, there are indications of occasional recombination events and gene flow even between MON-1 and non-MON-1. Sand fly vectors seem to play an important role in sustaining genetic diversity. No correlation was observed between Leishmania genotypes, host specificity, and clinical manifestation. In the case of relapse/re-infection, only re-infections by a strain with a different MLMT profile can be unequivocally identified, since not all strains have individual MLMT profiles. CONCLUSION In the present study for the first time several key epidemiological questions could be addressed for the MON-1 zymodeme, because of the high discriminatory power of microsatellite markers, thus creating a basis for further epidemiological investigations.
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Affiliation(s)
- Katrin Kuhls
- Institut für Mikrobiologie und Hygiene, Charité Universitätsmedizin Berlin, Berlin, Germany.
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Carrillo E, Crusat M, Nieto J, Chicharro C, Thomas MDC, Martínez E, Valladares B, Cañavate C, Requena JM, López MC, Alvar J, Moreno J. Immunogenicity of HSP-70, KMP-11 and PFR-2 leishmanial antigens in the experimental model of canine visceral leishmaniasis. Vaccine 2008; 26:1902-11. [PMID: 18321614 DOI: 10.1016/j.vaccine.2008.01.042] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/09/2008] [Accepted: 01/21/2008] [Indexed: 01/14/2023]
Abstract
Zoonotic visceral leishmaniasis (ZVL) is a parasitic disease caused by Leishmania infantum/L. chagasi that is emerging as an important medical and veterinary problem. Dogs are the domestic reservoir for this parasite and, therefore, the main target for controlling the transmission to humans. In the present work, we have evaluated the immunogenicity of the Leishmania infantum heat shock protein (HSP)-70, paraflagellar rod protein (PFR)-2 and kinetoplastida membrane protein (KMP)-11 recombinant proteins in dogs experimentally infected with the parasite. We have shown that peripheral blood mononuclear cells (PBMC) from experimentally infected dogs proliferated in response to these recombinant antigens and against the soluble leishmanial antigen (SLA). We have also quantified the mRNA expression level of the cytokines induced in PBMC upon stimulation with the HSP-70, PFR-2 and KMP-11 proteins. These recombinant proteins induced an up-regulation of IFN-gamma. HSP-70 and PFR-2 also produced an increase of the TNF-alpha transcripts abundance. No measurable induction of IL-10 was observed and low levels of IL-4 mRNA were produced in response to the three mentioned recombinant antigens. Serum levels of specific antibodies against HSP-70, PFR-2 and KMP-11 recombinant proteins were also determined in these animals. Our study showed that HSP-70, KMP-11 and PFR-2 proteins are recognized by infected canines. Furthermore, these antigens produce a Th1-type immune response, suggesting that they may be involved in protection. The identification as vaccine candidates of Leishmania antigens that elicit appropriate immune responses in the canine model is a key step in the rational approach to generate a vaccine for canine visceral leishmaniasis.
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Affiliation(s)
- Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Inst. de Salud Carlos III, Majadahonda, Spain
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Moreno J, Nieto J, Masina S, Cañavate C, Cruz I, Chicharro C, Carrillo E, Napp S, Reymond C, Kaye PM, Smith DF, Fasel N, Alvar J. Immunization with H1, HASPB1 and MML Leishmania proteins in a vaccine trial against experimental canine leishmaniasis. Vaccine 2007; 25:5290-300. [PMID: 17576026 PMCID: PMC2695600 DOI: 10.1016/j.vaccine.2007.05.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 01/13/2007] [Accepted: 05/13/2007] [Indexed: 11/21/2022]
Abstract
The protective capabilities of three Leishmania recombinant proteins – histone 1 (H1) and hydrophilic acylated surface protein B1 (HASPB1) immunized singly, or together as a protein cocktail vaccine with Montanide™, and the polyprotein MML immunized with MPL®-SE adjuvant – were assessed in beagle dogs. Clinical examination of the dogs was carried out periodically under blinded conditions and the condition of the dogs defined as asymptomatic or symptomatic. At the end of the trial, we were able to confirm that following infection with L. infantum promastigotes, five out of eight dogs immunized with H1 Montanide™, and four out of eight dogs immunized with either the combination of HASPB1 with Montanide™ or the combination of H1 + HASPB1 with Montanide™, remained free of clinical signs, compared with two out of seven dogs immunized with the polyprotein MML and adjuvant MPL®-SE, and two out of eight dogs in the control group. The results demonstrate that HASPB1 and H1 antigens in combination with Montanide™ were able to induce partial protection against canine leishmaniasis, even under extreme experimental challenge conditions.
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Affiliation(s)
- J Moreno
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
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Botilde Y, Laurent T, Quispe Tintaya W, Chicharro C, Cañavate C, Cruz I, Kuhls K, Schönian G, Dujardin JC. Comparison of molecular markers for strain typing of Leishmania infantum. Infection, Genetics and Evolution 2006; 6:440-6. [PMID: 16581311 DOI: 10.1016/j.meegid.2006.02.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 02/22/2006] [Accepted: 02/23/2006] [Indexed: 11/20/2022]
Abstract
The epidemiology of Leishmania infantum, the etiological agent of visceral leishmaniasis, is changing rapidly; hence powerful typing tools are required in order to monitor the parasite populations spreading and to adapt adequate control measures. We compared here the resolving power of four molecular methods at the zymodeme level: PCR-RFLP analysis of kDNA minicircles (kDNAPCR-RFLP) and antigen genes (cysteine proteinase b and major surface protease, cpb- and gp63PCR-RFLP), multilocus microsatellite typing (MLMT) and random amplification of polymorphic DNA (RAPD) were applied to samples of 25 L. infantum MON-1 strains obtained from different hosts (HIV+ patients, HIV- patients and dogs) coming from three Spanish foci: Madrid, Mallorca and Ibiza. While RAPD was not sufficiently resolving, the other three methods allowed genotyping within the zymodeme. KDNAPCR-RFLP and MLMT were the most discriminatory and appeared the most adequate for strain fingerprinting. In an eco-geographical context, cpbPCR-RFLP, MLMT and kDNAPCR-RFLP were all informative: they showed here a similar picture, with the existence of cluster(s) of isolates from the islands and other one(s) of mixed composition (Madrid and the islands). None of the markers revealed an association with the host type or the clinical form. In general, there was a significant correlation between each pair of distances calculated from the cpb, microsatellite and kDNA data, respectively, but visual inspection of the trees revealed a better congruence between cpb and microsatellite trees. The methods used here are complementary and each adapted to answer specific epidemiological questions. Their choice should be the result of a compromise between the required resolving power, the genetic features of the respective markers and the technical aspects.
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Affiliation(s)
- Yanick Botilde
- Laboratory of Molecular Parasitology, Instituut voor Tropische Geneeskunde, Nationalestraat 155, B-2000 Antwerpen, Belgium
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Cruz I, Chicharro C, Nieto J, Bailo B, Cañavate C, Figueras MC, Alvar J. Comparison of new diagnostic tools for management of pediatric Mediterranean visceral leishmaniasis. J Clin Microbiol 2006; 44:2343-7. [PMID: 16825347 PMCID: PMC1489479 DOI: 10.1128/jcm.02297-05] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
New techniques are available for diagnosing leishmaniasis, but their efficacy in the identification of pediatric visceral leishmaniasis (VL) has not been compared with that of traditional methods. Blood, bone marrow, and urine samples were taken from 25 children with VL during their first clinical episode, 22 days after the start of treatment with liposomal amphotericin B (3 mg/kg/day on 6 days over a 10-day period), and when a relapse was suspected during follow-up. The results obtained suggest that antibody detection techniques, the antigen detection in urine (KAtex kit), and Leishmania nested PCR (LnPCR) analysis of the blood could be used for diagnosis of the first clinical episode. After treatment, clinical improvement was associated with negativization of Novy-MacNeal-Nicolle culture and microscopy of bone marrow aspirate, KAtex test, and LnPCR blood analysis results. Interestingly, LnPCR analysis of the bone marrow aspirate showed that sterile cure was not achieved in eight patients, two of which suffered a relapse within 10 to 20 weeks. All of the new noninvasive techniques tested showed high diagnostic sensitivity. However, LnPCR analysis of the bone marrow was the most sensitive; this test was able to detect the persistence of parasites and predict potential relapses.
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Affiliation(s)
- Israel Cruz
- WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Pozuelo-Majadahonda km 2, 28220 Majadahonda, Madrid, Spain.
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Folgueira C, Cañavate C, Chicharro C, Requena JM. Genomic organization and expression of the HSP70 locus in New and Old World Leishmania species. Parasitology 2006; 134:369-77. [PMID: 17054823 DOI: 10.1017/s0031182006001570] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 08/31/2006] [Accepted: 08/31/2006] [Indexed: 01/23/2023]
Abstract
Heat shock is believed to be a developmental inductor of differentiation in Leishmania. Furthermore, heat shock genes are extensively studied as gene models to decipher mechanisms of gene regulation in kinetoplastids. Here, we describe the organization and expression of the HSP70 loci in representative Leishmania species (L. infantum, L. major, L. tropica, L. mexicana, L. amazonensis and L. braziliensis). With the exception of L. braziliensis, the organization of the HSP70 loci was found to be well conserved among the other Leishmania species. Two types of genes, HSP70-I and HSP70-II, were found to be present in these Leishmania species except for L. braziliensis that lacks HSP70-II gene. Polymorphisms in the HSP70 locus allow the differentiation of the Old and New World species within the subgenus Leishmania. A notable discrepancy between our data and those of the L. major genome database in relation to the gene copy number composing the L. major HSP70 locus was revealed. The temperature-dependent accumulation of the HSP70-I mRNAs is also conserved among the different Leishmania species with the exception of L. braziliensis. In spite of these differences, analysis of the HSP70 synthesis indicated that the HSP70 mRNAs are also preferentially translated during heat shock in L. braziliensis.
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Affiliation(s)
- C Folgueira
- Centro de Biología Molecular Severo Ochoa, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Abstract
Although the family Trypanosomatidae includes parasites of plants, insects and vertebrates, only two genera in the family, Leishmania and Trypanosoma, are usually found in humans. Since 1995, however, other monoxenous trypanosomatids have been isolated from several HIV-positive individuals, in whom the parasites cause either visceral or cutaneous lesions. These odd cases are reviewed here. It appears that immunocompromised patients may be vulnerable to infection with trypanosomatids (and other parasites) that either fail to survive or never cause detectable morbidity in the immunocompetent.
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Affiliation(s)
- C Chicharro
- WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
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Abstract
In many areas of the Mediterranean basin, leishmaniasis can now be found in HIV-positive individuals. Such cases of Leishmania/HIV co-infection are relatively common in southern Europe, Spain being the country that has reported the greatest number. Since 1984, 359 Spanish isolates of Leishmania infantum have been characterized at the Instituto de Salud Carlos III in Madrid. Most (94.6%) of the isolates came from HIV-positive patients. The results of iso-enzymatic analysis indicated a high level of variability among the isolates, the visceralization in HIV-positive individuals of variants considered to be dermotropic in the immunocompetent, and the appearance of new zymodemes among the HIV-positive human population.
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Affiliation(s)
- C Chicharro
- WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
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Morales MA, Cruz I, Rubio JM, Chicharro C, Cañavate C, Laguna F, Alvar J. Relapses versus reinfections in patients coinfected with Leishmania infantum and human immunodeficiency virus type 1. J Infect Dis 2002; 185:1533-7. [PMID: 11992294 DOI: 10.1086/340219] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2001] [Revised: 01/14/2002] [Indexed: 11/03/2022] Open
Abstract
In the Mediterranean basin, Leishmania infantum is a major opportunistic parasite in people with acquired immunodeficiency syndrome (AIDS), and up to 9% of the patients with AIDS suffer from newly acquired or reactivated visceral leishmaniasis. Distinguishing between reinfections and relapses in these patients is important because some apparent treatment failures occur in patients with new rather than reactivated infections. Isoenzyme characterization is limited for use in determining relapsed versus newly acquired leishmaniasis in human immunodeficiency virus (HIV)-infected patients because of the variability of L. infantum and the predominance of the MON-1 zymodeme in people coinfected with HIV. A seminested polymerase chain reaction (PCR) was used to amplify L. infantum minicircle kinetoplast DNA, and, after digestion, the restriction fragment-length polymorphism (RFLP) profiles showed that 3 (7.5%) of 40 patients coinfected with L. infantum and HIV had a new infection, whereas isoenzyme characterization indicated that all 40 patients had infection relapses. These results suggest the utility of this PCR-RFLP analysis in detecting leishmaniasis reinfection in HIV-positive patients.
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Affiliation(s)
- Miguel A Morales
- World Health Organization Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Madrid, Spain.
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Cruz I, Cañavate C, Rubio JM, Morales MA, Chicharro C, Laguna F, Jiménez-Mejías M, Sirera G, Videla S, Alvar J. A nested polymerase chain reaction (Ln-PCR) for diagnosing and monitoring Leishmania infantum infection in patients co-infected with human immunodeficiency virus. Trans R Soc Trop Med Hyg 2002; 96 Suppl 1:S185-9. [PMID: 12055836 DOI: 10.1016/s0035-9203(02)90074-x] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We investigated a Leishmania-specific nested polymerase chain reaction (Ln-PCR) for the diagnosis and treatment monitoring of L. infantum infections in patients co-infected with human immunodeficiency virus (HIV). Peripheral blood and bone marrow samples from 89 HIV patients in Spain suspected of having leishmaniasis were examined by different diagnostic techniques (Ln-PCR, microscopy, NNN culture and indirect fluorescent antibody test). The sensitivity of Ln-PCR compared with microscopy and culture of bone marrow was 95.45% using blood and 100% when using bone marrow. 38 of these patients with confirmed leishmaniasis were entered in a chemotherapy trial (reported elsewhere), and samples from them were collected before treatment, one month after treatment ended and during follow-up (1-20 months), and examined similarly. Ln-PCR was shown to be a good method for testing efficacy of treatment and for predicting relapses after treatment (relapses were predicted on average 5 months earlier than when using classical diagnostic techniques). We suggest that Ln-PCR (especially using peripheral blood) should be the technique of choice for diagnosis, monitoring the success of treatment, and predicting relapses in patients with HIV and suspected or confirmed L. infantum infection.
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Affiliation(s)
- I Cruz
- WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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Chicharro C, Morales MA, Serra T, Ares M, Salas A, Alvar J. Molecular epidemiology of Leishmania infantum on the island of Majorca: a comparison of phenotypic and genotypic tools. Trans R Soc Trop Med Hyg 2002; 96 Suppl 1:S93-9. [PMID: 12055859 DOI: 10.1016/s0035-9203(02)90058-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In the Mediterranean basin, Leishmania infantum is the causative agent of both visceral and cutaneous leishmaniasis, and is an important opportunistic parasite in patients infected with human immunodeficiency virus (HIV). The commonest method used to study the variability of Leishmania spp. is isoenzyme analysis. In addition to this, we employed 3 assays based on the polymerase chain reaction (PCR): random amplified polymorphic deoxyribonucleic acid (RAPD), intergenic region typing (IRT), based on the amplification of ribosomal ribonucleic acid internal transcribed spacers and restriction fragment length polymorphism (PCR-RFLP). We used 54 L. infantum stocks isolated from HIV co-infected patients, 38 isolated from dogs, 3 isolated from immunocompetent patients and 3 isolated from 1826 sand files in the island of Majorca (Spain), a closed ecological niche. Zymodemes MON-1 (70%), MON-24 (11%) and MON-34 (18%) were found among the human isolates, and MON-1 (95%) and MON-108 (5%) among those from dogs. RAPD and IRT could not discriminate among the strains as they all gave the same pattern, even when different zymodemes were examined. In contrast, PCR-RFLP was able to distinguish the strains and, furthermore, a dendrogram (unweighted pair group method with arithmetic average [UPGMA]) was constructed from the genetic distances derived from RFLP data. The Leishmania isolates from HIV-infected subjects formed a single cluster, supporting the existence of an artificial anthroponotic cycle previously proposed by our group, in which syringes have been substituted for sand flies, and in which certain clones have been spread among intravenous drug users. This contrasts with the clusters representing a zoonotic cycle, involving dogs, sand flies and both immunocompetent and immunocompromised humans.
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Affiliation(s)
- C Chicharro
- World Health Organization Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Mahadahonda, Madrid, Spain
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Chicharro C, Granata C, Lozano R, Andreu D, Rivas L. N-terminal fatty acid substitution increases the leishmanicidal activity of CA(1-7)M(2-9), a cecropin-melittin hybrid peptide. Antimicrob Agents Chemother 2001; 45:2441-9. [PMID: 11502512 PMCID: PMC90675 DOI: 10.1128/aac.45.9.2441-2449.2001] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In order to improve the leishmanicidal activity of the synthetic cecropin A-melittin hybrid peptide CA(1-7)M(2-9) (KWKLFKKIGAVLKVL-NH(2)), a systematic study of its acylation with saturated linear fatty acids was carried out. Acylation of the N(epsilon)-7 lysine residue led to a drastic decrease in leishmanicidal activity, whereas acylation at lysine 1, in either the alpha or the epsilon NH(2) group, increased up to 3 times the activity of the peptide against promastigotes and increased up to 15 times the activity of the peptide against amastigotes. Leishmanicidal activity increased with the length of the fatty acid chain, reaching a maximum for the lauroyl analogue (12 carbons). According to the fast kinetics, dissipation of membrane potential, and parasite membrane permeability to the nucleic acid binding probe SYTOX green, the lethal mechanism was directly related to plasma membrane permeabilization.
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Affiliation(s)
- C Chicharro
- Centro de Investigaciones Biológicas (CSIC), Velázquez 144, 28006 Madrid, Spain
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Abstract
Leishmania infantum is a major opportunistic parasite in patients with acquired immune deficiency syndrome and is very variable in these subjects. Isoenzyme characterization is not able to explain this variability, since half of the stocks isolated from patients co-infected with human immunodeficiency virus and Leishmania belong to zymodeme MON-1. Amplification of L. infantum minicircles by the polymerase chain reaction (PCR) and digestion of the amplified product to reveal restriction fragment length polymorphisms (RFLP) has proved very useful in distinguishing between relapses and reinfections in co-infected, treated patients. We have confirmed the existence of a leishmaniasis outbreak among intravenous drug users in north-east Spain, previously detected by isoenzymatic analysis. We have documented persistence of the same strain of Leishmania in 2 treated co-infected patients throughout several years, regardless of the theoretical rapid evolution ascribed to kinetoplast deoxyribonucleic acid minicircle sequences. We suggest using this PCR-RFLP technique to detect reinfections in treated co-infected subjects.
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Affiliation(s)
- M A Morales
- WHO Collaborating Centre for Leishmaniasis, Research Unit in Tropical Medicine and International Health (FIS-ISCIII), Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28220 Majadahonda, Madrid, Spain
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Chicharro C, Sirera G, Ares M, Sans A, Videla S, Alvar J. Is Leishmania infantum zymodeme MON-253 involved in an outbreak among intravenous drug users? Trans R Soc Trop Med Hyg 1999; 93:385-6. [PMID: 10674082 DOI: 10.1016/s0035-9203(99)90125-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- C Chicharro
- WHO Collaborating Centre on Leishmaniasis, Research Unit in Tropical Medicine and International Health (FIS-ISCIII), Madrid, Spain.
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Abstract
In order to determine whether in vitro Leishmania exposure to conditions comparable to those encountered inside the host cell would induce specific signals, we have studied tyrosine phosphorylation patterns in Leishmania pifanoi. Incubation of L. pifanoi at acidic pH resulted in the phosphorylation of several proteins including three of 27, 43 and 51 kDa, as well as the dephosphorylation of a 175 and a 39 kDa proteins in promastigotes recently transformed. In contrast, heat shock at 37 degrees C did not change the tyrosine phosphorylation pattern. Phosphorylation only occurs at pH 5.0 or lower and reached completion after 1 h. Changes returned to the initial conditions in 2 h after pH medium neutralization, indicating a reversible mechanism of phosphorylation.
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Kima PE, Soong L, Chicharro C, Ruddle NH, McMahon-Pratt D. Leishmania-infected macrophages sequester endogenously synthesized parasite antigens from presentation to CD4+ T cells. Eur J Immunol 1996; 26:3163-9. [PMID: 8977318 DOI: 10.1002/eji.1830261249] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CD4+ T cell lines raised against the protective leishmanial antigens GP46 and P8 were used to study the presentation of endogenously synthesized Leishmania antigens by infected cells. Using two different sources of macrophages, the I4.07 macrophage cell line (H-2k) which constitutively expresses major histocompatibility complex (MHC) class II molecules, and elicited peritoneal exudate cells, we found that cells infected with Leishmania amastigotes presented little, if any endogenously synthesized parasite antigens to CD4+ T cells. In contrast, promastigote-infected macrophages did present endogenous parasite molecules to CD4+ T cells, although only for a limited time, with maximal presentation occurring within 24 h of infection and decreasing to minimal antigen presentation at 72 h post-infection. These observations suggest that once within the macrophage, Leishmania amastigote antigens are sequestered from the MHC class II pathway of antigen presentation. This allows live parasites to persist in infected hosts by evading the activation of CD4+ T cells, a major and critical anti-leishmanial component of the host immune system. Studies with drugs that modify fusion patterns of phagosomes suggest that the mechanism of this antigen sequestration includes targeted fusion of the parasitophorous vacuole with certain endocytic compartments.
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Affiliation(s)
- P E Kima
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA
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