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Kumar A, Mahajan H, Chaturvedi S, Kumar A, Kumar S, Sahoo GC, Das VNR, Pandey K. Hepatitis C virus seroprevalence among patients enrolled at the opioid substitution therapy center in Bihar: A cross-sectional study. PLoS One 2023; 18:e0287333. [PMID: 37319276 PMCID: PMC10270565 DOI: 10.1371/journal.pone.0287333] [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: 11/29/2022] [Accepted: 06/02/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND AIM Hepatitis C virus (HCV) infection poses a major public health challenge in Indian settings due to its huge population and easy transmissibility of HCV among individuals who inject drugs (PWID, which is increasing in India). The National AIDS Control Organization (NACO), India has started the Opioid Substitution Therapy (OST) centers to improve the health status of opioid dependent PWID and prevent the spread of HIV/AIDS among them. We conducted a cross-sectional study to find out the HCV sero-positive status and associated determinants in patients attending the OST centre in the ICMR-RMRIMS, Patna. MATERIALS AND METHODS We utilized the routinely collected (as a part of the National AIDS Control Program) and de-identified data from the OST center from 2014 to 2022 (N = 268). We abstracted the information for exposure variables (such as socio-demographic features and drug history) and outcome variable (HCV serostatus). The association of exposure variables with HCV serostatus was examined using robust Poisson regression. RESULTS All the enrolled participants were male and the prevalence of HCV seropositivity was 28% [95% confidence interval (CI): 22.7% - 33.8%)]. There was a rising prevalence of HCV seropositivity with number of years of injection use (p-trend <0.001) and age (p-trend 0.025). Approximately, 6.3% participants were injecting drugs for >10 years and reported the maximum prevalence of HCV seropositivity (47.1%, 95% CI: 23.3%-70.8%). In adjusted analyses, being employed compared to unemployed patients [adjusted prevalence ratio (aPR) = 0.59; 95% CI: 0.38-0.89]; graduated patients compared to illiterate patients [aPR = 0.11; 95% CI: 0.02-0.78]; and patients with education up to higher secondary compared to illiterate patients [aPR = 0.64; 95% CI: 0.43-0.94] had significantly lesser HCV seropositivity. A-one year increase in injection use [aPR = 1.07; 95% CI: 1.04-1.10] was associated with 7% higher prevalence of HCV seropositivity. CONCLUSIONS In this OST center-based study of 268 PWIDs residing in Patna, ~28% of patients were HCV seropositive, which was positively associated with years of injection use, unemployment, and illiteracy. Our findings suggest that OST centers offer an opportunity to reach a high-risk difficult to reach group for HCV infection and thus support the notion of integrating HCV care into the OST or de-addiction centres.
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Affiliation(s)
- Ashish Kumar
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Hemant Mahajan
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Sanjay Chaturvedi
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Ashok Kumar
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Shiril Kumar
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Ganesh Chandra Sahoo
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Vidya Nand Rabi Das
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Krishna Pandey
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
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Pandey K, Pal B, Siddiqui NA, Lal CS, Ali V, Bimal S, Kumar A, Verma N, Das VNR, Singh SK, Topno RK, Das P. A randomized, open-label study to evaluate the efficacy and safety of liposomal amphotericin B (AmBisome) versus miltefosine in patients with post-kala-azar dermal leishmaniasis. Indian J Dermatol Venereol Leprol 2021; 87:34-41. [PMID: 33580944 DOI: 10.25259/ijdvl_410_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/01/2019] [Accepted: 05/01/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Treatment of post-kala-azar dermal leishmaniasis cases is of paramount importance for kala-azar elimination; however, limited treatment regimens are available as of now. AIM To compare the effectiveness of liposomal amphotericin B vs miltefosine in post-kala-azar dermal leishmaniasis patients. METHODOLOGY This was a randomized, open-label, parallel-group study. A total of 100 patients of post kala azar dermal leishmaniasis, aged between 5 and 65 years were recruited, 50 patients in each group A (liposomal amphotericin B) and B (miltefosine). Patients were randomized to receive either liposomal amphotericin B (30 mg/kg), six doses each 5 mg/kg, biweekly for 3 weeks or miltefosine 2.5 mg/kg or 100 mg/day for 12 weeks. All the patients were followed at 3rd, 6th and 12th months after the end of the treatment. RESULTS In the liposomal amphotericin B group, two patients were lost to follow-up, whereas four patients were lost to follow-up in the miltefosine group. The initial cure rate by "intention to treat analysis" was 98% and 100% in liposomal amphotericin B and miltefosine group, respectively. The final cure rate by "per protocol analysis" was 74.5% and 86.9% in liposomal amphotericin B and miltefosine, respectively. Twelve patients (25.5%) in the liposomal amphotericin B group and six patients (13%) in the miltefosine group relapsed. None of the patients in either group developed any serious adverse events. LIMITATIONS Quantitative polymerase chain reaction was not performed at all the follow-up visits and sample sizes. CONCLUSION Efficacy of miltefosine was found to be better than liposomal amphotericin B, hence, the use of miltefosine as first-line therapy for post-kala-azar dermal leishmaniasis needs to be continued. However, liposomal amphotericin B could be considered as one of the treatment options for the elimination of kala-azar from the Indian subcontinent.
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Affiliation(s)
- Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Patna, Bihar, India
| | - Biplab Pal
- Department of Pharmacology, Lovely Professional University, Phagwara, Punjab
| | | | - Chandra Shekhar Lal
- Department of Biochemistry, Lovely Professional University, Phagwara, Punjab
| | - Vahab Ali
- Department of Microbiology, Lovely Professional University, Phagwara, Punjab
| | - Sanjiva Bimal
- Department of Immunology, Lovely Professional University, Phagwara, Punjab
| | - Ashish Kumar
- Department of Molecular Biology, Lovely Professional University, Phagwara, Punjab
| | - Neena Verma
- Department of Pathology, Lovely Professional University, Phagwara, Punjab
| | - Vidya Nand Rabi Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Patna, Bihar, India
| | | | - Roshan Kamal Topno
- Department of Epidemiology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Patna, Bihar, India
| | - Pradeep Das
- Department of Molecular Biology, Lovely Professional University, Phagwara, Punjab
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Pandey K, Pal B, Topno RK, Lal CS, Das VNR, Das P. Acute uveitis: A rare adverse effect of miltefosine in the treatment of post-kala-azar dermal leishmaniasis. Rev Soc Bras Med Trop 2020; 54:e20200208. [PMID: 33338118 PMCID: PMC7747827 DOI: 10.1590/0037-8682-0208-2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022] Open
Abstract
Post-kala-azar dermal leishmaniasis is a skin disorder occurring in 5-10% of visceral leishmaniasis patients after treatment with miltefosine,the first-line drug for this skin disorder. We reported a case of acute anterior uveitis,a rare adverse effect, experienced by a patient treated with miltefosine for post-kala-azar dermal leishmaniasis. This adverse effect developed after 15 days of miltefosine consumption, and the patient himself discontinued the treatment. The ophthalmic complication was completely resolved with antibiotics and steroid eye drops. After recovery from the ophthalmic complication, the patient was successfully treated with liposomal amphotericin B for the skin lesions.
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Affiliation(s)
- Krishna Pandey
- Indian Council of Medical Research - Rajendra Memorial Research Institute of Medical Sciences, Department of Clinical Medicine, Agamkuan, Patna, Bihar, India
| | - Biplab Pal
- Lovely Professional University, Department of Pharmacology, Jalandhar - Delhi G.T. Road, Phagwara, Punjab, India
| | - Roshan Kamal Topno
- Indian Council of Medical Research - Rajendra Memorial Research Institute of Medical Sciences, Department of Epidemiology, Agamkuan, Patna, Bihar, India
| | - Chandra Shekhar Lal
- Indian Council of Medical Research - Rajendra Memorial Research Institute of Medical Sciences, Department of Biochemistry, Agamkuan, Patna, Bihar, India
| | - Vidya Nand Rabi Das
- Indian Council of Medical Research - Rajendra Memorial Research Institute of Medical Sciences, Department of Clinical Medicine, Agamkuan, Patna, Bihar, India
| | - Pradeep Das
- Indian Council of Medical Research - Rajendra Memorial Research Institute of Medical Sciences, Department of Molecular Biology, Agamkuan, Patna, Bihar, India
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Suman SS, Kumar A, Singh AK, Amit A, Topno RK, Pandey K, Das VNR, Das P, Ali V, Bimal S. Dendritic cell engineered cTXN as new vaccine prospect against L. donovani. Cytokine 2020; 145:155208. [PMID: 32736961 DOI: 10.1016/j.cyto.2020.155208] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
Dendritic cells (DCs), as antigen-presenting cells, can reportedly be infected withLeishmaniaparasites and hence provide a better option to trigger T-cell primary immune responses and immunological memory. We consistently primed DCs during culture with purified recombinant cytosolic tryparedoxin (rcTXN) and then evaluated the vaccine prospect of presentation of rcTXN against VL in BALB/c mice. We reported earlier the immunogenic properties of cTXN antigen derived fromL. donovani when anti-cTXN antibody was detected in the sera of kala-azar patients. It was observed that cTXN antigen, when used as an immunogen with murine DCs acting as a vehicle, was able to induce complete protection against VL in an infected group of immunized mice. This vaccination triggered splenic macrophages to produce more IL-12 and GM-CSF, and restricted IL-10 release to a minimum in an immunized group of infected animals. Concomitant changes in T-cell responses against cTXN antigen were also noticed, which increased the release of protective cytokine-like IFN-γ under the influence of NF-κβ in the indicated vaccinated group of animals. All cTXN-DCs-vaccinated BALB/c mice survived during the experimental period of 120 days. The results obtained in our study suggest that DCs primed with cTXN can be used as a vaccine prospect for the control of visceral leishmaniasis.
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Affiliation(s)
- Shashi S Suman
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Akhilesh Kumar
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Ashish K Singh
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Ajay Amit
- Department of Forensic Science, Guru Ghasidas Vishwavidyalaya, Bilaspur (C.G.) 495009, India
| | - R K Topno
- Department of Epidemiology, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - K Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - V N R Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - P Das
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Vahab Ali
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Sanjiva Bimal
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India.
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Siddiqui NA, Pandey K, R Das VN, Sinha SK, Verma RB, Lal CS, Ali V, Topno RK, Dikhit MR, Das P. Magnitude of unreported kala-azar cases in a highly endemic district of Bihar, India: A positive impact of Indian elimination programme. J Vector Borne Dis 2019; 56:315-322. [PMID: 33269731 DOI: 10.4103/0972-9062.302034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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 In India, kala-azar surveillance is weak and no public-private partnership exists for disease containment. Estimate of disease burden is not reliably available and still cases are going to private providers for the treatment. The present study aimed to assess the magnitude of kala-azar cases actually detected and managed at private set-up and unreported to existing health management information system. METHODS Institution based cross-sectional prospective pilot study was conducted. List of facilities was created with the help of key informants. The information about incidence of kala-azar cases were captured on monthly basis from July 2010 to June 2011. Rapid diagnostic strip test (rk-39) or bone marrow/splenic puncture were applied as laboratory methods for the diagnosis of kala-azar. Descriptive statistics as well as chi-square test for comparison between proportions was conducted. RESULTS Overall availability of private practitioners (PPs) was 4.59/1,00,000 population and maximum PPs (46; 93.9%) were from qualified category. The median years of medical practice was 25 yr (inter quartile-range [18, 28]). Interestingly, only a small proportion (240; 19%) of cases was managed by PPs. Amongst the PPs, only low proportion (32; 18.2%) managed >2 cases per month. The mean number of kala-azar suspects and cases identified varied significantly between different PPs' professions with p <0.048 and p <0.032, respectively. A highly significant difference (p <0.0001) was observed for kala-azar case load between qualified and unqualified practitioners. A small proportion (38; 15.8%) of kala-azar cases was not present in the public health system record. INTERPRETATION & CONCLUSION Still sizeable proportions of cases are going to PPs and unrecorded into government surveillance system. A mechanism need to be devised to involve at least qualified PPs in order to reduce treatment delay and increase case detection in the region.
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Affiliation(s)
- N A Siddiqui
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - K Pandey
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - V N R Das
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - S K Sinha
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - R B Verma
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - C S Lal
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - V Ali
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - R K Topno
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - M R Dikhit
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - P Das
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
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Goyal V, Burza S, Pandey K, Singh SN, Singh RS, Strub-Wourgaft N, Das VNR, Bern C, Hightower A, Rijal S, Sunyoto T, Alves F, Lima N, Das P, Alvar J. Field effectiveness of new visceral leishmaniasis regimens after 1 year following treatment within public health facilities in Bihar, India. PLoS Negl Trop Dis 2019; 13:e0007726. [PMID: 31557162 PMCID: PMC6782108 DOI: 10.1371/journal.pntd.0007726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/28/2019] [Revised: 10/08/2019] [Accepted: 08/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND An earlier open label, prospective, non-randomized, non-comparative, multi-centric study conducted within public health facilities in Bihar, India (CTRI/2012/08/002891) measured the field effectiveness of three new treatment regimens for visceral leishmaniasis (VL): single dose AmBisome (SDA), and combination therapies of AmBisome and miltefosine (AmB+Milt) and miltefosine and paromomycin (Milt+PM) up to 6 months follow-up. The National Vector Borne Disease Control Program (NVBDCP) recommended an extended follow up at 12 months post-treatment of the original study cohort to quantify late relapses. METHODS The 1,761 patients enrolled in the original study with the three new regimens were contacted and traced between 10 and 36 months following completion of treatment to determine their health status and any occurrence of VL relapse. RESULTS Of 1,761 patients enrolled in the original study, 1,368 were traced at the extended follow-up visit: 711 (80.5%), 295 (83.2%) and 362 (71.5%) patients treated with SDA, AmB+Milt and Milt+PM respectively. Of those traced, a total of 75 patients were reported to have relapsed by the extended follow-up; 45 (6.3%) in the SDA, 25 (8.5%) in the AmB+Milt and 5 (1.4%) in the Milt+PM arms. Of the 75 relapse cases, 55 had already been identified in the 6-months follow-up and 20 were identified as new cases of relapse at extended follow-up; 7 in the SDA, 10 in the AmB+Milt and 3 in the Milt+PM arms. CONCLUSION Extending follow-up beyond the standard 6 months identified additional relapses, suggesting that 12-month sentinel follow-up may be useful as a programmatic tool to better identify and quantify relapses. With limited drug options, there remains an urgent need to develop effective new chemical entities (NCEs) for VL.
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Affiliation(s)
- Vishal Goyal
- Drugs for Neglected Diseases initiative (DNDi), New York, United States of America
- * E-mail:
| | - Sakib Burza
- Médecins Sans Frontières (MSF), New Delhi, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | | | | | | | - Vidya Nand Rabi Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | - Caryn Bern
- University of California San Francisco, San Francisco, California, United States of America
| | | | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Goyal V, Mahajan R, Pandey K, Singh SN, Singh RS, Strub-Wourgaft N, Alves F, Rabi Das VN, Topno RK, Sharma B, Balasegaram M, Bern C, Hightower A, Rijal S, Ellis S, Sunyoto T, Burza S, Lima N, Das P, Alvar J. Field safety and effectiveness of new visceral leishmaniasis treatment regimens within public health facilities in Bihar, India. PLoS Negl Trop Dis 2018; 12:e0006830. [PMID: 30346949 PMCID: PMC6197645 DOI: 10.1371/journal.pntd.0006830] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 04/02/2018] [Accepted: 09/10/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2010, WHO recommended the use of new short-course treatment regimens in kala-azar elimination efforts for the Indian subcontinent. Although phase 3 studies have shown excellent results, there remains a lack of evidence on a wider treatment population and the safety and effectiveness of these regimens under field conditions. METHODS This was an open label, prospective, non-randomized, non-comparative, multi-centric trial conducted within public health facilities in two highly endemic districts and a specialist referral centre in Bihar, India. Three treatment regimens were tested: single dose AmBisome (SDA), concomitant miltefosine and paromomycin (Milt+PM), and concomitant AmBisome and miltefosine (AmB+Milt). Patients with complicated disease or significant co-morbidities were treated in the SDA arm. Sample sizes were set at a minimum of 300 per arm, taking into account inter-site variation and an estimated failure risk of 5% with 5% precision. Outcomes of drug effectiveness and safety were measured at 6 months. The trial was prospectively registered with the Clinical Trials Registry India: CTRI/2012/08/002891. RESULTS Out of 1,761 patients recruited, 50.6% (n = 891) received SDA, 20.3% (n = 358) AmB+Milt and 29.1% (n = 512) Milt+PM. In the ITT analysis, the final cure rates were SDA 91.4% (95% CI 89.3-93.1), AmB+Milt 88.8% (95% CI 85.1-91.9) and Milt+PM 96.9% (95% CI 95.0-98.2). In the complete case analysis, cure rates were SDA 95.5% (95% CI 93.9-96.8), AmB+Milt 95.5% (95% CI 92.7-97.5) and Milt+PM 99.6% (95% CI 98.6-99.9). All three regimens were safe, with 5 severe adverse events in the SDA arm, two of which were considered to be drug related. CONCLUSION All regimens showed acceptable outcomes and safety profiles in a range of patients under field conditions. Phase IV field-based studies, although extremely rare for neglected tropical diseases, are good practice and an important step in validating the results of more restrictive hospital-based studies before widespread implementation, and in this case contributed to national level policy change in India. TRIAL REGISTRATION Clinical trial is registered at Clinical trial registry of India (CTRI/2012/08/002891, Registered on 16/08/2012, Trial Registered Prospectively).
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Affiliation(s)
- Vishal Goyal
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | | | - Krishna Pandey
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (RMRI), New Delhi, India
| | | | | | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Vidya Nand Rabi Das
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (RMRI), New Delhi, India
| | - Roshan Kamal Topno
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (RMRI), New Delhi, India
| | - Bhawna Sharma
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | | | - Caryn Bern
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco CA, United States of America
| | | | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | - Sally Ellis
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Sakib Burza
- Médecins Sans Frontières (MSF), New Delhi, India
| | - Nines Lima
- Médecins Sans Frontières (MSF), Barcelona, Spain
| | - Pradeep Das
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (RMRI), New Delhi, India
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Dikhit MR, Das S, Mahantesh V, Kumar A, Singh AK, Dehury B, Rout AK, Ali V, Sahoo GC, Topno RK, Pandey K, Das VNR, Bimal S, Das P. The potential HLA Class I-restricted epitopes derived from LeIF and TSA of Leishmania donovani evoke anti-leishmania CD8+ T lymphocyte response. Sci Rep 2018; 8:14175. [PMID: 30242172 PMCID: PMC6154976 DOI: 10.1038/s41598-018-32040-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/29/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
To explore new protective measure against visceral leishmaniasis, reverse vaccinology approach was employed to identify key immunogenic regions which can mediate long-term immunity. In-depth computational analysis revealed nine promiscuous epitopes which can possibly be presented by 46 human leukocyte antigen, thereby broadening the worldwide population up to 94.16%. This is of reasonable significance that most of the epitopes shared 100% sequence homology with other Leishmania species and could evoke a common pattern of protective immune response. Transporter associated with antigen processing binding affinity, molecular docking approach followed by dynamics simulation and human leukocyte antigen stabilization assay suggested that the best five optimal set of epitopes bind in between α1 and α2 binding groove with sufficient affinity and stability which allows the translocation of intact epitope to the cell surface. Fascinatingly, the human leukocyte antigen stabilization assay exhibited a modest correlation with the positive immunogenicity score predicted by class I pMHC immunogenicity predictor. A support for this notion came from ELISA and FACS analysis where the epitopes as a cocktail induced CD8+ IFN-γ and Granzyme B levels significantly in treated visceral leishmaniasis subject which suggests the immunogenic ability of the selected epitopes.
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Affiliation(s)
- Manas Ranjan Dikhit
- BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India.,Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Sushmita Das
- Department of Microbiology, All India Institute of Medical Sciences, Patna, 801507, Bihar, India
| | - Vijaya Mahantesh
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Akhilesh Kumar
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Ashish Kumar Singh
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Budheswar Dehury
- BioMedical Informatics Centre, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, Odisha, India
| | - Ajaya Kumar Rout
- Biotechnology Laboratory, ICAR-Central Inland Fisheries Research Institute, Barrackpore, Kolkata, 700120, West Bengal, India
| | - Vahab Ali
- Department of Clinical Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Ganesh Chandra Sahoo
- BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Roshan Kamal Topno
- Department of Epidemiology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - V N R Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Sanjiva Bimal
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India
| | - Pradeep Das
- Department of Molecular Parasitology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, 800007, Bihar, India.
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Singh MK, Jamal F, Dubey AK, Shivam P, Kumari S, Pushpanjali, Bordoloi C, Narayan S, Das VNR, Pandey K, Das P, Singh SK. Visceral leishmaniasis: A novel nuclear envelope protein 'nucleoporins-93 (NUP-93)' from Leishmania donovani prompts macrophage signaling for T-cell activation towards host protective immune response. Cytokine 2018; 113:200-215. [PMID: 30001865 DOI: 10.1016/j.cyto.2018.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/02/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 02/06/2023]
Abstract
The shift of macrophage and T-cell repertoires towards proinflammatory cytokine signalling ensures the generation of host-protective machinery that is otherwise compromised in cases of the intracellular Leishmania parasite. Different groups have attempted to restore host protective immunity. These vaccine candidates showed good responses and protective effects in murine models, but they generally failed during human trials. In the present study, we evaluated the effect of 97 kDa recombinant nucleoporin-93 of Leishmania donovani (rLd-NUP93) on mononuclear cells in healthy and treated visceral leishmaniasis (VL) patients and on THP-1 cell lines. rLd-NUP93 stimulation increased the expression of the early lymphocyte activation marker CD69 on CD4+ and CD8+ T cells. The expression of the host protective pro-inflammatory cytokines IFN-γ, IL-12 and TNF-α was increased, with a corresponding down-regulation of IL-10 and TGF-β upon rLd-NUP93 stimulation. This immune polarization resulted in the up-regulation of NF-κB p50 with scant expression of SMAD-4. Augmenting lymphocyte proliferation upon priming with rLd-NUP93 ensured its potential for activation and generation of strong T-cell mediated immune responses. This stimulation extended the leishmanicidal activity of macrophages by releasing high amounts of reactive oxygen species (ROS). Further, the leishmanicidal activity of macrophages was intensified by the elevated production of nitric oxide (NO). The fact that this antigen was earlier reported in circulating immune complexes of VL patients highlights its antigenic importance. In addition, in silico analysis suggested the presence of MHC class I and II-restricted epitopes that proficiently trigger CD8+ and CD4+ T-cells, respectively. This study reported that rLd-NUP93 was an effective immunoprophylactic agent that can be explored in future vaccine design.
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Affiliation(s)
- Manish K Singh
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Fauzia Jamal
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Amit K Dubey
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India; National Institute of Pharmaceutical Education and Research, Hajipur 844102, India
| | - Pushkar Shivam
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Sarita Kumari
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Pushpanjali
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Chayanika Bordoloi
- National Institute of Pharmaceutical Education and Research, Hajipur 844102, India
| | - S Narayan
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - V N R Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - K Pandey
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - P Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India
| | - Shubhankar K Singh
- Rajendra Memorial Research Institute of Medical Sciences, Patna 800007, India.
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Kumar A, Dikhit MR, Amit A, Zaidi A, Pandey RK, Singh AK, Suman SS, Ali V, Das VNR, Pandey K, kumar V, Singh SK, Narayan S, Chourasia HK, Das P, Bimal S. Immunomodulation induced through ornithine decarboxylase DNA immunization in Balb/c mice infected with Leishmania donovani. Mol Immunol 2018; 97:33-44. [DOI: 10.1016/j.molimm.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 12/21/2022]
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Dikhit MR, Kumar A, Das S, Dehury B, Rout AK, Jamal F, Sahoo GC, Topno RK, Pandey K, Das VNR, Bimal S, Das P. Identification of Potential MHC Class-II-Restricted Epitopes Derived from Leishmania donovani Antigens by Reverse Vaccinology and Evaluation of Their CD4+ T-Cell Responsiveness against Visceral Leishmaniasis. Front Immunol 2017; 8:1763. [PMID: 29312304 PMCID: PMC5735068 DOI: 10.3389/fimmu.2017.01763] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 08/25/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023] Open
Abstract
Visceral leishmaniasis (VL) is one of the most neglected tropical diseases for which no vaccine exists. In spite of extensive efforts, no successful vaccine is available against this dreadful infectious disease. To support vaccine development, an immunoinformatics approach was applied to screen potential MHC class-II-restricted epitopes that can activate the immune cells. Initially, 37 epitopes derived from six stage-dependent, overexpressed antigens were predicted, which were presented by at least 26 diverse MHC class-II allele. Based on a population coverage analysis and human leukocyte antigen cross-presentation ability, six of the 37 epitopes were selected for further analysis. Stimulation with synthetic peptide alone or as a cocktail triggered intracellular IFN-γ production. Moreover, specific IgG antibodies were detected in the serum of active VL cases against P1, P4, P5, and P6 in order to evaluate the peptide effect on the humoral immune response. Additionally, most of the peptides, except P2, were found to be non-inducers of CD4+ IL-10 against both active VL as well as treated VL subjects. This finding suggests there is no role of these peptides in the pathogenesis of Leishmania. Peptide immunogenicity was validated in BALB/c mice immunized with a cocktail of synthetic peptide emulsified in complete Freund’s adjuvant/incomplete Freund’s adjuvant. The immunized splenocytes induced strong spleen cell proliferation upon parasite re-stimulation. Furthermore, increased IFN-γ, interleukin-12, IL-17, and IL-22 production augmented with elevated nitric oxide (NO) synthesis is thought to play a crucial role in macrophage activation. In this investigation, we identified six MHC class-II-restricted epitope hotspots of Leishmania antigens that induce CD4+ Th1 and Th17 responses, which could be used to potentiate a human universal T-epitope vaccine against VL.
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Affiliation(s)
- Manas Ranjan Dikhit
- BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Patna, India.,Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Akhilesh Kumar
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Sushmita Das
- Department of Microbiology, All India Institute of Medical Sciences, Patna, India
| | - Budheswar Dehury
- Biomedical Informatics Centre, ICMR-Regional Medical Research Centre, Odisha, India
| | - Ajaya Kumar Rout
- Biotechnology Laboratory, ICAR-Central Inland Fisheries Research Institute, Kolkata, India
| | - Fauzia Jamal
- Department of Microbiology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Ganesh Chandra Sahoo
- BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Roshan Kamal Topno
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - V N R Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Sanjiva Bimal
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Pradeep Das
- Department of Molecular Parasitology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
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Pandey K, Pal B, Siddiqui NA, Rabi Das VN, Murti K, Lal CS, Verma N, Babu R, Ali V, Kumar R, Das P. Efficacy and Safety of Liposomal Amphotericin B for Visceral Leishmaniasis in Children and Adolescents at a Tertiary Care Center in Bihar, India. Am J Trop Med Hyg 2017; 97:1498-1502. [PMID: 29016288 DOI: 10.4269/ajtmh.17-0094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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
Liposomal amphotericin B is being used increasingly to reduce the burden of kala-azar from the Indian subcontinent. There are studies which have evaluated efficacy and safety of liposomal amphotericin B for visceral leishmaniasis in all age groups. However, the only study that specifically addressed treatment of childhood visceral leishmaniasis did not include all ages or document renal and liver function. We, therefore, felt it was important to reassess the efficacy and safety of single dose liposomal amphotericin B in children and adolescents. A total of 100 parasitologically confirmed visceral leishmaniasis patients aged < 15 years were included in this study. Participants consisted of 65 males and 35 females. All of them had come from the endemic region of Bihar. They were administered one dose intravenous infusion of liposomal amphptericin B at 10 mg/kg body weight. Efficacy was assessed as initial and final cure at 1 and 6 months, respectively, and safety of all participants who were recruited in the study. The initial and final cure rate by per protocol analysis was 100% and 97.9%, respectively. Chills and rigors were the most commonly occurring adverse events (AEs). All the AEs were mild in intensity, and none of the patients experienced any serious AEs. No patients developed nephrotoxicity. Our finding indicates that liposomal amphotericin B at 10 mg/kg body weight is safe and effective in children. Results of our study support the use of single dose liposomal amphotericin B in all age group populations for elimination of kala-azar from the Indian subcontinent.
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Affiliation(s)
- Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian, Council of Medical Research), Patna, Bihar, India
| | - Biplab Pal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Niyamat Ali Siddiqui
- Department of Biostatistics, Rajendra Memorial Research Institute of Medical Sciences (Indian Council, of Medical Research), Patna, Bihar, India
| | - Vidya Nand Rabi Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian, Council of Medical Research), Patna, Bihar, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Chandra Shekhar Lal
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, (Indian Council of Medical Research), Patna, Bihar, India
| | - Neena Verma
- Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of, Medical Research), Patna, Bihar, India
| | - Rajendra Babu
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Vahab Ali
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, (Indian Council of Medical Research), Patna, Bihar, India
| | - Rakesh Kumar
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian, Council of Medical Research), Patna, Bihar, India
| | - Pradeep Das
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences (Indian, Council of Medical Research), Patna, Bihar, India
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Pandey K, Pal B, Das VNR, Murti K, Lal CS, Verma N, Bimal S, Ali V, Verma RB, Topno RK, Siddiqi NA, Das P. Safety and efficacy of a combination of paromomycin and miltefosine for two vs. three courses in patients with post-kala-azar dermal leishmaniasis: an observational pilot study. Br J Dermatol 2017; 177:557-559. [PMID: 27781268 DOI: 10.1111/bjd.15119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - B Pal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - V N R Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - K Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - C S Lal
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - N Verma
- Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - S Bimal
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - V Ali
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - R B Verma
- Department of Biostatistics, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - R K Topno
- Department of Epidemiology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - N A Siddiqi
- Department of Biostatistics, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - P Das
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
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Jamal F, Dikhit MR, Singh MK, Shivam P, Kumari S, Pushpanjali S, Dubey AK, Kumar P, Narayan S, Gupta AK, Pandey K, Das VNR, Bimal S, Das P, Singh SK. Identification of B-cell Epitope of Leishmania donovani and its application in diagnosis of visceral leishmaniasis. J Biomol Struct Dyn 2016; 35:3569-3580. [PMID: 27892844 DOI: 10.1080/07391102.2016.1263240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/20/2022]
Abstract
Diagnosis of visceral leishmaniasis (VL) is often hindered by cross-reactions with antigens from other related parasite infections. This study aimed to develop an immunochromatographic test (ICT) which can detect the antigen present in circulating immune complexes (CICs) of VL patients using B-cell epitope-specific antibodies. MS analysis of six immunoreactive 2DE spots revealed two epitopes i.e. RFFVQGDGIGQHSLQEALERR (P1) and RRVAVLVLLDRL (P2) (From a hypothetical protein [Acc No: XP_003861458.1]). The epitope conservancy analysis suggested that the linear epitope (P1P2) is 97-100% conserved among Leishmania species and diverged from Homo sapiens (61% query coverage and 80% identity). Further, immunoinformatics analysis of hydrophilicity and flexibility confirmed the antigenicity of the peptide fragment. The linear epitope (P1P2) was synthesized (98% purity) and the purity was confirmed by high-performance liquid chromatography and MS. The indirect Enzyme linked immunosorbent assay results confirmed the presence of the corresponding antibody in VL patient's sera but not in those of healthy and other diseases. The result demonstrated a sensitivity 90%; Se Cl95% (82.16-96.27)% and specificity 100%; Sp Cl95% (84.56-100)% which indicated the possibility to be used as a diagnostic tool. Sensitivity, specificity, and diagnostic efficiency of colloidal gold conjugated anti-P1P2 antibody ICT strip was 100, 95.2, and 96.7%, respectively, which is slightly better as compared to other ICT for VL. Though, our result indicated the utility of anti-P1P2 antibody to detect CICs epitopes, a large-scale inspection in endemic and non-endemic area and in different ethnic population is needed for its validation and authentication.
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Affiliation(s)
- Fauzia Jamal
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Manas Ranjan Dikhit
- b Department of Bioinformatics , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Manish K Singh
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Pushkar Shivam
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Sarita Kumari
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Sinha Pushpanjali
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Amit K Dubey
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India.,c Department of Biotechnology , National Institute of Pharmaceutical Education and Research , Hajipur 844102 , India
| | - Prakash Kumar
- c Department of Biotechnology , National Institute of Pharmaceutical Education and Research , Hajipur 844102 , India
| | - Shyam Narayan
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Anil K Gupta
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Krishna Pandey
- d Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - V N R Das
- d Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Sanjiva Bimal
- e Department of Immunology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Pradeep Das
- f Department of Molecular Biology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Shubhankar K Singh
- a Department of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
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Kumar R, Das VNR, Topno RK, Pal B, Imam A, Agrawal K, Singh A, Murti K, Lal CS, Verma N, Das P, Pandey K. Para-kala-azar dermal Leishmaniasis cases in Indian subcontinent - A case series. Pathog Glob Health 2016; 110:326-329. [PMID: 27871210 DOI: 10.1080/20477724.2016.1258163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Rakesh Kumar
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Vidya Nand Rabi Das
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Roshan Kamal Topno
- b Department of Epidemiology , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Biplab Pal
- c Department of Pharmacy Practice , National Institute of Pharmaceutical Education and Research , Hajipur , India
| | - Adnan Imam
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Kanhaiya Agrawal
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Anima Singh
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Krishna Murti
- c Department of Pharmacy Practice , National Institute of Pharmaceutical Education and Research , Hajipur , India
| | - Chandra Shekhar Lal
- d Department of Clinical Biochemistry , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Neena Verma
- e Department of Pathology , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Pradeep Das
- f Department of Molecular Biology , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Krishna Pandey
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
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Amit A, Dikhit MR, Mahantesh V, Chaudhary R, Singh AK, Singh A, Singh SK, Das VNR, Pandey K, Ali V, Narayan S, Sahoo GC, Das P, Bimal S. Immunomodulation mediated through Leishmania donovani protein disulfide isomerase by eliciting CD8+ T-cell in cured visceral leishmaniasis subjects and identification of its possible HLA class-1 restricted T-cell epitopes. J Biomol Struct Dyn 2016; 35:128-140. [PMID: 26727289 DOI: 10.1080/07391102.2015.1134349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/16/2023]
Abstract
Protein disulphide isomerase (PDI) is one of the key enzymes essential for the survival of Leishmania donovani in the host. Our study suggested that PDI is associated with the generation of Th1-type of cellular responses in treated Visceral leishmaniasis (VL) subjects. The stimulation of Peripheral blood mononuclear cells (PBMCs) with recombinant Protein Disulphide Isomerase upregulated the reactive oxygen species generation, Nitric oxide release, IL12 and IFN-γ production indicating its pivotal role in protective immune response. Further, a pre-stimulation of PBMCs with Protein disulphide isomerase induced a strong IFN-γ response through CD8+ T cells in treated VL subjects. These findings also supported through the evidence that this antigen was processed and presented by major histocompatibility complex class I (MHC-1) dependent pathway and had an immunoprophylactic potential which can induce CD8+ T cell protective immune response in MHC class I dependent manner against VL. To find out the possible epitopes that might be responsible for CD8+ T cell specific IFN-γ response, computational approach was adopted. Six novel promiscuous epitopes were predicted to be highly immunogenic and can be presented by 32 different HLA allele to CD8+ T cells. Further investigation will explore more about their immunological relevance and usefulness as vaccine candidates.
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Affiliation(s)
- Ajay Amit
- a Division of Immunology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Manas R Dikhit
- a Division of Immunology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India.,b Department of Bioinformatics , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Vijay Mahantesh
- a Division of Immunology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India.,c Department of Biotechnology , National Institutes of Pharmaceutical Education and Research , Hajipur 844102 , India
| | - Rajesh Chaudhary
- a Division of Immunology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Ashish Kumar Singh
- a Division of Immunology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India.,d Dept. of Pathology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Ashu Singh
- c Department of Biotechnology , National Institutes of Pharmaceutical Education and Research , Hajipur 844102 , India
| | - Shubhankar Kumar Singh
- h Dept. of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - V N R Das
- e Dept. of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Krishna Pandey
- e Dept. of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Vahab Ali
- f Dept. of Molecular Biochemistry , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Shyam Narayan
- h Dept. of Microbiology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Ganesh C Sahoo
- b Department of Bioinformatics , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Pradeep Das
- g Dept. of Molecular Biology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
| | - Sanjiva Bimal
- a Division of Immunology , Rajendra Memorial Research Institute of Medical Sciences , Patna 800007 , India
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Das P, Amit A, Singh SK, Chaudhary R, Dikhit MR, yadav A, Pandey K, Das VNR, Sundram S, Das P, Bimal S. Leishmania donovani phosphoproteins pp41 and pp29 re-establishes host protective immune response in visceral leishmaniasis. Parasitol Int 2015; 64:18-25. [DOI: 10.1016/j.parint.2014.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 08/07/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
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Jain P, Das VNR, Ranjan A, Chaudhary R, Pandey K. Comparative study for the efficacy, safety and quality of life in patients of chronic myeloid leukemia treated with Imatinib or Hydroxyurea. J Res Pharm Pract 2014; 2:156-61. [PMID: 24991625 PMCID: PMC4076923 DOI: 10.4103/2279-042x.128145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Indexed: 12/03/2022] Open
Abstract
Objective: Chronic myeloid leukemia (CML) is a clonal hematopoietic disorder caused by acquired genetic defect in pluripotent stem cells characterized by acquisition of the philadelphia chromosome. The aim of this study was to compare the efficacy, safety and quality of life (QoL) in CML patients treated with imatinib or hydroxyurea. Methods: A prospective observational study was conducted on 40 patients with pathologically confirmed CML in an in-patient department of Mahavir Cancer Sansthan and Research Centre (tertiary care cancer hospital) in India. Patients were divided into two groups (group A: Imatinib consuming patients and group B: Hydroxyurea consuming patients). Complete blood count was done every month to assess the efficacy and safety/toxicity profile of these drugs. The results were analyzed 12 months after completion of treatment. QoL was assessed by The European Organization for Research and Treatment of Cancer QoL Questionnaire core 30. Hematological response was analyzed using kaplan-meier survival analysis. Chi-square test was applied to assess the association of two regimens with complete hematological response, hematological and non-hematological toxicity. White blood cell (WBC) was noted each month in every patient of each group and analyzed by generalized linear mode (repeated measures) analysis of variance (ANOVA). Independent t-test was used to compare changes in QoL between treatment groups. Findings: At the end of treatment, significant improvement (P = 0.001) in hematological response was observed in the group A (95%) compared to group B (30%). WBC count analyzed at each month of treatment by ANOVA achieved better results for patients treated with imatinib (P = 0.0001). The hematological toxicity was higher in imatinib group while non-hematological toxicity was higher in the hydroxyurea group; however only little toxicities such as nausea and constipation were statistically significant. QoL assessment of patients related to functional scale showed significantly better results in group A (P = 0.046). Conclusion: The study showed that imatinib has better profile compared to hydroxyurea, with siginificant statistical differences in terms of efficacy, non-hematological toxicity and QoL in CML patients. Even with such better efficacy and safety profile, pharmacoeconomic evaluation needs to be done to justify and support the use of imatinib for CML patients in India.
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Affiliation(s)
- Parveen Jain
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
| | - V N R Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Alok Ranjan
- Department of Biostatistics, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Rahul Chaudhary
- Department of Clinical Oncology, Mahavir Cancer Institute and Research Centre, Patna, India
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
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Das VNR, Pandey K, Singh D, Forwood C, Lal CS, Das P. Development of post-kala-azar dermal leishmaniasis in AmBisome treated visceral leishmaniasis: a possible challenge to elimination program in India. J Postgrad Med 2014; 59:226-8. [PMID: 24029204 DOI: 10.4103/0022-3859.118046] [Citation(s) in RCA: 5] [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] [Indexed: 11/04/2022] Open
Abstract
We report two cases, one male (33 years) and a female (14 years), that developed Post-Kala-azar Dermal Leishmaniasis (PKDL) after successful treatment for visceral leishmaniasis (VL) or Kala-azar with AmBisome, the lipid complex of Amphotericin B. Both cases presented with hypo-pigmented macular lesions all over the body. The patients responded well to AmBisome after treatment with three courses. This first ever case report from India indicates that possibly there is no effective drug for VL until date, which can prevent post-treatment development of PKDL.
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Affiliation(s)
- V N R Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India
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Kumar N, Pandey K, Das VNR, Sinha PK, Topno RK, Verma N, Lal CS, Das P, Bhattacharya SK. Miltefosine in the treatment of a case of visceral leishmaniasis with renal dysfunction. Annals of Tropical Medicine & Parasitology 2013; 101:649-51. [PMID: 17877883 DOI: 10.1179/136485907x193914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- N Kumar
- Rajendra Memorial Research Institute of Medical Sciences, (Indian Council of Medical Research), Agamkuan, Patna - 800 007, India.
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Pandey K, Sinha PK, Das VNR, Kumar N, Hassan SM, Verma N, Lal CS, Bimal S, Das P, Bhattacharya SK. HIV-1 infection, visceral leishmaniasis, Koch's chest and tuberculous meningitis in the same patient — a case report. Annals of Tropical Medicine & Parasitology 2013; 99:807-11. [PMID: 16297295 DOI: 10.1179/136485905x75386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- K Pandey
- Rajendra Memorial Research Institute of Medical Sciences (ICMR), Agam Kuan, P.O. Gulzarbagh, Patna - 800007, Bihar, India.
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Pandey K, Singh D, Lal CS, Das VNR, Das P. Fatal acute pancreatitis in a patient with visceral leishmaniasis during miltefosine treatment. J Postgrad Med 2013; 59:306-8. [DOI: 10.4103/0022-3859.123161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Singh D, Pandey K, Das VNR, Das S, Verma N, Ranjan A, Lal SC, Topno KR, Singh SK, Verma RB, Kumar A, Sardar AH, Purkait B, Das P. Evaluation of rK-39 strip test using urine for diagnosis of visceral leishmaniasis in an endemic region of India. Am J Trop Med Hyg 2012; 88:222-6. [PMID: 23149580 DOI: 10.4269/ajtmh.2012.12-0489] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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
The definitive diagnosis of visceral leishmaniasis (VL) requires invasive procedures for demonstration of parasites in tissue smear or culture. These procedures need expertise and laboratory supports and cannot be performed in the field. The aim of the present study was to evaluate the existing rK-39 immunochromatographic nitrocellulose strips test (ICT) with some modification in human urine for diagnosis of VL. The test was performed on both sera and urine samples on the same 786 subjects (365 confirmed VL and 421 control subjects). The sensitivity of the rK-39 ICT in serum was 100%, whereas the specificity was 93.8%, 100%, and 96.2% in healthy controls from endemic, non-endemic, and other infectious diseases, respectively. However, in urine samples, the test showed 96.1% sensitivity and 100% specificity. Considering sensitivity and feasibility of the test in the field, rK-39 ICT using urine samples can be an alternative to conventional invasive VL diagnosis.
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Affiliation(s)
- Dharmendra Singh
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India.
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Sundar S, Sinha P, Jha TK, Chakravarty J, Rai M, Kumar N, Pandey K, Narain MK, Verma N, Das VNR, Das P, Berman J, Arana B. Oral miltefosine for Indian post-kala-azar dermal leishmaniasis: a randomised trial. Trop Med Int Health 2012; 18:96-100. [PMID: 23136856 DOI: 10.1111/tmi.12015] [Citation(s) in RCA: 40] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Standard treatment of Indian post-kala-azar dermal leishmaniasis (PKDL) is unsatisfactory because to achieve therapeutic effectiveness, heroic courses of parenteral and toxic agents have to be administered. Our objective was to evaluate oral miltefosine for its potential to provide effective as well as tolerable treatment for this disease. METHOD Open-label, randomised, parallel-group multicentric trial. Miltefosine, 100 mg/day to all but one patient, was administered for 12 weeks or 8 weeks, with a target of 18 patients in each treatment group. Key endpoints were tolerance during treatment and efficacy at 12 months of follow-up. RESULTS The ITT and per-protocol cure rates after 12 months of follow-up for patients receiving 12 weeks of therapy were 78% (14 of 18 patients: 95% CI = 61-88%) and 93% (14 of 15 patients: 95% CI = 71-95%), respectively, after 12 months of follow-up. The ITT and per-protocol cure rates for patients receiving 8 weeks of therapy were 76% (13 of 17 patients: 95% CI = 53-90%) and 81% (13 of 16 patients: 95% CI = 57-93%), respectively. Gastrointestinal and other adverse events were rare. CONCLUSIONS This study suggests that oral miltefosine for 2-3 months can be considered a treatment of choice for Indian PKDL.
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Affiliation(s)
- Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Das VNR, Ranjan A, Pandey K, Singh D, Verma N, Das S, Lal CS, Sinha NK, Verma RB, Siddiqui NA, Das P. Clinical epidemiologic profile of a cohort of post-kala-azar dermal leishmaniasis patients in Bihar, India. Am J Trop Med Hyg 2012; 86:959-61. [PMID: 22665600 DOI: 10.4269/ajtmh.2012.11-0467] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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
Post-kala-azar dermal leishmaniasis (PKDL) has important public health implications for transmission of visceral leishmaniasis (VL). Clinical and epidemiologic profiles of 102 PKDL patients showed that median age of males and females at the time of diagnosis was significantly different (P = 0.013). A significant association was observed between family history of VL and sex of PKDL patients (χ(2) = 5.72, P < 0.01). Nearly 33% of the patients showed development of PKDL within one year of VL treatment. The observed time (median = 12 months) between appearance of lesions and diagnosis is an important factor in VL transmission. A significant association was observed between type of lesions and duration of appearance after VL treatment (χ(2) = 6.59, P = 0.001). Because PKDL was observed during treatment with all currently used anti-leishmanial drugs, new drug regimens having high cure rates and potential to lower the PKDL incidence need to be investigated.
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Affiliation(s)
- Vidya Nand Rabi Das
- Rajendra Memorial Research Institute of Medical Sciences (ICMR), Agamkuan, Patna, Bihar, India.
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Bimal S, Sinha S, Singh SK, Narayan S, Kumar V, Verma N, Ranjan A, Sinha PK, Das VNR, Pandey K, Kar SK, Das P. Leishmania donovani: CD2 biased immune response skews the SAG mediated therapy for a predominant Th1 response in experimental infection. Exp Parasitol 2012; 131:274-82. [PMID: 22580024 DOI: 10.1016/j.exppara.2012.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 04/03/2012] [Accepted: 04/10/2012] [Indexed: 11/28/2022]
Abstract
We have evaluated the effect of combining CD2 with conventional antimonial (sb) therapy in protection in BALB/c mice infected with either drug sensitive or resistant strain of Leishmania donovani with 3×10(7) parasites via-intra-cardiac route. Mice were treated with anti CD2 adjunct SAG sub-cutaneously twice a week for 4 weeks. Assessment for measurement of weight, spleen size, anti-Leishmania antibody titer, T cell and anti-leishmanial macrophage function was carried out day 0, 10, 22 and 34 post treatments. The combination therapy was shown boosting significant proportion of T cells to express CD25 compared to SAG monotherapy. Although, the level of IFN-γ was not statistically different between combination vs monotherapy (p=0.298) but CD2 treatment even alone significantly influenced IFN-γ production than either SAG treatment (p=0.045) or with CD2 adjunct SAG treatment (p=0.005) in Ld-S strain as well as in Ld-R strain. The influence of CD2 adjunct treatment was also documented in anti-leishmanial functions in macrophages. As shown, the super-oxide generation began enhancing very early on day 10 after SAG treatment with CD2 during which SAG action was at minimum. Interestingly, the super-oxide generation ability remained intact in macrophage after treatment with immuno-chemotherapy even in mice infected with Leishmania resistant strain. Unlike SAG treatment, treatment of SAG with CD2 also led to production of nitric oxide and TNF-α, resulting in resulting in most effective clearance of L. donovani from infected macrophages. Our results indicate that CD2, which can boost up a protective Th1 response, might also be beneficial to enable SAG to induce Macrophages to produce Leishmanicidal molecules and hence control the infection in clinical situation like Kala-azar. Drug resistance is the major impedance for disease control but the encouraging results obtained after infecting mice with resistant strain of the parasite strongly imply that this drug can be effective even in treating resistant cases of Kala-azar.
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Affiliation(s)
- Sanjiva Bimal
- Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India.
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Ghosh J, Lal CS, Pandey K, Das VNR, Das P, Roychoudhury K, Roy S. Human visceral leishmaniasis: decrease in serum cholesterol as a function of splenic parasite load. Ann Trop Med Parasitol 2011; 105:267-71. [PMID: 21801506 DOI: 10.1179/136485911x12899838683566] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J Ghosh
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Agam Kuan, Patna, India
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Das VNR, Siddiqui NA, Verma RB, Topno RK, Singh D, Das S, Ranjan A, Pandey K, Kumar N, Das P. Asymptomatic infection of visceral leishmaniasis in hyperendemic areas of Vaishali district, Bihar, India: a challenge to kala-azar elimination programmes. Trans R Soc Trop Med Hyg 2011; 105:661-6. [PMID: 21945327 DOI: 10.1016/j.trstmh.2011.08.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/15/2011] [Accepted: 08/15/2011] [Indexed: 10/17/2022] Open
Abstract
A cohort of 91 asymptomatic individuals with visceral leishmaniasis (VL) were identified during base line screening using recombinant 39-aminoacid antigen (rk-39) and polymerase chain reaction (PCR) conducted from December 2005 to June 2006 involving 997 individuals of two highly endemic villages of Vaishali district, Bihar. The point prevalence of asymptomatic infection was 98 per 1000 persons at baseline. There was no statistically significant difference between rk-39 and PCR positivity rate (P>0.05), even though PCR positivity alone was found significantly higher (4.2%) than rk-39 positivity alone (2.6%). The monthly follow-up of the asymptomatic cohort revealed a disease conversion rate of 23.1 per 100 persons within a year. There was a statistically significant difference in conversion of disease when individuals were positive by both tests as compared to single tests by rk-39 and PCR (P<0.01). Disease conversion rate in the subjects residing in households with a history of VL (62%, 13/21) was higher than those residing in the households without a history of VL (38%, 8/21). Most of the identified asymptomatic individuals were from low socio-economic strata similar to that of VL cases in general. Apart from rk-39, PCR may be considered for screening of asymptomatic Leishmania donovani infection in large-scale epidemiological studies. Screening of asymptomatic cases and their close follow-up to ascertain early detection and treatment of VL may be considered in addition to the existing VL control strategies.
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Affiliation(s)
- V N R Das
- Rajendra Memorial Research Institute of Medical Sciences, ICMR, Agam-Kuan, Patna-800 007, Bihar, India.
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Wairagkar N, Chowdhury D, Vaidya S, Sikchi S, Shaikh N, Hungund L, Tomar RS, Biswas D, Yadav K, Mahanta J, Das VNR, Yergolkar P, Gunasekaran P, Raja D, Jadi R, Ramamurty N, Mishra AC. Molecular epidemiology of measles in India, 2005-2010. J Infect Dis 2011; 204 Suppl 1:S403-13. [PMID: 21666192 DOI: 10.1093/infdis/jir150] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Measles is a childhood disease that causes great morbidity and mortality in India and worldwide. Because measles surveillance in India is in its infancy, there is a paucity of countrywide data on circulating Measles virus genotypes. This study was conducted in 21 of 28 States and 2 of 7 Union Territories of India by MeaslesNetIndia, a national network of 27 centers and sentinel practitioners. MeaslesNetIndia investigated 52 measles outbreaks in geographically representative areas from 2005 through June 2010. All outbreaks were serologically confirmed by detection of antimeasles virus immunoglobulin M (IgM) antibodies in serum or oral fluid samples. Molecular studies, using World Health Organization (WHO)-recommended protocols obtained 203 N-gene, 40 H-gene, and 4 M-gene sequences during this period. Measles genotypes D4, D7, and D8 were found to be circulating in various parts of India during the study period. Further phylogenetic analysis revealed 4 lineages of Indian D8 genotypes: D8a, D8b, D8c, and D8d. This study generated a large, countrywide sequence database that can form the baseline for future molecular studies on measles virus transmission pathways in India. This study has created support and capabilities for countrywide measles molecular surveillance that must be carried forward.
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Affiliation(s)
- Niteen Wairagkar
- WHO Regional Measles Reference Laboratory, National Institute of Virology, Pune, India.
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Sinha PK, Roddy P, Palma PP, Kociejowski A, Lima MA, Rabi Das VN, Gupta J, Kumar N, Mitra G, Saint-Sauveur JF, Seena S, Balasegaram M, Parreño F, Pandey K. Effectiveness and safety of liposomal amphotericin B for visceral leishmaniasis under routine program conditions in Bihar, India. Am J Trop Med Hyg 2010; 83:357-64. [PMID: 20682882 DOI: 10.4269/ajtmh.2010.10-0156] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
We evaluated, through the prospective monitoring of 251 patients at Sadar Hospital in Bihar, India, the effectiveness and safety of 20 mg/kg body weight of liposomal amphotericin B for the treatment of visceral leishmaniasis. The treatment success rates for the intention-to-treat, per protocol, and intention-to-treat worse-case scenario analyses were 98.8%, 99.6%, and 81.3%, respectively. Nearly one-half of patients experienced mild adverse events, but only 1% developed serious but non-life-threatening lips swelling. The lost to follow-up rate was 17.5%. Our findings indicate that the 20 mg/kg body weight treatment dosage is effective and safe under routine program conditions. Given that the exorbitant cost of liposomal amphotericin B is a barrier to its widespread use, we recommend further study to monitor and evaluate a lowered dosage and a shorter treatment course.
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Affiliation(s)
- Prabhat K Sinha
- Rajendra Memorial Research Institute of Medical Science, Patna, Bihar, India
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Das VNR, Pandey K, Verma N, Bimal S, Lal CS, Singh D, Das P. Post-kala-azar dermal leishmaniasis (PKDL), HIV and pulmonary tuberculosis. Natl Med J India 2010; 23:88-89. [PMID: 20925205] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Post-kala-azar dermal leishmaniasis is usually a sequel to visceral leishmaniasis. A 25-year-old woman presented with hypopigmented maculopapular lesions all over the body for the past 4 years without any previous history of visceral leishmaniasis. She was on treatment for leprosy and pulmonary tuberculosis for the past 2 months, but did not show any improvement. Investigations confirmed that she had post-kala-azar dermal leishmaniasis associated with pulmonary tuberculosis and HIV-1 infection. She was started on treatment for the triad of diseases, and showed improvement.
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Affiliation(s)
- V N R Das
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna 800007, Bihar, India.
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Siddiqui NA, Kumar N, Ranjan A, Pandey K, Das VNR, Verma RB, Das P. Awareness about kala-azar disease and related preventive attitudes and practices in a highly endemic rural area of India. Southeast Asian J Trop Med Public Health 2010; 41:1-12. [PMID: 20578475] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study was undertaken to assess the extent of community awareness and related practices about kala-azar undertaken by them to control the disease, in an highly endemic focus of Bihar, India. A household-based cross-sectional knowledge, attitude, and practices (KAP) survey consisting of quantitative components on knowledge, attitude, and practices concerning kala-azar was administered to heads-of-household through a semi-structured questionnaire. Data indicated that 61% respondents were illiterate, 4% had correct knowledge that sandfly bites caused kala-azar, 26% do not know any specific transmission agents for kala-azar. A majority (72%) of respondents were not able to recognize sandfly, 33% had no specific knowledge about the symptoms. All of them (100%) believed that this disease could affect his or her family income. Nearly all (95%) were positive that the kala-azar cases could be reduced with implementation of proper health measures. A few (11%) suggested isolation of patients to avoid contacting kala-azar while a high proportion (93%) of respondents favored specific allopathic medicine, and a majority (72%) favored the utilization of the services offered by primary health centers or government hospitals. Just over half (66%) of the respondents were not using any prevention measures to avoid contacting disease. These results could prove to be useful for health planners in developing suitable control strategies.
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Affiliation(s)
- N A Siddiqui
- Rajendra Memorial Research Institute of Medical Sciences (ICMR), Agam-Kuan, Patna, Bihar, India.
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Kesari S, Kumar V, Palit A, Kishore K, Das VNR, Das P, Bhattacharya SK. A localized foci of kala-azar in a village of Chandi PHC (Nalnda district). J Commun Dis 2009; 41:211-214. [PMID: 22010490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- S Kesari
- Rajendra Memorial Research Institute of Medical Sciences, (I.C.M.R) Agamkuan, Patna 800 007
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Das VNR, Pandey K, Verma N, Lal CS, Bimal S, Topno RK, Singh D, Siddiqui NA, Verma RB, Das P. Short report: Development of post-kala-azar dermal leishmaniasis (PKDL) in miltefosine-treated visceral leishmaniasis. Am J Trop Med Hyg 2009; 80:336-338. [PMID: 19270277] [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: 05/27/2023] Open
Abstract
We report two cases of post-kala-azar dermal leishmaniasis (PKDL), which had subsequently developed after successful treatment of visceral leishmaniasis with miltefosine. Both patients had maculo-nodular lesions all over the body, and they were diagnosed as PKDL by parasitologic examination for Leishmania donovani bodies in a skin snip of lesions. Patients were put on amphotericin B and responded very well for nodular lesions with one course of treatment. However, longer duration of the treatment is needed for total clearance of macular lesions from body surface in PKDL cases. This is the first case report of PKDL in India, which developed after successful treatment of visceral leishmaniasis with miltefosine.
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Affiliation(s)
- Vidya Nand Rabi Das
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India.
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Das VNR, Das P, Topno RK, Lal CS, Siddiqui NA, Pandey K, Bimal S, Verma RB, Verma N, Singh D. Development of Post–Kala-Azar Dermal Leishmaniasis (PKDL) in Miltefosine-Treated Visceral Leishmaniasis. Am J Trop Med Hyg 2009. [DOI: 10.4269/ajtmh.2009.80.336] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [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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Das VNR, Siddiqui NA, Pandey K, Singh VP, Topno RK, Singh D, Verma RB, Ranjan A, Sinha PK, Das P. A controlled, randomized nonblinded clinical trial to assess the efficacy of amphotericin B deoxycholate as compared to pentamidine for the treatment of antimony unresponsive visceral leishmaniasis cases in Bihar, India. Ther Clin Risk Manag 2009; 5:117-24. [PMID: 19436614 PMCID: PMC2697519] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND There is significant variation in Amphotericin B (AMB) efficacy and relapses in antimony unresponsive visceral leishmaniasis (VL) cases over a period of time (10-15 years). Keeping in mind the above mentioned view this study was undertaken with an objective to assess the magnitude of cure and relapse rates of AMB in the treatment of antimony unresponsive VL cases. METHODS In a controlled, randomized nonblinded clinical trial, we evaluated the cure and relapse rate of Amphotericin B deoxycholate as compared to pentamidine. A total of 82 sodium stibogluconate (SSG) unresponsive and parasitologically confirmed VL cases were included in this study and randomized into two groups, test (Amphotericin B) and control (Pentamidine). Both the groups were treated with recommended dosages (as per World Health Organization guidelines) of respective medicines. All the patients were followed up on 1st, 2nd, and 6th month after end of treatment. RESULTS Apparent cure rate in the Amphotericin B group was found to be 95% (39/41) compared with 83% (34/41) in the Pentamidine group, which shows significant statistical difference (p = 0.05). The ultimate cure rate was found 92% (38/41) in the Amphotericin B group compared to 73% (30/41) in the Pentamidine group, which shows a significant statistical difference (Yates corrected chi-square = 4.42, p = 0.04). Similarly, significant statistical difference was observed in the relapse rate of the Amphotericin group compared to the Pentamidine group (p = 0.03). CONCLUSIONS AMB may still be the drug of choice in the management of resistant VL cases in Bihar, India. This is due to its consistent apparent cure rate (95%), low relapse rate (2.5%), and cost effectiveness compared with other available antileishmanial drugs. It is a safe drug even in case of pregnancy. Efforts should be taken to form a future strategy so that this drug and coming newer drugs do not meet a similar fate as has happened to SSG and pentamidine over a span of 10-15 years.
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Affiliation(s)
- Vidya Nand Rabi Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, Bihar, India;,Correspondence: Vidya N R Das, Rajendra Memorial Research, Institute of Medical Sciences (I.C.M.R.), Govt of India, Ministry of Health and F. W., Agam-Kuan, Patna-800007 (Bihar), India, Tel +91 612 263 1561, Fax +91 612 263 4379, Email
| | | | | | | | | | | | | | | | - Prabhat Kumar Sinha
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, Bihar, India
| | - Pradeep Das
- Director and Institutional Head, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, Bihar, India
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Pandey K, Sinha PK, Das VNR, Kumar N, Verma N, Bimal S, Lal CS, Topno RK, Singh D, Verma RB, Bhattacharya SK, Das P. Wilson disease with visceral leishmaniasis: an extremely uncommon presentation. Am J Trop Med Hyg 2007; 77:560-1. [PMID: 17827379] [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: 05/17/2023] Open
Abstract
Visceral leishmaniasis (VL), which is caused by the protozoa Leishmania donovani and transmitted by the bite of the female sand fly Phlebotomus argentipes, is common in Bihar, India. Wilson disease is an autosomal recessive disorder of copper metabolism in which copper is deposited in the brain and liver. We report a case of an extremely uncommon combination of these diseases in a patient. Treatment options for such a combination of diseases are limited and difficult.
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Affiliation(s)
- K Pandey
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Agamkuan Patna, Bihar, India.
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Das VNR, Siddiqui NA, Kumar N, Verma N, Verma RB, Dinesh DS, Kar SK, Das P. A pilot study on the status of lymphatic filariasis in a rural community of Bihar. J Commun Dis 2006; 38:169-75. [PMID: 17370681] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A pilot study of lymphatic filariasis was conducted in two contiguous villages of Patna district in Bihar situated at the side of the river Ganges, known to be endemic for lymphatic filariasis, to study present status of transmission parameters of filariasis. Of the 1872 persons examined, 8.4% were found asymptomatic but microfilaraemic. Morbidity pattern due to filarial infection showed an increase with advancement of age and significantly high in males as compared to female (p < 0.001). Acute and chronic filarial disease was observed as 0.5% and 9% respectively. Microfilaria was found in 10% of acute and 11.2% of chronic filarial cases. The Mf rate was found to be 9.9% in males and 9.0% in females respectively. The parasite species was identified as W. bancrofti. The vector fauna surveyed show highest prevalence of vector species of Cx. quinquefasciatus (43%) in both domestic as well as predomestic area in the community. Other species like Cx. vishnui and Ma. uniformis were also seen. Each household and predomestic area was searched for mosquito fauna at night. The infection rate in vectors was found to be 14% and infectivity rate (L3) was 8%. The filariasis cases detected in the study were treated with 12 days course of DEC 6 mg/kg body weight.
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Affiliation(s)
- V N R Das
- Division of Clinical Medicine, Rajendra Memorial Institute of Medical Sciences (ICMR), Agam-kuan, Patna, BIHAR, India.
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Bimal S, Das VNR, Sinha PK, Gupta AK, Verma N, Ranjan A, Singh SK, Sen A, Bhattacharya SK, Das P. Usefulness of the direct agglutination test in the early detection of subclinical Leishmania donovani infection: a community-based study. Ann Trop Med Parasitol 2006; 99:743-9. [PMID: 16297287 DOI: 10.1179/136485905x65107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The value of a direct agglutination test (DAT) in the detection of subclinical infections with Leishmania donovani has recently been investigated in the Indian state of Bihar, after the sensitivity and specificity of the test had been determined. When used to screen sera from 108 parasitologically confirmed cases of visceral leishmaniasis, 50 patients with active, non-leishmanial infection, and 641 healthy controls living close to, or distant from, an endemic area, the test was found to be 91.7% sensitive and 100% specific if a titre of 1:800 was used as the threshold for seropositivity. During a longitudinal clinical study in a rural, VL-endemic area of the Indian state of Bihar, the test was used, with 1:800 set as the threshold titre, to determine the baseline prevalence of infection with L. donovani among villagers who, though showing no symptoms of VL, had recently been febrile for at least 2 weeks. The 234 subjects of this study were either VL-case contacts [i.e. members of households in which there were active or cured VL cases (N=78)] or the members of control households with no cases or history of the disease (N=156). The results of DAT at the start of the study indicated that 49 (20.9%) of the subjects--29 (37.2%) of the VL-case contacts and 20 (12.8%) of the other subjects--were seropositive and therefore probably had subclinical infections with L. donovani. During the subsequent 9 months of follow-up, however, only eight of the subjects found seropositive at the start of the study--seven (24.1%) of the seropositive case contacts but only one (5.0%) of the other seropositives--developed symptomatic VL, all by month 6 of the follow-up. Compared with their neighbours, therefore, individuals who shared households with active or cured cases of VL appeared at greater risk not only of L. donovani infection (indicating focal transmission) but also of developing symptomatic disease once infected. Curiously, among the seropositive case contacts, those from the households that harboured active cases of VL at the baseline survey were less likely to develop symptomatic VL during the 9 months of follow-up than those from households that harboured only cured cases (18.8% v. 30.8%). The wide-spread use of DAT could allow the detection and early treatment of latent L. donovani infections and so contribute to the elimination of VL, at least as a public-health problem, from India.
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Affiliation(s)
- S Bimal
- Division of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna - 800007, India.
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Das VNR, Pandey K, Kumar N, Hassan SM, Bimal S, Lal CS, Siddiqui NA, Bhattacharya SK. Visceral leishmaniasis and tuberculosis in patients with HIV co-infection. Southeast Asian J Trop Med Public Health 2006; 37:18-21. [PMID: 16771207] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We describe here two cases, one male and one female, both age 40 years, with visceral leishmaniasis and HIV-1 co-infection. The female patient had features of Koch's abdomen. The male patient had features of tuberculous lymphadenitis and bilateral pleural effusion more marked on the right side. Both were treated with highly active antiretroviral therapy, antituberculous drugs, antibiotics, antifungal medicine (fluconazole) and miltefosine. Both patients showed marked improvement with therapy.
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Affiliation(s)
- V N R Das
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Sciences, Patna, Bihar.
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Sinha PK, Ranjan A, Singh VP, Das VNR, Pandey K, Kumar N, Verma N, Lal CS, Sur D, Manna B, Bhattacharya SK. Visceral leishmaniasis (kala-azar)--the Bihar (India) perspective. J Infect 2005; 53:60-4. [PMID: 16269185 DOI: 10.1016/j.jinf.2005.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 08/08/2004] [Revised: 09/14/2005] [Accepted: 09/15/2005] [Indexed: 11/20/2022]
Abstract
From a hospital-based surveillance carried out in Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India, the socio-economic, demographic and treatment response information of 737 patients admitted with visceral leishmaniasis (VL) during January 2001-December 2003, were analysed. The disease was two times higher in males than in females because of several factors including clothing pattern, sleeping habits and occupation. In Bihar, the second poorest state in India, poverty plays a major role in perpetuation of the disease, contributing to malnutrition, illiteracy (60%), and poor housing (82%). Further, presences of peri-domestic animal shelters around houses (63%) and vegetations (77%) facilitate breeding of sand fly vector. Clinical and laboratory characteristics were similar in the age groups <12 years and >12 years. The increasing unresponsiveness of VL patients to conventional anti-leishmanial drugs, e.g. sodium antimony gluconate (SAG) and pentamidine, has definitely posed a major therapeutic challenge in combating the disease. Amphotericin B, though costly, is highly effective. Miltefosine is a highly promising new oral drug for VL.
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Affiliation(s)
- P K Sinha
- Rajendra Memorial Research Institute of Medical Sciences (ICMR), Agaumkuan, P.O. Gulzarbagh, Patna 800 007, Bihar, India
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Bimal S, Singh SK, Das VNR, Sinha PK, Gupta AK, Bhattacharya SK, Das P. Leishmania donovani: Effect of therapy on expression of CD2 antigen and secretion of macrophage migration inhibition factor by T-cells in patients with visceral leishmaniasis. Exp Parasitol 2005; 111:130-2. [PMID: 16023642 DOI: 10.1016/j.exppara.2005.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 01/18/2005] [Revised: 05/26/2005] [Accepted: 05/27/2005] [Indexed: 11/28/2022]
Abstract
Visceral leishmaniasis (VL) commonly known as Kala-azar in India is one of the several clinically important infections, where Th1 sub-population of CD4+ T-cells, despite a pre-requisite, fails to express macrophage migration inhibition factor (MIF) and interferon-gamma which both activate the macrophage and coordinate the immune response to intra-cellular Leishmania sp. Expression of CD2 receptors before and after antileishmanial therapy on CD4+ T-cells of VL patients and their corresponding effect on MIF were examined. Before treatment the number of T-cells expressing CD2 was low which incorporated insignificant MIF response. The immunological reconstitution was, however, observed after treatment as manifested through upregulation of CD2+ T-cells with pronounced MIF generation response. The study, therefore, identifies a possible role of CD2 antigen in immunity to VL.
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Affiliation(s)
- S Bimal
- Division of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India.
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Das VNR, Pandey K, Kumar N, Hassan SM, Bhattacharya SK. HIV infection, pneumonic patch with tuberculosis and hepatitis--a case report. J Commun Dis 2005; 37:155-7. [PMID: 16749282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- V N R Das
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Agamkuan, Patna
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Das VNR, Ranjan A, Bimal S, Siddique NA, Pandey K, Kumar N, Verma N, Singh VP, Sinha PK, Bhattacharya SK. Magnitude of unresponsiveness to sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar. Natl Med J India 2005; 18:131-3. [PMID: 16130613] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The Indian government proposes to eliminate kala-azar, which has been a serious public health problem in Bihar. This study aimed to assess the magnitude of unresponsiveness to sodium stibogluconate in the treatment of new cases of visceral leishmaniasis and to identify the associated factors. METHODS Patients with clinically and parasitologically confirmed visceral leishmaniasis (n = 182) who had received no prior treatment, were enrolled for the study. The patients were treated with sodium stibogluconate (20 mg/kg body weight; upper limit 850 mg), intramuscularly for 30 days. The vital parameters and side-effects, if any, were monitored. Patients who developed toxicity during treatment were excluded from the study but were given rescue treatment with liposomal amphotericin B. All patients who completed the treatment were followed up for 6 months. RESULTS Unresponsiveness to sodium stibogluconate at the end of treatment was 43%. It was higher in women (48%) compared to men (40%). A significant association was observed between unresponsiveness and level of endemicity (p = 0.0002), large spleen size (p = 0.04) and immune response (migration inhibition factor) (p = 0.00002). At the end of 6 months' follow up, 27% of patients relapsed, giving a total unresponsiveness rate of 58%. CONCLUSION Unresponsiveness to sodium stibogluconate is a serious problem in the management of patients with visceral leishmaniasis. In patients with factors associated with nonresponse to sodium stibogluconate, alternative drugs such as miltefosine or amphotericin B should be considered as first-line drugs.
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Affiliation(s)
- V N R Das
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Agamkuan, Patna 800007, Bihar, India.
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Lal CS, Kumar V, Ranjan A, Das VNR, Kumar N, Kishore K, Bhattacharya SK. Evaluation of cholinesterase level in an endemic population exposed to malathion suspension formulation as a vector control measure. Mem Inst Oswaldo Cruz 2005; 99:219-21. [PMID: 15250479 DOI: 10.1590/s0074-02762004000200018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/22/2022] Open
Abstract
The manuscript describes a study on the blood cholinesterase (ChE) level in an exposed population at different interval of time after spraying with malathion suspension (SRES) use for kala-azar vector control in an endemic area of Bihar, India. The toxicity of a 5% malathion formulation in the form of a slow release emulsified suspension (SRES) was assessed by measuring serum ChE levels in spraymen and in the exposed population. The study showed a significant decrease in ChE levels in the spraymen (p < 0.01) after one week of spraying and in exposed population one week and one month after of spraying (p < 0.01), but was still within the normal range of ChE concentration, one year after spraying, the ChE concentration in the exposed population was the same as prior to spraying (p > 0.01). On no occasion was the decrease in ChE level alarming. A parallel examination of the clinical status also showed the absence of any over toxicity or any behavioural changes in the exposed population. Hence, it may be concluded that 5% malathion slow release formulation, SRES, is a safe insecticide for use as a vector control measure in endemic areas of kala-azar in Bihar, India so long as good personal protection for spraymen is provided to minimize absorption and it can substitute the presently used traditional DDT spray.
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Affiliation(s)
- C S Lal
- Rajendra Memorial Research Institute of Medical Sciences, (Indian Council of Medical Research), Patna 800 007, India.
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Das VNR, Dinesh DS, Verma N, Kar SK. A case report on self-cure of visceral leishmaniasis. J Commun Dis 2002; 34:302-3. [PMID: 14710862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- V N R Das
- Rajendra Memorial Research Institute of Medical Sciences (ICMR) Agamkuan, Patna-800 007, India
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