1
|
Abdullahi B, Mutiso J, Gicheru M. Social Demographic Characteristics Associated with Visceral Leishmaniasis in West Pokot, Kenya. Am J Trop Med Hyg 2024; 110:930-935. [PMID: 38531111 PMCID: PMC11066342 DOI: 10.4269/ajtmh.23-0241] [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: 04/22/2023] [Accepted: 01/14/2024] [Indexed: 03/28/2024] Open
Abstract
Visceral leishmaniasis is a tropical disease with a significant global public health burden. This study aimed to determine the social demographic characteristics associated with visceral leishmaniasis in West Pokot of Kenya. A mixed-methods research design was adopted where household questionnaires and key informant interviews were administered. Quantitative data was analyzed using SPSS version 22, and qualitative data were analyzed to establish patterns for interpretation. Male children aged 10 years or younger were the most infected by Leishmania donovani in the community. The hospital record indicated that 60% of previously treated visceral leishmaniasis patients were severely malnourished during admission. Risk factors associated with the disease included low formal education (adjusted odds ratio [aOR] = 4.39; 95% CI = 1.66-11.59; P <0.05), peasant farming (aOR = 8.49; 95% CI = 2.77-26.00; P <0.05), and dog ownership (aOR = 4.86; 95% CI = 1.87-12.60; P <0.05). Social demographic risk factors for visceral leishmaniasis remain a major public health concern in West Pokot.
Collapse
Affiliation(s)
- Bulle Abdullahi
- Department of Community Health and Epidemiology, School of Health Sciences, Kenyatta University, Nairobi, Kenya
| | - Joshua Mutiso
- Department of Zoological Sciences, School of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
| | - Michael Gicheru
- Department of Zoological Sciences, School of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
| |
Collapse
|
2
|
Roy S, Moulik S, Chaudhuri SJ, Ghosh MK, Goswami RP, Saha B, Chatterjee M. Molecular monitoring of treatment efficacy in human visceral leishmaniasis. Trans R Soc Trop Med Hyg 2024; 118:343-345. [PMID: 38223920 DOI: 10.1093/trstmh/trad103] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/03/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Focused efforts of the visceral leishmaniasis elimination program have led to a drastic decline in cases, and the present challenge is disease monitoring, which this study aimed to assess. METHODS A Leishmania kinetoplastid-targeted qPCR quantified parasite load at disease presentation, and following treatment completion (n=49); an additional 80 cases were monitored after completion of treatment. RESULTS The parasite load at disease presentation was 13 461.00 (2560.00-37764.00)/µg gDNA, which upon completion of treatment reduced in 47 of 49 cases to 1(1-1)/µg gDNA, p<0.0001. In 80 cases that presented >2 months post-treatment, their parasite burden similarly decreased to 1(1-1)/µg gDNA except in 6 of 80 cases, which were qPCR positive. CONCLUSION In 129 cases of visceral leishmaniasis, qPCR by quantification of parasite burden proved effective for monitoring treatment.
Collapse
Affiliation(s)
- Sutopa Roy
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata 700020, India
| | - Srija Moulik
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata 700020, India
| | - Surya Jyati Chaudhuri
- Department of Microbiology, Sarat Chandra Chattopadhyay Government Medical College and Hospital, Uluberia, Howrah 711316, India
| | - Manab K Ghosh
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata700073, India
| | - R P Goswami
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata700073, India
| | - Bibhuti Saha
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata700073, India
| | - Mitali Chatterjee
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata 700020, India
| |
Collapse
|
3
|
Tadesse D, Abdissa A, Mekonnen M, Belay T, Hailu A. Antibody and cytokine levels in visceral leishmaniasis patients with varied parasitemia before, during, and after treatment in patients admitted to Arba Minch General Hospital, southern Ethiopia. PLoS Negl Trop Dis 2021; 15:e0009632. [PMID: 34351903 PMCID: PMC8370634 DOI: 10.1371/journal.pntd.0009632] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 08/17/2021] [Accepted: 07/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Visceral leishmaniasis is a disease caused by disseminated Leishmania donovani infection which affects almost half a million people annually. Most of the patients are reported from the Indian sub-continent, Eastern Africa and Brazil. In this study, we aimed to determine the levels of antibodies and cytokines in visceral leishmaniasis patients and to examine associations of parasitemia with the clinical states of patients. A prospective study was carried out, enrolling a total of 48 active VL patients who were evaluated before, during different time points and, three months after treatment. Serum cytokine concentrations, antibody levels, parasitemia, laboratory (hematologic and biochemical) measurements, and clinical parameters were assessed. Results Counts of WBC and platelets, and measurements of hemoglobin (Hb) increased during treatment (P ≤ 0.05). Elevated levels of circulating IL-10, IFN-γ, and TGF-β1 were measured before treatment. The observed increase in serum IL-10 remarkably declined within 7 days after the start of treatment. Anti-leishmanial antibody index (AI) was high in all VL patients irrespective of spleen aspirate parasite grade before treatment and at different times during treatment. However, a significant (P ≤ 0.05) decrease of AI was observed 120 days post-treatment. IL-2 serum levels were below the detection limit at all sampling points. Conclusions The present results suggest that IL-10, IFN-γ, and TGF-β1 can be used as markers of active visceral leishmaniasis. In addition, measuring circulating cytokines concentrations, particularly IL-10, in combination with other clinical evaluations, could be used as criteria for the cure. The observation that a high serum concentration of IFN-gamma at baseline was associated with low parasitemia deserves further investigations. Visceral leishmaniasis (also known as kala-azar) is a neglected tropical disease that occurs in widely dispersed areas of the world, including Ethiopia. Parasites in the Leishmania donovani complex are responsible for causing visceral leishmaniasis. The condition is difficult to diagnose and treat. We investigated how the immune response generated during follow-up treatment periods of active VL before, during, and post-treatment was influenced by the presence of different cytokines. It is important to identify possible immunological biomarkers that could be correlated with patients’ clinical and parasitological presentation as well as the response patterns to treatment in VL patients of southwestern Ethiopia.
Collapse
Affiliation(s)
- Dagimawie Tadesse
- Department of Medical Laboratory Science, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- * E-mail: (DT); (AH)
| | - Alemseged Abdissa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Mekidim Mekonnen
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Tariku Belay
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Asrat Hailu
- Departments of Microbiology, Immunology, and Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail: (DT); (AH)
| |
Collapse
|
4
|
Kurt Ö, Mansur Özen N, Aydın EM, Kaya DE, Kayhan CK, Öktem Okullu S, İnce Ü, Yıldız Zeyrek F. Characterisation of the Leishmania donovani/L. infantum Hybrid Isolated from an Autochothonous Kala-Azar Patient: Preliminary Results of an In Vivo Model. Turkiye Parazitol Derg 2021; 45:95-100. [PMID: 34103284 DOI: 10.4274/tpd.galenos.2021.14622] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE In the present study, preliminary outcomes of the in vivo assessment of a Leishmania donovani/L. infantum hybrid isolated from a hospitalised patient with visceral leishmaniasis in Manisa and identified through analysis of the Leishmania-specific ITS-1, hsp70 and cpb gene regions are presented in comparison with reference strains of L. donovani and L. infantum. METHODS Three different study groups [(SG); n=16 mice each] and a control group (n=8 mice) were established with female Balb/C mice weighing 25-30 g. Reference L. donovani (MHOM/IN/1980/DD8), reference L. infantum (MHOM/TN/1980/IP1) and a L. donovani/L. infantum hybrid (MHOM/TR/2014/CBVL-LI/ LD), stored in liquid nitrogen, were thawed, cultured and incubated at 25 °C. A 15-μL dose of 1x108/mL promastigotes of three strains was applied to the tail veins of mice in the SG. After the mice were sacrificed, the liver and spleen tissues were removed and stored for immunological, immunohistochemical and pathological analyses. RESULTS The presence of infection in the liver and spleen tissues of mice was detected both by a specific enzyme-linked immunosorbent assay test and from the recovery of Leishmania promastigotes from liver and spleen tissues in NNN medium. However, Leishmania amastigotes were not observed in the touch biopsy smears of livers or spleens in either of the SGs. In addition, no evidence of tissue damage was identified in the SGs after immunohistochemical staining (with antibodies against IL-9, CD-117, MBP, CD163, CD4, CD8 and CD31). CONCLUSION The obtained results show that hybrid Leishmania and reference L. donovani and L. infantum strains reached the liver and spleens of Balb/C mice in SGs but were of no pathological consequence. Yet, these three Leishmania isolates caused skin lesions when applied subcutaneously in Balb/C mice in another study. The findings presented in this study will be reassessed upon completion of the project, once the final results are obtained.
Collapse
Affiliation(s)
- Özgür Kurt
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Nesteren Mansur Özen
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Sağlık Bilimleri Enstitüsü, Medikal Biyoteknoloji Anabilim Dalı, İstanbul, Türkiye
| | - Elif Merve Aydın
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Sağlık Bilimleri Enstitüsü, Medikal Biyoteknoloji Anabilim Dalı, İstanbul, Türkiye
| | - Deniz Ece Kaya
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Sağlık Bilimleri Enstitüsü, Biyoistatistik ve Biyoinformatik Anabilim Dalı, İstanbul, Türkiye
| | - Cavit Kerem Kayhan
- Acıbadem Sağlık Grubu, Maslak Hastanesi, Patoloji Kliniği, İstanbul, Türkiye
| | - Sinem Öktem Okullu
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Ümit İnce
- Acıbadem Sağlık Grubu, Maslak Hastanesi, Patoloji Kliniği, İstanbul, Türkiye
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Tıp Fakültesi, Tıbbi Patoloji Anabilim Dalı, İstanbul, Türkiye
| | - Fadile Yıldız Zeyrek
- Harran Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, Şanlıurfa, Türkiye
| |
Collapse
|
5
|
Affiliation(s)
- Chong Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ang Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qingmiao Shi
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zujiang Yu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| |
Collapse
|
6
|
Marlais T, Bhattacharyya T, Pearson C, Gardner BL, Marhoon S, Airs S, Hayes K, Falconar AK, Singh OP, Reed SG, El-Safi S, Sundar S, Miles MA. Isolation and characterisation of Leishmania donovani protein antigens from urine of visceral leishmaniasis patients. PLoS One 2020; 15:e0238840. [PMID: 32925980 PMCID: PMC7489519 DOI: 10.1371/journal.pone.0238840] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022] Open
Abstract
Diagnosis of visceral leishmaniasis (VL) relies on invasive and risky aspirate procedures, and confirmation of cure after treatment is unreliable. Detection of Leishmania donovani antigens in urine has the potential to provide both a non-invasive diagnostic and a test of cure. We searched for L. donovani antigens in urine of VL patients from India and Sudan to contribute to the development of urine antigen capture immunoassays. VL urine samples were incubated with immobilised anti-L. donovani polyclonal antibodies and captured material was eluted. Sudanese eluted material and concentrated VL urine were analysed by western blot. Immunocaptured and immunoreactive material from Indian and Sudanese urine was submitted to mass spectrometry for protein identification. We identified six L. donovani proteins from VL urine. Named proteins were 40S ribosomal protein S9, kinases, and others were hypothetical. Thirty-three epitope regions were predicted with high specificity in the 6 proteins. Of these, 20 were highly specific to Leishmania spp. and are highly suitable for raising antibodies for the subsequent development of an antigen capture assay. We present all the identified proteins and analysed epitope regions in full so that they may contribute to the development of non-invasive immunoassays for this deadly disease.
Collapse
Affiliation(s)
- Tegwen Marlais
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Tapan Bhattacharyya
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Callum Pearson
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bathsheba L. Gardner
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Safiyyah Marhoon
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephanie Airs
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kiera Hayes
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Om Prakash Singh
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Steven G. Reed
- Infectious Disease Research Institute, Seattle, Washington, United States of America
| | - Sayda El-Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Michael A. Miles
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
7
|
Chen HM, Chen HY, Tao F, Gao JP, Li KL, Shi H, Peng H, Ma YJ. Leishmania infection and blood sources analysis in Phlebotomus chinensis (Diptera: Psychodidae) along extension region of the loess plateau, China. Infect Dis Poverty 2020; 9:125. [PMID: 32867841 PMCID: PMC7461359 DOI: 10.1186/s40249-020-00746-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) was one of the most important parasitic diseases in China, caused by Leishmania protozoans and transmitted by sand flies. Recently VL cases have reappeared in China, including the extension region of the Loess Plateau. The purpose of this study was to collect fundamental data on the host-vector VL system in the Loess Plateau to assist in the development of prevention and control measures. METHODS Sand flies were collected by light traps from rural areas in Shanxian, Henan, China in 2015, as well as in Wuxiang and Yangquan, Shanxi, China in 2017. The blood sources of sand flies were analyzed by PCR detecting the host-specific mitochondrial cytochrome b (mtDNA cyt b) gene fragments. Leishmania infection in sand flies was detected by amplifying and sequencing ribosomal DNA internal transcribed spacer 1 (ITS1). The Leishmania specific antibodies in the sera of local dogs were detected by ELISA kit. RESULTS Blood sources showed diversity in the extension region of the Loess Plateau, including human, chicken, dog, cattle, pig and goat. Multiple blood sources within a sand fly were observed in samples from Yangquan (17/118, 14.4%) and Wuxiang (12/108, 11.1%). Leishmania DNA was detected in sand flies collected from Yangquan with minimum infection rate of 1.00%. The ITS1 sequences were conserved with the Leishmania donovani complex. The positive rate of Leishmania specific antibodies in dogs was 5.97%. CONCLUSIONS This study detected the blood sources and Leishmania parasites infection of sand flies by molecular methods in the extension region of Loess Plateau, China. A high epidemic risk of leishmaniasis is currently indicated by the results as the infection of Leishmania in sand flies, the extensive blood sources of sand flies including humans, and positive antibody of Leishmania in local dog sera. Given the recent increase of VL cases, asymptomatic patients, dogs and other potential infected animals should be screened and treated. Furthermore, the density of sand flies needs to be controlled and personal protection should be strengthened.
Collapse
Affiliation(s)
- Han-Ming Chen
- Department of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
| | - Hui-Ying Chen
- Department of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
| | - Feng Tao
- Department of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
| | - Jing-Peng Gao
- Department of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
| | - Kai-Li Li
- Department of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China
| | - Hua Shi
- Institute of Disease Control and Prevention of People's Liberation Army of China, Beijing, 100071, China
| | - Heng Peng
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
| | - Ya-Jun Ma
- Department of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
| |
Collapse
|
8
|
Sevá ADP, Ferreira F, Amaku M. How much does it cost to prevent and control visceral leishmaniasis in Brazil? Comparing different measures in dogs. PLoS One 2020; 15:e0236127. [PMID: 32692783 PMCID: PMC7373293 DOI: 10.1371/journal.pone.0236127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022] Open
Abstract
Visceral leishmaniasis (VL) is an important zoonosis in Brazil. Dogs are considered the main domestic reservoirs of the disease in the country; hence, control measures are focused on these reservoirs. Despite efforts to prevent and control VL, important reductions in disease prevalence and incidence have not been identified, stimulating the development and application of new strategies. The choice and implementation of new control strategies can benefit from the application of mathematical models that allow the simulation of different strategies in different scenarios. Selecting the best strategy to be implemented is also supported by cost-effectiveness studies. Here we used the results of a mathematical model in which scenarios, including isolated use of the vaccine and insecticide-impregnated collar (IIC), both at different coverage rates, were simulated to conduct a cost-effectiveness study. The costs were calculated for each scenario considering a simulation period of four years. Collar application in both infected and non-infected animals was the most cost-effective strategy. For example, to reduce the prevalence in humans and dogs by approximately 70%, the costs ranged from $250,000 and $550,000 for the IICs and vaccination, respectively. Even in the scenario with 40% loss/replacement of IICs, this measure was more advantageous in terms of cost-effectiveness than vaccination. If the vaccine were applied with culling of seropositive tested dogs, then the measure became more effective with a reduced cost compared with the vaccine alone. The use of the three first consecutive vaccine doses had the greatest impact on the cost of the vaccination strategy. The advantage of using IICs is that there is no need for a prior diagnosis, unlike vaccination, reducing costs and facilitating implementation. The present study aims to contribute to strategies to reduce hosts infected with VL by reducing public expenditure.
Collapse
Affiliation(s)
- Anaiá da Paixão Sevá
- Department of Animal Health and Preventive Veterinary, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Exact and Technological Sciences, State University of Santa Cruz, Ilhéus, Brazil
- * E-mail: ,
| | - Fernando Ferreira
- Department of Animal Health and Preventive Veterinary, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marcos Amaku
- Department of Animal Health and Preventive Veterinary, University of São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
9
|
Tadele M, Abay SM, Makonnen E, Hailu A. Leishmania donovani Growth Inhibitors from Pathogen Box Compounds of Medicine for Malaria Venture. Drug Des Devel Ther 2020; 14:1307-1317. [PMID: 32280200 PMCID: PMC7130106 DOI: 10.2147/dddt.s244903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/18/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Leishmaniasis is a collective term used to describe various pathological conditions caused by an obligate intracellular protozoan of the genus Leishmania. It is one of the neglected diseases and has been given minimal attention by drug discovery and development stakeholders to narrow the safety and efficacy gaps of the drugs currently used to treat leishmaniasis. The challenge is further exacerbated by the emergence of drug resistance by the parasites. METHODS Aiming to look for potential anti-leishmanial hits and leads, we screened Medicines for Malaria Venture (MMV) Pathogen Box compounds against clinically isolated Leishmania donovani strain. In this medium-throughput primary screening assay, the compounds were screened against promastigotes, and then against amastigote stages. RESULTS From the total 400 compounds screened, 35 compounds showed >50% inhibitory activity on promastigotes in the initial screen (1 μM). Out of these compounds, nine showed >70% inhibition, with median inhibitory concentration (IC50) ranging from 12 to 491 nM using the anti-promastigote assay, and from 53 to 704 nM using the intracellular amastigote assay. Identified compounds demonstrated acceptable safety profiles on THP-1 cell lines and sheep red blood cells, and had appropriate physicochemical properties suitable for further drug development. Two compounds (MMV690102 and MMV688262) were identified as leads. The anti-tubercular agent MMV688262 (delamanid) showed a synergistic effect with amphotericin B, indicating the prospect of using this compound for combination therapy. CONCLUSION The current study indicates the presence of additional hits which may hold promise as starting points for anti-leishmanial drug discovery and in-depth structure-activity relationship studies.
Collapse
Affiliation(s)
- Markos Tadele
- Animal Health Research Program, Ethiopian Institute of Agricultural Research, Holetta, Ethiopia
| | - Solomon M Abay
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Hailu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
10
|
Tasdemir D, MacIntosh AJJ, Stergiou P, Kaiser M, Mansour NR, Bickle Q, Huffman MA. Antiprotozoal and antihelminthic properties of plants ingested by wild Japanese macaques (Macaca fuscata yakui) in Yakushima Island. J Ethnopharmacol 2020; 247:112270. [PMID: 31589965 DOI: 10.1016/j.jep.2019.112270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Primates forage on a variety of plant parts to balance their dietary intake to meet requirements of energy, nutrition and maintenance, however the reason(s) leading them to ingest some plants which have no nutritional value and/or contain bioactive or even toxic secondary metabolites is recently gaining closer attention. The growing literature suggests that primates consume plants for medicinal purposes (self-medication) as well, particularly when infected with parasites and pathogens (bacteria, viruses, microbes). Interestingly, some of the plants they consume are also used by humans for similar purposes or may have potential uses for humans. MATERIALS AND METHODS As part of a 16-month study of the parasite ecology of a sub-species of Japanese macaques (Macaca fuscata yakui) on the island of Yakushima, we surveyed their feeding habits and collected a subset of plants and plant parts observed being ingested by macaques. The ethnomedicinal value of these plants was surveyed and methanolic extracts of 45 plant parts were tested in vitro against important parasites of humans, including four protozoan parasites Plasmodium falciparum, Trypanosoma brucei rhodesiense, T. cruzi and Leishmania donovani, and the trematode flatworm Schistosoma mansoni. Potential toxicity of the extracts was also assessed on mammalian cells. RESULTS A wide range of ethnomedicinal uses in Asia for these plants is noted, with 37% associated with the treatment of parasites, pathogens and related symptoms. Additionally, the 45 extracts tested showed broad and significant activity against our test organisms. All extracts were active against T. b. rhodesiense. The majority (over 80%) inhibited the growth of P. falciparum and L. donovani. Half of the extracts also displayed antiprotozoal potential against T. cruzi while only several extracts were active against both larval and adult stages of S. mansoni. Cytotoxicity was generally low, although several extracts lacked specific toxicity to test parasites. CONCLUSIONS Our results indicated a number of plants and their parts to have antiparasitic activity not previously reported in the ethnopharmacological literature. Enhanced understanding of the primate diets, particularly during periods of intensified parasite infection risk may help to further narrow down plants of interest for lead compound development. The study of animal self-medication is a complementary approach, with precedence, to drug discovery of new lead drug compounds against human parasitic diseases.
Collapse
Affiliation(s)
- Deniz Tasdemir
- Department of Pharmaceutical and Biological Chemistry, Centre for Pharmacognosy and Phytotherapy, School of Pharmacy, University of London, London, WC1N 1AX, UK; GEOMAR Centre for Marine Biotechnology, Research Unit Marine Natural Products Chemistry, GEOMAR Helmholtz Centre for Ocean Research Kiel, 24106, Kiel, Germany; Kiel University, Christian-Albrechts-Platz 4, 24118, Kiel, Germany.
| | - Andrew J J MacIntosh
- Primate Research Institute, Kyoto University, Kanrin 41-2, 484-8506, Inuyama, Japan
| | - Polyxeni Stergiou
- Department of Pharmaceutical and Biological Chemistry, Centre for Pharmacognosy and Phytotherapy, School of Pharmacy, University of London, London, WC1N 1AX, UK
| | - Marcel Kaiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, CH-4051, Basel, Switzerland; University of Basel, 4003, Basel, Switzerland
| | - Nuha R Mansour
- Department of Infection Biology, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Quentin Bickle
- Department of Infection Biology, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Michael A Huffman
- Primate Research Institute, Kyoto University, Kanrin 41-2, 484-8506, Inuyama, Japan.
| |
Collapse
|
11
|
Ty MC, Loke P, Alberola J, Rodriguez A, Rodriguez-Cortes A. Immuno-metabolic profile of human macrophages after Leishmania and Trypanosoma cruzi infection. PLoS One 2019; 14:e0225588. [PMID: 31841511 PMCID: PMC6913957 DOI: 10.1371/journal.pone.0225588] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 04/01/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022] Open
Abstract
Macrophages can reprogram their metabolism in response to the surrounding stimuli, which affects their capacity to kill intracellular pathogens. We have investigated the metabolic and immune status of human macrophages after infection with the intracellular trypanosomatid parasites Leishmania donovani, L. amazonensis and T. cruzi and their capacity to respond to a classical polarizing stimulus (LPS and IFN-γ). We found that macrophages infected with Leishmania preferentially upregulate oxidative phosphorylation, which could be contributed by both host cell and parasite, while T. cruzi infection did not significantly increase glycolysis or oxidative phosphorylation. Leishmania and T. cruzi infect macrophages without triggering a strong inflammatory cytokine response, but infection does not prevent a potent response to LPS and IFN-γ. Infection appears to prime macrophages, since the cytokine response to activation with LPS and IFN-γ is more intense in infected macrophages compared to uninfected ones. Metabolic polarization in macrophages can influence infection and immune evasion of these parasites since preventing macrophage cytokine responses would help parasites to establish a persistent infection. However, macrophages remain responsive to classical inflammatory stimuli and could still trigger inflammatory cytokine secretion by macrophages.
Collapse
Affiliation(s)
- Maureen C. Ty
- New York University School of Medicine, Department of Microbiology, New York, NY, United States of America
| | - P’ng Loke
- New York University School of Medicine, Department of Microbiology, New York, NY, United States of America
| | - Jordi Alberola
- Dept Farmacologia, Toxicologia i Terapeutica, Facultat de Veterinaria, Edifici V, Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Ana Rodriguez
- New York University School of Medicine, Department of Microbiology, New York, NY, United States of America
- * E-mail:
| | - Alheli Rodriguez-Cortes
- New York University School of Medicine, Department of Microbiology, New York, NY, United States of America
- Dept Farmacologia, Toxicologia i Terapeutica, Facultat de Veterinaria, Edifici V, Universitat Autonoma de Barcelona, Bellaterra, Spain
| |
Collapse
|
12
|
Pereira A, Valente J, Parreira R, Cristovão JM, Azinheira S, Campino L, Maia C. An Unusual Case of Feline Leishmaniosis With Involvement of the Mammary Glands. Top Companion Anim Med 2019; 37:100356. [PMID: 31837752 DOI: 10.1016/j.tcam.2019.100356] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/31/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022]
Abstract
We report an unusual case of leishmaniosis with the involvement of mammary glands in an old cat with what seems to be a concurrent regressive feline leukemia virus infection. Leishmania donovani complex parasites were identified for the first time in inflammatory breast fluid during a clinical recurrence manifested about 4 years after the first diagnosis of feline leishmaniosis. Combined treatment with allopurinol and meglumine antimoniate resulted in clinical cure of mammary lesion and a concurrent uveitis.
Collapse
Affiliation(s)
- André Pereira
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (NOVA), Lisbon, Portugal; Medical Parasitology Unit, IHMT, NOVA, Lisbon, Portugal
| | | | - Ricardo Parreira
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (NOVA), Lisbon, Portugal; Medical Microbiology Unit, IHMT, NOVA, Lisbon, Portugal
| | - José Manuel Cristovão
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (NOVA), Lisbon, Portugal; Medical Parasitology Unit, IHMT, NOVA, Lisbon, Portugal
| | | | - Lenea Campino
- Medical Parasitology Unit, IHMT, NOVA, Lisbon, Portugal
| | - Carla Maia
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (NOVA), Lisbon, Portugal; Medical Parasitology Unit, IHMT, NOVA, Lisbon, Portugal.
| |
Collapse
|
13
|
Thilakarathne IK, Ratnayake P, Vithanage A, Sugathadasa DP. Role of Histopathology in the Diagnosis of Cutaneous Leishmaniasis: A Case-Control Study in Sri Lanka. Am J Dermatopathol 2019; 41:566-570. [PMID: 31335408 DOI: 10.1097/dad.0000000000001367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cutaneous leishmaniasis (CL) displays a spectrum of manifestations clinically and histologically. Then, it becomes a diagnostic challenge and must discern from the other clinical and histological mimics, especially when the Leishman-Donovan bodies are inattentive. In this study, we compared the distinguishing histomorphological characteristics of CL against the other skin diseases with similar clinical and histological features. Skin biopsies of 181 patients, which suspect CL clinically, are evaluated histologically. Pertaining to the first case-control comparison, which performed between skin lesions of CL with or without discernible organisms and the other granulomatous dermatitis, highlighted that the ill-formed coalescent granulomata (OR = 14.83) and diffuse dense dermal plasma cell infiltrate (OR = 74.25) are significantly associated with the skin lesions of CL. The second case-control analysis was between CL without discernible organisms and the other granulomatous dermatitis, and identified a significant association in the presence of ill-formed coalescent granulomata (OR = 16.94) and diffuse dense (>50/HPF) dermal plasma cell infiltrate (OR = 74.5) in the skin lesions of CL. Pertaining to epidermal changes, acanthosis (OR = 2.38), spongiosis (OR = 9.13), and the presence of ulceration (OR = 20.26) are among the major concerns in CL. In conclusion, in the presence of clinical suspicion, dermal granulomata in ill-formed coalescent morphology with high plasma cell density in a diffuse arrangement are positive factors for the diagnosis of CL, especially when the discernible Leishmania amastigotes are absent. Resource utilization such as polymerase chain reaction and other ancillary techniques during the diagnosis of CL can be minimized by using a range of histopathological features and special attention should be focused on this in the future.
Collapse
|
14
|
Deepachandi B, Weerasinghe S, Soysa P, Karunaweera N, Siriwardana Y. A highly sensitive modified nested PCR to enhance case detection in leishmaniasis. BMC Infect Dis 2019; 19:623. [PMID: 31307404 PMCID: PMC6631494 DOI: 10.1186/s12879-019-4180-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/11/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Human leishmaniasis is one of the major parasitic diseases with worldwide distribution. Sri Lanka is a recently established focus of leishmaniasis caused by a variant Leishmania donovani. Early case detection and management is a main approach identified for L. donovani control in the regional leishmaniasis elimination drive. Usefulness of light microscopy and in-vitro culture are limited in chronic, atypical or treated lesions though timely and accurate detection of all light microscopy/in-vitro culture negative cases of all forms of leishmaniasis is necessary for treatment. Timely treatment is important to minimize risk for death in visceral disease and undesired sequelae of long standing infection and illness on both patients and community. We described a 100% sensitive, Leishmania spp. specific modified version of a nested PCR (Mo-STNPCR) that also minimizes carry over and cross contaminations while facilitate investigation of light microscopy and in-vitro culture negative clinically suggestive cases of leishmaniasis. METHODS Leishmania DNA was amplified using previously published P221: 5'-GGTTCCTTTCCTGATTTACG-3' and P332: 5'-GGCCGGTAAAGGCCGAATAG-3'outer primers followed by a nested reaction using P223: 5'-TCCCATCGCAACCTCGGTT-3' and P333: 5'-AAGCGGGCGCGGTGCTG-3' inner primers that by passes the requirement of tube handling between the two steps of the conventional nested PCR. Leishmania DNA was detected in a range of infected tissue material. Infected material from patients with cutaneous leishmaniasis (n = 30), visceral leishmaniasis (n = 10) and from a control group including patients with non-leishmanial skin diseases (n = 10), other systemic diseases (n = 10) and healthy individuals (n = 10) were examined with Mo-STNPCR. Results were further compared with those of light microscopy and in-vitro culture. RESULTS Mo-STNPCR method was 100% sensitive and 100% specific for diagnosis of leishmaniasis. Light microscopy and in-vitro culture were positive in 75.0% (n = 30/40) and 72.5% (n = 29/40) samples respectively where combined results of them gave 87.5% (n = 35/40) sensitivity. Mo-STNPCR did not cross react with control samples. Furthermore, Mo-STNPCR reduces the risk of cross-contaminations and carry over contaminations since the full reaction is carried out without opening the tubes. Per patient cost was calculated as 22 USD while the same was 3 and 6 USD for light microscopy and in-vitro culture respectively. CONCLUSION Mo-STNPCR method is a useful tool in detecting leishmaniasis in minority of cases that go undetected by first line investigations.
Collapse
Affiliation(s)
- Bhagya Deepachandi
- Deparment of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sudath Weerasinghe
- Deparment of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Preethi Soysa
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Nadira Karunaweera
- Deparment of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Yamuna Siriwardana
- Deparment of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
15
|
Singh OP, Gedda MR, Mudavath SL, Srivastava ON, Sundar S. Envisioning the innovations in nanomedicine to combat visceral leishmaniasis: for future theranostic application. Nanomedicine (Lond) 2019; 14:1911-1927. [PMID: 31313971 PMCID: PMC7006826 DOI: 10.2217/nnm-2018-0448] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/12/2019] [Indexed: 01/06/2023] Open
Abstract
Visceral leishmaniasis (VL) is a life-threatening parasitic disease affecting impoverished people of the developing world; and much effort has been spent on the early case detection and treatment. However, current diagnostics and treatment options are not sufficient for appropriate surveillance in VL elimination setting. Hence, there is a dire need to develop highly sensitive diagnostics and less toxic effective treatments for proper management of cases and to achieve the sustained disease elimination. Although, promising results have been observed with nanomedicines in leishmaniasis; there are great challenges ahead especially in translating this to clinical setting. This review provides updated progress of nanomedicines in VL, and discussed how these innovations and future directions play vital role in achieving VL elimination.
Collapse
Affiliation(s)
- Om Prakash Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Mallikarjuna Rao Gedda
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shyam Lal Mudavath
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Department of Chemical Biology & Therapeutics, Institute of Nano Science & Technology, Habitat Centre, Phase 10, Sector 64, Mohali, Punjab, India
| | - Onkar Nath Srivastava
- Department of Physics, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| |
Collapse
|
16
|
Bremer Hinckel BC, Marlais T, Airs S, Bhattacharyya T, Imamura H, Dujardin JC, El-Safi S, Singh OP, Sundar S, Falconar AK, Andersson B, Litvinov S, Miles MA, Mertens P. Refining wet lab experiments with in silico searches: A rational quest for diagnostic peptides in visceral leishmaniasis. PLoS Negl Trop Dis 2019; 13:e0007353. [PMID: 31059497 PMCID: PMC6522066 DOI: 10.1371/journal.pntd.0007353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/28/2018] [Revised: 05/16/2019] [Accepted: 04/01/2019] [Indexed: 11/19/2022] Open
Abstract
Background The search for diagnostic biomarkers has been profiting from a growing number of high quality sequenced genomes and freely available bioinformatic tools. These can be combined with wet lab experiments for a rational search. Improved, point-of-care diagnostic tests for visceral leishmaniasis (VL), early case detection and surveillance are required. Previous investigations demonstrated the potential of IgG1 as a biomarker for monitoring clinical status in rapid diagnostic tests (RDTs), although using a crude lysate antigen (CLA) as capturing antigen. Replacing the CLA by specific antigens would lead to more robust RDTs. Methodology Immunoblots revealed L. donovani protein bands detected by IgG1 from VL patients. Upon confident identification of these antigens by mass spectrometry (MS), we searched for evidence of constitutive protein expression and presence of antigenic domains or high accessibility to B-cells. Selected candidates had their linear epitopes mapped with in silico algorithms. Multiple high-scoring predicted epitopes from the shortlisted proteins were screened in peptide arrays. The most promising candidate was tested in RDT prototypes using VL and nonendemic healthy control (NEHC) patient sera. Results Over 90% of the proteins identified from the immunoblots did not satisfy the selection criteria and were excluded from the downstream epitope mapping. Screening of predicted epitope peptides from the shortlisted proteins identified the most reactive, for which the sensitivity for IgG1 was 84% (95% CI 60—97%) with Sudanese VL sera on RDT prototypes. None of the sera from NEHCs were positive. Conclusion We employed in silico searches to reduce drastically the output of wet lab experiments, focusing on promising candidates containing selected protein features. By predicting epitopes in silico we screened a large number of peptides using arrays, identifying the most promising one, for which IgG1 sensitivity and specificity, with limited sample size, supported this proof of concept strategy for diagnostics discovery, which can be applied to the development of more robust IgG1 RDTs for monitoring clinical status in VL. Visceral leishmaniasis (VL) is a neglected tropical disease caused by protozoan parasites of the Leishmania donovani complex. Without treatment, VL is fatal. Although diagnostic techniques, mainly based on the detection of anti-Leishmania antibodies are available, invasive procedures such as microscopy from spleen or bone marrow aspirates are still required for the diagnosis of seronegative VL suspects, for the detection of recurrent cases and to confirm cure after successful treatment. Previous investigations showed the potential of IgG1 as a biomarker of post-chemotherapeutic relapse for VL in rapid diagnostic tests (RDTs) sensitised with crude lysate antigen (CLA). Here we employed in silico tools to search for desired protein features in a large number of L. donovani antigens detected by human IgG1 in western blots. We then employed prediction algorithms to profile epitopes from the shortlisted proteins. We screened a panel of high-scoring peptides in a high-throughput manner using arrays, with low reagent consumption. The most reactive peptide was adapted to RDTs, showing promising results of both sensitivity and specificity. This peptide has the potential of replacing the CLAs in IgG1 RDTs. Thus we believe that in silico tools can be used to optimise wet lab experiments for a rational search of biomarkers.
Collapse
Affiliation(s)
- Bruno Cesar Bremer Hinckel
- Coris BioConcept, Gembloux, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Tegwen Marlais
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephanie Airs
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tapan Bhattacharyya
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hideo Imamura
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Sayda El-Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Om Prakash Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | - Bjorn Andersson
- Department of Cell- and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | | | - Michael A. Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
17
|
Diro E, Blesson S, Edwards T, Ritmeijer K, Fikre H, Admassu H, Kibret A, Ellis SJ, Bardonneau C, Zijlstra EE, Soipei P, Mutinda B, Omollo R, Kimutai R, Omwalo G, Wasunna M, Tadesse F, Alves F, Strub-Wourgaft N, Hailu A, Alexander N, Alvar J. A randomized trial of AmBisome monotherapy and AmBisome and miltefosine combination to treat visceral leishmaniasis in HIV co-infected patients in Ethiopia. PLoS Negl Trop Dis 2019; 13:e0006988. [PMID: 30653490 PMCID: PMC6336227 DOI: 10.1371/journal.pntd.0006988] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 07/11/2018] [Accepted: 11/12/2018] [Indexed: 12/25/2022] Open
Abstract
Background Visceral leishmaniasis (VL) in human immunodeficiency virus (HIV) co-infected patients requires special case management. AmBisome monotherapy at 40 mg/kg is recommended by the World Health Organization. The objective of the study was to assess if a combination of a lower dose of AmBisome with miltefosine would show acceptable efficacy at the end of treatment. Methodology/Principal findings An open-label, non-comparative randomized trial of AmBisome (30 mg/kg) with miltefosine (100 mg/day for 28 days), and AmBisome monotherapy (40 mg/kg) was conducted in Ethiopian VL patients co-infected with HIV (NCT02011958). A sequential design was used with a triangular continuation region. The primary outcome was parasite clearance at day 29, after the first round of treatment. Patients with clinical improvement but without parasite clearance at day 29 received a second round of the allocated treatment. Efficacy was evaluated again at day 58, after completion of treatment. Recruitment was stopped after inclusion of 19 and 39 patients in monotherapy and combination arms respectively, as per pre-specified stopping rules. At D29, intention-to-treat efficacy in the AmBisome arm was 70% (95% CI 45–87%) in the unadjusted analysis, and 50% (95% CI 27–73%) in the adjusted analysis, while in the combination arm, it was 81% (95% CI 67–90%) and 67% (95% CI 48–82%) respectively. At D58, the adjusted efficacy was 55% (95% CI 32–78%) in the monotherapy arm, and 88% (95% CI 79–98%) in the combination arm. No major safety concerns related to the study medication were identified. Ten SAEs were observed within the treatment period, and 4 deaths unrelated to the study medication. Conclusions/Significance The extended treatment strategy with the combination regimen showed the highest documented efficacy in HIV-VL patients; these results support a recommendation of this regimen as first-line treatment strategy for HIV-VL patients in eastern Africa. Trial registration number www.clinicaltrials.govNCT02011958. Visceral Leishmaniasis is a complex parasitological disease and is particularly challenging to treat in patients coinfected with human immunodeficiency virus (HIV). Antimonial drugs used in first-line treatments for immunocompetent patients in eastern Africa are more toxic in immunocompromised patients. In 2010, a WHO expert committee recommended a lipid formulation of amphotericin B as first line treatment for HIV/VL co-infected patients, based on a single clinical trial conducted in Spain and empirical information obtained from scattered case reports using AmBisome (liposomal amphotericin B). In addition, Médecins Sans Frontières began a compassionate use regimen combining AmBisome and miltefosine a in a treatment centre in Northwest Ethiopia with encouraging results. Here, we report the results of a trial to assess the efficacy and safety of both the currently internationally recommended treatment of AmBisome monotherapy and the new AmBisome-miltefosine combination regimen, in Ethiopian patients. The results of this trial show that one course of treatment with either regimen could be insufficient to clear parasites in a high proportion of patients and that an extended treatment strategy, of administrating a second course of treatment, could lead to a high parasite clearance rate in patients treated with the combination regimen.
Collapse
Affiliation(s)
- Ermias Diro
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Severine Blesson
- Research & Development Department, Drugs for Neglected Diseases initiative, Geneva, Switzerland
- * E-mail:
| | - Tansy Edwards
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Helina Fikre
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Henok Admassu
- Abdurafi Health Centre, Médecins sans Frontières, Abdurafi, Ethiopia
| | - Aderajew Kibret
- Abdurafi Health Centre, Médecins sans Frontières, Abdurafi, Ethiopia
| | - Sally J. Ellis
- Research & Development Department, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Clelia Bardonneau
- Research & Development Department, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Eduard E. Zijlstra
- Research & Development Department, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | | | - Brian Mutinda
- Drugs for Neglected Diseases initiative, Nairobi, Kenya
| | | | | | | | | | - Fentahun Tadesse
- Neglected Tropical Diseases, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fabiana Alves
- Research & Development Department, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Nathalie Strub-Wourgaft
- Research & Development Department, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Asrat Hailu
- Department of Microbiology, Immunology, and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jorge Alvar
- Research & Development Department, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| |
Collapse
|
18
|
Theodosiou AA, Hiew HJ, Petridou C. An acute presentation of haemophagocytic lymphohistiocytosis due to visceral leishmaniasis in a British adult returning traveller. Acute Med 2019; 18:184-188. [PMID: 31536056] [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: 06/10/2023]
Abstract
A 62-year old British Caucasian woman normally resident in Spain presented with fever and pancytopaenia after returning to the UK. Her symptoms persisted despite broad-spectrum antibiotics, and she gradually became confused, hypotensive and progressively more pancytopaenic. Imaging demonstrated hepatosplenomegaly, and a bone marrow aspirate confirmed a diagnosis of haemophagocytic lymphohistiocytosis (HLH). Bone marrow polymerase chain reaction (PCR) and blood serology were both positive for Leishmania donovani, consistent with visceral leishmaniasis (VL). Following treatment with dexamethasone and amphotericin, she improved clinically and biochemically, and was able to return to Spain. Fever in the returning traveller is a common acute medical presentation. Although HLH and VL are rare diagnoses, both carry a very high mortality rate if undiagnosed and untreated.
Collapse
Affiliation(s)
| | - H J Hiew
- BMedSci(Hons) BM Portsmouth Hospitals NHS Trust
| | | |
Collapse
|
19
|
Chapman LAC, Morgan ALK, Adams ER, Bern C, Medley GF, Hollingsworth TD. Age trends in asymptomatic and symptomatic Leishmania donovani infection in the Indian subcontinent: A review and analysis of data from diagnostic and epidemiological studies. PLoS Negl Trop Dis 2018; 12:e0006803. [PMID: 30521526 PMCID: PMC6283524 DOI: 10.1371/journal.pntd.0006803] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Age patterns in asymptomatic and symptomatic infection with Leishmania donovani, the causative agent of visceral leishmaniasis (VL) in the Indian subcontinent (ISC), are currently poorly understood. Age-stratified serology and infection incidence have been used to assess transmission levels of other diseases, which suggests that they may also be of use for monitoring and targeting control programmes to achieve elimination of VL and should be included in VL transmission dynamic models. We therefore analysed available age-stratified data on both disease incidence and prevalence of immune markers with the aim of collating the currently available data, estimating rates of infection, and informing modelling and future data collection. METHODOLOGY/PRINCIPAL FINDINGS A systematic literature search yielded 13 infection prevalence and 7 VL incidence studies meeting the inclusion criteria. Statistical tests were performed to identify trends by age, and according to diagnostic cut-off. Simple reversible catalytic models with age-independent and age-dependent infection rates were fitted to the prevalence data to estimate infection and reversion rates, and to test different hypotheses about the origin of variation in these rates. Most of the studies showed an increase in infection prevalence with age: from ≲10% seroprevalence (<20% Leishmanin skin test (LST) positivity) for 0-10-year-olds to >10% seroprevalence (>20% LST-positivity) for 30-40-year-olds, but overall prevalence varied considerably between studies. VL incidence was lower amongst 0-5-year-olds than older age groups in most studies; most showing a peak in incidence between ages 5 and 20. The age-independent catalytic model provided the best overall fit to the infection prevalence data, but the estimated rates for the less parsimonious age-dependent model were much closer to estimates from longitudinal studies, suggesting that infection rates may increase with age. CONCLUSIONS/SIGNIFICANCE Age patterns in asymptomatic infection prevalence and VL incidence in the ISC vary considerably with geographical location and time period. The increase in infection prevalence with age and peaked age-VL-incidence distribution may be due to lower exposure to infectious sandfly bites in young children, but also suggest that acquired immunity to the parasite increases with age. However, poor standardisation of serological tests makes it difficult to compare data from different studies and draw firm conclusions about drivers of variation in observed age patterns.
Collapse
Affiliation(s)
- Lloyd A. C. Chapman
- Zeeman Institute, University of Warwick, Coventry, United Kingdom
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alex L. K. Morgan
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- School of Biological Sciences, University of Edinburgh, Edinbugh, United Kingdom
| | - Emily R. Adams
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Graham F. Medley
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - T. Déirdre Hollingsworth
- Zeeman Institute, University of Warwick, Coventry, United Kingdom
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
20
|
Dixit KK, Verma S, Singh OP, Singh D, Singh AP, Gupta R, Negi NS, Das P, Sundar S, Singh R, Salotra P. Validation of SYBR green I based closed tube loop mediated isothermal amplification (LAMP) assay and simplified direct-blood-lysis (DBL)-LAMP assay for diagnosis of visceral leishmaniasis (VL). PLoS Negl Trop Dis 2018; 12:e0006922. [PMID: 30439953 PMCID: PMC6264900 DOI: 10.1371/journal.pntd.0006922] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/29/2018] [Accepted: 10/12/2018] [Indexed: 12/24/2022] Open
Abstract
Background The World Health Organization has targeted elimination of visceral leishmaniasis (VL) in the Indian subcontinent (ISC) by 2020. Despite distinctive decline seen in the number of VL cases in ISC, there is still a quest for development of a diagnostic test which has the utility for detection of active infection and relapse cases and as a test of cure. The present study validated the sensitivity and specificity of SYBR Green I based closed tube LAMP assay reported by us for diagnosis of VL. Methodology The validation study was carried out at two endemic sites in India, located at Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna and Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), Varanasi. Standard operating protocols were provided at the two sites for applying LAMP assay on confirmed VL cases. The diagnostic accuracy of LAMP assay was evaluated by Receiver operator curve (ROC) analysis. Furthermore, a simplified LAMP assay based on direct blood lysis, DBL-LAMP, was developed and verified for its diagnostic accuracy. Principal findings A total of 267 eligible participants were included in the study which comprised of 179 VL cases and 88 controls. Sensitivity and specificity of the LAMP assay were 98.32% (95% C.I– 95.2–99.7%) and 96.59% (95% C.I.-90.4–99.3%), respectively. ROC curve analysis depicted no significant difference between area under curve (AUCROC) for LAMP assay and rK39 RDT, indicative of LAMP as an excellent diagnostic test. DBL-LAMP assay, performed on 67 VL and 100 control samples, yielded a sensitivity of 93.05% (95% C.I- 84.75–97%) and specificity of 100% (95% C.I.- 96.30–100%). Conclusions/Significance The validated closed tube LAMP for diagnosis of VL will provide impetus to the ongoing VL elimination programme in ISC. The assay based on direct blood lysis promotes its scope for application in field settings by further reducing time and cost. Definitive diagnosis of visceral leishmaniasis(VL) by demonstration of amastigotes by microscopy is invasive and risky. Serology based diagnosis using rK39 rapid diagnostic test(RDT) has excellent sensitivity of~97% when combined with clinical symptoms but is inconclusive for detection of active infection and relapses due to persistence of anti-leishmanial antibodies. The developed SYBR Green I based closed tube LAMP assay overcomes these constraints and further, direct blood lysis (DBL)-LAMP, makes it more suitable for field application. The study involved validation of LAMP assay at two endemic sites in India, on a total of 179 VL patients confirmed by rK39 RDT and/ or microscopy and 88 controls. The assay was highly sensitive (98.32%) and specific (96.59%). Further, DBL-LAMP assay yielded a sensitivity and specificity of 93.05% and 100%, respectively. In conclusion, the study has validated the field potential of LAMP assay for diagnosis of VL which will provide momentum to ongoing VL elimination in the Indian subcontinent (ISC).
Collapse
Affiliation(s)
- Keerti Kaumudee Dixit
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
- Faculty of Health and Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Sandeep Verma
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Om Prakash Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dharmendra Singh
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Akhil Pratap Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ratan Gupta
- Department of Paediatrics, Safdarjung Hospital and Vardhman Mahavir Medical college, New Delhi, India
| | - Narendra Singh Negi
- Department of Medicine, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ruchi Singh
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Poonam Salotra
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
- * E-mail:
| |
Collapse
|
21
|
Abstract
RATIONALE T-cell prolymphocytic leukaemia (T-PLL) is a rare aggressive lymphoid disease featured by a significant increased lymphocyte count and obvious hepatosplenomegaly with poor prognosis. The concomitant presentation of T-PLL and visceral leishmaniasis (VL) has not previously been reported. PATIENT CONCERNS The patient initially suffered from anorexia, skin pigmentation, fever and hepatosplenomegaly. Bone marrow smear described leishmania and antibody test was positive. VL was diagnosed and he was given antimony gluconate therapy. His symptoms recurred. DIAGNOSIS A combination of serological rk39 test, morphologic evaluation and immunophenotyping by flow cytometry finally supported the diagnosis of concomitant VL and T-PLL. OUTCOMES Amphotericin B was used for the treatment of VL first and a referral for treating T-PLL after recovery from VL was suggested. Unfortunately, the patient requested to be discharged. Telephone follow-up indicated that he died a few days after leaving the hospital. LESSONS Due to the rarity of the disease combination, the pathogenesis association of T-PLL and VL is unclear. However, a duly diagnosis is crucial for treatment. In immunosuppressed patients due to malignancies and treatment, VL should be considered as an opportunistic infection. In VL infections, the clinical manifestations mimicking hematological malignancies may cover up the underlying disease. Under such conditions, a complete work-up based on laboratory test is necessary to achieve a correct diagnosis.
Collapse
MESH Headings
- Amphotericin B/administration & dosage
- Amphotericin B/therapeutic use
- Antiprotozoal Agents/therapeutic use
- Fatal Outcome
- Hepatomegaly/etiology
- Humans
- Immunophenotyping/methods
- Leishmania donovani/isolation & purification
- Leishmaniasis, Visceral/blood
- Leishmaniasis, Visceral/drug therapy
- Leishmaniasis, Visceral/parasitology
- Leishmaniasis, Visceral/pathology
- Leukemia, Prolymphocytic, T-Cell/blood
- Leukemia, Prolymphocytic, T-Cell/complications
- Leukemia, Prolymphocytic, T-Cell/pathology
- Leukemia, Prolymphocytic, T-Cell/therapy
- Male
- Middle Aged
- Splenomegaly/etiology
Collapse
|
22
|
Knudsen DK, Kofoed K, Hjorth SV. [Not Available]. Ugeskr Laeger 2018; 180:V69596. [PMID: 29984701] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
23
|
Knudsen DK, Kofoed K. [Not Available]. Ugeskr Laeger 2018; 180:V69596. [PMID: 29804562] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
24
|
Abstract
Leishmania donovani, the most virulent species of Leishmania, is found in the South Asian region that harbours the majority of visceral leishmaniasis (VL) cases in the world. The traditionally accepted relationships between the causative species of Leishmania and the resultant disease phenotype have been challenged during recent years and have underscored the importance of revisiting the previously established taxonomy with revisions to its classification. The weak voice of the afflicted with decades of neglect by scientists and policy makers have led to the miserably inadequate and slow advancements in product development in the fields of diagnostics, chemotherapeutics and vector control that continue to hinder the effective management and control of this infection. Limitations notwithstanding, the regional drive for the elimination of VL initiated over a decade ago that focused on India, Nepal and Bangladesh, the three main afflicted countries in the Indian subcontinent is therefore, commendable, with the subsequent status reviews and restructuring of strategies possibly even more so. However, the renewed efforts would need to be combined with plans to combat new challenges in the South-Asian region that includes the emergence of atypical parasite variants, in order to realistically achieve the set goal of regional elimination of VL.
Collapse
Affiliation(s)
| | - MARCELO U FERREIRA
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, Brazil
| |
Collapse
|
25
|
Mukhtar M, Ali SS, Boshara SA, Albertini A, Monnerat S, Bessell P, Mori Y, Kubota Y, Ndung’u JM, Cruz I. Sensitive and less invasive confirmatory diagnosis of visceral leishmaniasis in Sudan using loop-mediated isothermal amplification (LAMP). PLoS Negl Trop Dis 2018; 12:e0006264. [PMID: 29444079 PMCID: PMC5828521 DOI: 10.1371/journal.pntd.0006264] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 06/19/2017] [Revised: 02/27/2018] [Accepted: 01/24/2018] [Indexed: 12/01/2022] Open
Abstract
Background Confirmatory diagnosis of visceral leishmaniasis (VL), as well as diagnosis of relapses and test of cure, usually requires examination by microscopy of samples collected by invasive means, such as splenic, bone marrow or lymph node aspirates. This causes discomfort to patients, with risks of bleeding and iatrogenic infections, and requires technical expertise. Molecular tests have great potential for diagnosis of VL using peripheral blood, but require well-equipped facilities and trained personnel. More user-friendly, and field-amenable options are therefore needed. One method that could meet these requirements is loop-mediated isothermal amplification (LAMP) using the Loopamp Leishmania Detection Kit, which comes as dried down reagents that can be stored at room temperature, and allows simple visualization of results. Methodology/Principal findings The Loopamp Leishmania Detection Kit (Eiken Chemical Co., Japan), was evaluated in the diagnosis of VL in Sudan. A total of 198 VL suspects were tested by microscopy of lymph node aspirates (the reference test), direct agglutination test-DAT (in house production) and rK28 antigen-based rapid diagnostic test (OnSite Leishmania rK39-Plus, CTK Biotech, USA). LAMP was performed on peripheral blood (whole blood and buffy coat) previously processed by: i) a direct boil and spin method, and ii) the QIAamp DNA Mini Kit (QIAgen). Ninety seven of the VL suspects were confirmed as cases by microscopy of lymph node aspirates. The sensitivity and specificity for each of the tests were: rK28 RDT 98.81% and 100%; DAT 88.10% and 78.22%; LAMP-boil and spin 97.65% and 99.01%; LAMP-QIAgen 100% and 99.01%. Conclusions/Significance Due to its simplicity and high sensitivity, rK28 RDT can be used first in the diagnostic algorithm for primary VL diagnosis, the excellent performance of LAMP using peripheral blood indicates that it can be also included in the algorithm for diagnosis of VL as a simple test when parasitological confirmatory diagnosis is required in settings that are lower than the reference laboratory, avoiding the need for invasive lymph node aspiration. Tissue aspiration, either from spleen, bone marrow or lymph node, remains the Gold Standard for parasitological confirmation in patients suspected of visceral leishmaniasis (VL), and is often used for detection of relapses, and as a test of cure. The procedure is invasive, with risks of severe complications, requires skilled personnel to perform, and appropriate facilities to manage severe adverse events, if they occur. These drawbacks can be solved by using sensitive diagnostic test based on peripheral blood. Nucleic acid amplification tests (NAAT) are sensitive for the detection of Leishmania parasites in blood; however, in VL-endemic settings, most NAAT are restricted to well-equipped laboratories. A robust NAAT, Loopamp Leishmania Detection Kit has recently been developed in a collaboration between FIND, Eiken Chemical Co. Ltd., Japan and other partners. We have evaluated this kit in Sudan and obtained a sensitivity of 97.6% and specificity of 99.1%, using DNA obtained from peripheral blood through a simple boil and spin method. Its simplicity and excellent diagnostic performance make this kit ideal for parasitological confirmation of VL in less equipped laboratories.
Collapse
Affiliation(s)
- Maowia Mukhtar
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Sababil S. Ali
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Salah A. Boshara
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Audrey Albertini
- Foundation for Innovative New Diagnostics—FIND, Geneva, Switzerland
| | | | - Paul Bessell
- Foundation for Innovative New Diagnostics—FIND, Geneva, Switzerland
| | | | | | | | - Israel Cruz
- Foundation for Innovative New Diagnostics—FIND, Geneva, Switzerland
- * E-mail:
| |
Collapse
|
26
|
Mahamoud A, Osman HA, Abass EM, El Agib A, Madi RR, Semiao-Santos SJ, El Harith A. Identification of an area predominantly endemic for childhood and adolescent visceral leishmaniasis in central Sudan. Acta Trop 2018; 178:142-147. [PMID: 29183852 DOI: 10.1016/j.actatropica.2017.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/12/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022]
Abstract
Although widely spread throughout Sudan, visceral leishmaniasis (VL) is predominantly endemic in the Gedaref, southern Blue-Nile, and Umrimta areas located in the eastern, southern, and central regions, respectively. Regardless of form (endemic or epidemic), VL occurrence follows similar patterns as all ages and both sexes are affected. From January 2005 to May 2016, we received a total of 563 patients with high suspicion for VL from various endemic areas; 159 were children and adolescents (0.5-18 years) from Umrimta (central Sudan). A significant observation during this 11-year period of uninterrupted monitoring using a standard liquid direct agglutination test (LQ-DAT) version was the exclusive VL occurrence (100%) in the child and adolescent populations of Umrimta when compared with other endemic areas (27.3%-48.0%). Among 12 child and adolescent suspects who initially tested marginal in the standard LQ-DAT, 6 scored unequivocally positive readings both in an improved LQ-DAT version (based on an autochthonous Leishmania donovani strain) and rK28 VL reference test. None of the 4 (2.5%) VL adult suspects (≥19years) referred had positive outcomes in the improved LQ-DAT version or the VL reference freeze-dried direct agglutination and rK28 tests. Further incorporation of antigens derived from autochthonous L. donovani strains from Umrimta (central Sudan) or Gedaref (eastern Sudan) in LQ-DAT significantly increased the agglutination titer levels in the respective VL homologous sera (p=0.0263 T=505 and p=0.2814T=219), suggesting possible antigenic variation within the predominant Sudanese L. donovani complex. Additional research is required to determine characteristics other than the serologically-based ones reported for the L. donovani strain involved.
Collapse
Affiliation(s)
- Abdelhafeiz Mahamoud
- Laboratory of Biomedical Research, Ahfad University for Women, P.O. Box 167, Omdurman, Sudan.
| | - Hussam Ali Osman
- Laboratory of Biomedical Research, Ahfad University for Women, P.O. Box 167, Omdurman, Sudan.
| | - Elfadil Mustafa Abass
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam, Saudi Arabia.
| | - Atif El Agib
- Tropical Medicine Research Institute, P.O. Box 1304, Khartoum, Sudan.
| | - Rubens Riscala Madi
- Post-graduate Program in Health and Environment, University of Tiradentes, Aracaju, Brazil.
| | | | - Abdallah El Harith
- Laboratory of Biomedical Research, Ahfad University for Women, P.O. Box 167, Omdurman, Sudan.
| |
Collapse
|
27
|
Kariyawasam UL, Selvapandiyan A, Rai K, Wani TH, Ahuja K, Beg MA, Premathilake HU, Bhattarai NR, Siriwardena YD, Zhong D, Zhou G, Rijal S, Nakhasi H, Karunaweera ND. Genetic diversity of Leishmania donovani that causes cutaneous leishmaniasis in Sri Lanka: a cross sectional study with regional comparisons. BMC Infect Dis 2017; 17:791. [PMID: 29273010 PMCID: PMC5741890 DOI: 10.1186/s12879-017-2883-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leishmania donovani is the etiological agent of visceral leishmaniasis (VL) in the Indian subcontinent. However, it is also known to cause cutaneous leishmaniasis (CL) in Sri Lanka. Sri Lankan L. donovani differs from other L. donovani strains, both at the molecular and biochemical level. To investigate the different species or strain-specific differences of L. donovani in Sri Lanka we evaluated sequence variation of the kinetoplastid DNA (kDNA). METHODS Parasites isolated from skin lesions of 34 CL patients and bone marrow aspirates from 4 VL patients were genotyped using the kDNA minicircle PCR analysis. A total of 301 minicircle sequences that included sequences from Sri Lanka, India, Nepal and six reference species of Leishmania were analyzed. RESULTS Haplotype diversity of Sri Lankan isolates were high (H d = 0.757) with strong inter-geographical genetic differentiation (F ST > 0.25). In this study, L. donovani isolates clustered according to their geographic origin, while Sri Lankan isolates formed a separate cluster and were clearly distinct from other Leishmania species. Within the Sri Lankan group, there were three distinct sub-clusters formed, from CL patients who responded to standard antimony therapy, CL patients who responded poorly to antimony therapy and from VL patients. There was no specific clustering of sequences based on geographical origin within Sri Lanka. CONCLUSION This study reveals high levels of haplotype diversity of L. donovani in Sri Lanka with a distinct genetic association with clinically relevant phenotypic characteristics. The use of genetic tools to identify clinically relevant features of Leishmania parasites has important therapeutic implications for leishmaniasis.
Collapse
Affiliation(s)
- Udeshika Lakmini Kariyawasam
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 8 Sri Lanka
| | | | - Keshav Rai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Kavita Ahuja
- JH-Institute of Molecular Medicine, Jamia Hamdard, New Delhi, India
| | - Mizra Adil Beg
- JH-Institute of Molecular Medicine, Jamia Hamdard, New Delhi, India
| | | | - Narayan Raj Bhattarai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Yamuna Deepani Siriwardena
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 8 Sri Lanka
| | - Daibin Zhong
- University of California Irvine, College of Health Sciences, Irvine, CA USA
| | - Guofa Zhou
- University of California Irvine, College of Health Sciences, Irvine, CA USA
| | - Suman Rijal
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Hira Nakhasi
- Division of Emerging and Transfusion Transmitted Diseases, Food and Drug Administration, Bethesda, USA
| | - Nadira D. Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 8 Sri Lanka
| |
Collapse
|
28
|
Zijlstra EE, Alves F, Rijal S, Arana B, Alvar J. Post-kala-azar dermal leishmaniasis in the Indian subcontinent: A threat to the South-East Asia Region Kala-azar Elimination Programme. PLoS Negl Trop Dis 2017; 11:e0005877. [PMID: 29145397 PMCID: PMC5689828 DOI: 10.1371/journal.pntd.0005877] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The South-East Asia Region Kala-azar Elimination Programme (KAEP) is expected to enter the consolidation phase in 2017, which focuses on case detection, vector control, and identifying potential sources of infection. Post-kala-azar dermal leishmaniasis (PKDL) is thought to play a role in the recurrence of visceral leishmaniasis (VL)/kala-azar outbreaks, and control of PKDL is among the priorities of the KAEP. Methodology and principal finding We reviewed the literature with regard to PKDL in Asia and interpreted the findings in relation to current intervention methods in the KAEP in order to make recommendations. There is a considerable knowledge gap regarding the pathophysiology of VL and PKDL, especially the underlying immune responses. Risk factors (of which previous VL treatments may be most important) are poorly understood and need to be better defined. The role of PKDL patients in transmission is largely unknown, and there is insufficient information about the importance of duration, distribution and severity of the rash, time of onset, and self-healing. Current intervention methods focus on active case detection and treatment of all PKDL cases with miltefosine while there is increasing drug resistance. The prevention of PKDL by improved VL treatment currently receives insufficient attention. Conclusion and significance PKDL is a heterogeneous and dynamic condition, and patients differ with regard to time of onset after VL, chronicity, and distribution and appearance of the rash, as well as immune responses (including tendency to self-heal), all of which may vary over time. It is essential to fully describe the pathophysiology in order to make informed decisions on the most cost-effective approach. Emphasis should be on early detection of those who contribute to transmission and those who are in need of treatment, for whom short-course, effective, and safe drug regimens should be available. The prevention of PKDL should be emphasised by innovative and improved treatment for VL, which may include immunomodulation.
Collapse
Affiliation(s)
- Eduard E. Zijlstra
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
- Rotterdam Centre for Tropical Medicine, Rotterdam, the Netherlands
- * E-mail:
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Suman Rijal
- Drugs for Neglected Diseases initiative, India Office, New Delhi, India
| | - Byron Arana
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| |
Collapse
|
29
|
De Silva G, Somaratne V, Senaratne S, Vipuladasa M, Wickremasinghe R, Wickremasinghe R, Ranasinghe S. Efficacy of a new rapid diagnostic test kit to diagnose Sri Lankan cutaneous leishmaniasis caused by Leishmania donovani. PLoS One 2017; 12:e0187024. [PMID: 29135995 PMCID: PMC5685575 DOI: 10.1371/journal.pone.0187024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [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: 06/28/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) in Sri Lanka is caused by Leishmania donovani. This study assessed the diagnostic value of a new rapid diagnostic immunochromatographic strip (CL-Detect™ IC-RDT), that captures the peroxidoxin antigen of Leishmania amastigotes. Methodology/Principal findings We sampled 74 clinically suspected CL lesions, of which 59 (79.7%) were positive by PCR, 43 (58.1%) by Giemsa stained slit skin smear (SSS) and 21 (28.4%) by the new IC-RDT. All samples which were positive either by SSS or IC-RDT or both were positive by PCR. The sensitivities of the IC-RDT and SSS compared to PCR were 36% and 73%, respectively. Fifteen patients from this endemic region were negative by all three tests. Twenty two clinically non-CL skin lesions from a CL non-endemic region were also negative by all three methods. Specificity and PPV of both IC-RDT and SSS compared to PCR were 100%; the NPVs of IC-RDT and SSS were 37% and 58%, respectively. The median parasite grading of the 59 PCR positive samples was 2+ (1–10 parasites/100 HPFs) and IC-RDT positive lesions was 3+ (1–10 parasites /10HPFs). The duration of the lesion was not associated with IC-RDT positivity. Conclusions/Significance The median parasite grade of Sri Lankan CL lesions is low. The low sensitivities of SSS and CL Detect™ IC-RDT may be due to low parasite counts or low expression of peroxidoxin antigen in amastigotes of the Sri Lankan L. donovani strain. Our results indicate that negative SSS has to be combined with PCR for confirmation of CL in Sri Lanka. The current commercially available IC-RDT is not suitable to diagnose CL in Sri Lanka; an IC-RDT with improved sensitivity to detect L. donovani would be a valuable addition in the diagnostic tool kit for Sri Lanka.
Collapse
Affiliation(s)
- Gayani De Silva
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Sujai Senaratne
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | | | - Renu Wickremasinghe
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Shalindra Ranasinghe
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- * E-mail:
| |
Collapse
|
30
|
Raina S, Raina RK, Bodh A, Rana BS, Sharma R. Gastrointestinal Leishmaniasis in Non-Endemic Region. J Assoc Physicians India 2017; 65:106-107. [PMID: 28782325] [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: 06/07/2023]
Abstract
We report a case of visceral leishmaniasis (VL) in an immunocompetent native from non-endemic region of India that presented with chronic diarrhoea. VL was not a differential diagnosis and was unexpectedly diagnosed as intestinal leishmaniasis through the identification of the Leishman-Donovan (LD) bodies in duodenal and colonic mucosa. The patient expired before receiving antileishmanial therapy.
Collapse
Affiliation(s)
| | | | - Anita Bodh
- Assistant Professor, Department of Pathology, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
| | | | | |
Collapse
|
31
|
Rai K, Bhattarai NR, Vanaerschot M, Imamura H, Gebru G, Khanal B, Rijal S, Boelaert M, Pal C, Karki P, Dujardin JC, Van der Auwera G. Single locus genotyping to track Leishmania donovani in the Indian subcontinent: Application in Nepal. PLoS Negl Trop Dis 2017; 11:e0005420. [PMID: 28249021 PMCID: PMC5348045 DOI: 10.1371/journal.pntd.0005420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/13/2017] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background We designed a straightforward method for discriminating circulating Leishmania populations in the Indian subcontinent (ISC). Research on transmission dynamics of visceral leishmaniasis (VL, or Kala-azar) was recently identified as one of the key research priorities for elimination of the disease in the ISC. VL in Bangladesh, India, and Nepal is caused by genetically homogeneous populations of Leishmania donovani parasites, transmitted by female sandflies. Classical methods to study diversity of these protozoa in other regions of the world, such as microsatellite typing, have proven of little use in the area, as they are not able to discriminate most genotypes. Recently, whole genome sequencing (WGS) so far identified 10 different populations termed ISC001-ISC010. Methodology / Principle findings As an alternative to WGS for epidemiological or clinical studies, we designed assays based on PCR amplification followed by dideoxynucleotide sequencing for identification of the non-recombinant genotypes ISC001 up to ISC007. These assays were applied on 106 parasite isolates collected in Nepal between 2011 and 2014. Combined with data from WGS on strains collected in the period 2002–2011, we provide a proof-of-principle for the application of genotyping to study treatment outcome, and differential geographic distribution. Conclusions / Significance Our method can aid in epidemiological follow-up of visceral leishmaniasis in the Indian subcontinent, a necessity in the frame of the Kala-azar elimination initiative in the region. Visceral Leishmaniasis (VL) or Kala-azar is a life-threatening neglected tropical disease that annually affects half a million people worldwide. In the Indian subcontinent (India, Nepal, Bangladesh), the disease is caused by infection with the protozoan parasite Leishmania donovani, which is transmitted by female sand flies. Currently, the Kala-azar elimination program aims at reducing the number of VL cases in the region to less than 1 in 10.000 at upazila, sub-district and district level in Bangladesh, India, and Nepal respectively. In support of this program, tools for tracking L. donovani populations are essential, because these allow monitoring geographic spread over time. However, the parasite populations in the region are highly homogeneous, requiring sequencing of the entire genome to gather sufficient information for discriminating them. Because whole genome sequencing (WGS) is impractical for large-scale use, we designed a simple alternative to identify the WGS-genotypes. Our method is based on PCR amplification followed by sequencing of one particular locus, diagnostic of each population. We provide proof-of-principle that our method can be used to track parasite populations over time, and to correlate them with clinical parameters. We believe that our assay can support the Kala-azar control efforts in the Indian subcontinent.
Collapse
Affiliation(s)
- Keshav Rai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- Department of Zoology, West Bengal State University, Barasat, West Bengal, India
| | - Narayan Raj Bhattarai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Manu Vanaerschot
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Hideo Imamura
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gebreyohans Gebru
- Department of Animal Science, College of Agriculture, Aksum University, Aksum, Ethiopia
| | - Basudha Khanal
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Rijal
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chiranjib Pal
- Department of Zoology, West Bengal State University, Barasat, West Bengal, India
| | - Prahlad Karki
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Belgium
- * E-mail: (JCD); (GVdA)
| | - Gert Van der Auwera
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail: (JCD); (GVdA)
| |
Collapse
|
32
|
Srivastava S, Mishra J, Gupta AK, Singh A, Shankar P, Singh S. Laboratory confirmed miltefosine resistant cases of visceral leishmaniasis from India. Parasit Vectors 2017; 10:49. [PMID: 28137296 PMCID: PMC5282768 DOI: 10.1186/s13071-017-1969-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Miltefosine unresponsive and relapse cases of visceral leishmaniasis (VL) are increasingly being reported. However, there has been no laboratory confirmed reports of miltefosine resistance in VL. Here, we report two laboratory confirmed cases of VL from India. METHODS Two patients with VL were referred to us with suspected VL. The first patient was a native of the VL endemic state of Bihar, but residing in Delhi, a VL non-endemic area. He was treated with broad-spectrum antibiotics and antipyretics but was unresponsive to treatment. The second patient was from Jharkhand state in eastern India (adjoining Bihar), another endemic state for VL. He was refractory to anti-leishmanial treatment, which included administration of miltefosine. Following investigation, both patients were serologically positive for VL, and blood buffy coat from both patients grew Leishmania donovani. The isolates derived from both cases were characterized for their drug susceptibility, genetically characterised, and SNPs typed for LdMT and LdROS gene expression. Both patients were successfully treated with amphotericin B. RESULTS The in vitro drug susceptibility assays carried out on both isolates showed good IC50 values to amphotericin B (0.1 ± 0.0004 μg/ml and 0.07 ± 0.0019 μg/ml). One isolate was refractory to SbIII with an IC50 of > 200 μM while the second isolate was sensitive to SbIII with an IC50 of 36.70 ± 3.2 μM. However, in both the isolates, IC50 against miltefosine was more than 10-fold higher (> 100 μM) than the standard strain DD8 (6.8 ± 0.1181 μM). Furthermore, genetic analyses demonstrated single nucleotide polymorphisms (SNPs) (354Tyr↔Phe and 1078Phe↔Tyr) in the LdMT gene of the parasites. CONCLUSIONS Here, we document two laboratory confirmed cases of miltefosine resistant VL from India. Our finding highlights the urgent need to establish control measures to prevent the spread of these strains. We also propose that LdMT gene mutation analysis could be used as a molecular marker of miltefosine resistance in L. donovani.
Collapse
Affiliation(s)
- Saumya Srivastava
- 0000 0004 1767 6103grid.413618.9Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Mishra
- 0000 0004 1767 6103grid.413618.9Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Kumar Gupta
- 0000 0004 1767 6103grid.413618.9Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Singh
- 0000 0004 1767 6103grid.413618.9Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Shankar
- 0000 0004 1767 6103grid.413618.9Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- 0000 0004 1767 6103grid.413618.9Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
33
|
Khanra S, Sarraf NR, Das S, Das AK, Roy S, Manna M. Genetic markers for antimony resistant clinical isolates differentiation from Indian Kala-azar. Acta Trop 2016; 164:177-184. [PMID: 27629023 DOI: 10.1016/j.actatropica.2016.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/09/2016] [Accepted: 09/09/2016] [Indexed: 02/07/2023]
Abstract
Visceral Leishmaniasis or Kala-azar is caused by the protozoan parasites belonging to the Genus Leishmania. Once thought eradicated from the Indian subcontinent, the disease came back with drug resistance to almost all prevalent drugs. Molecular epidemiological studies revealed the polymorphic nature of the population of the main player of the disease, Leishmania donovani and involvement of other species (L. tropica) and other genus (Leptomonas) with the disease. This makes control measures almost futile. It also strongly demands the characterization of each and every isolate mandatory which is not done. In this background, the present study has been carried out to assess the genetic attributes of each clinical isolates (n=26) of KA and PKDL patients from India and Bangladesh. All the isolates were characterized through Restriction Fragment Length Polymorphism (RFLP) analysis to ascertain their species identity. 46.2% of the isolates were found to be Sodium Stibogluconate (SSG) resistant by amastigote-macrophage model. When the clinical isolates were subjected to Single Stranded Conformation Polymorphism (SSCP) of Internal Transcribed Spacer 1 (ITS1), Internal Transcribed Spacer 2 (ITS2) and some anonymous markers, the drug resistant Leishmania isolates of SSG can be distinguished from the sensitive isolates distinctly. This study showed for the first time, the genetic markers for SSG drug resistance of Indian Kala-azar clinical isolates.
Collapse
Affiliation(s)
- Supriya Khanra
- Department of Zoology, Barasat Govt. College, 10, K.N.C Road, Kolkata 700124, India
| | | | - Shantanabha Das
- Department of Infectious Diseases & Immunology, Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata 700032, India
| | - Anjan Kumar Das
- Department of Medicine, Calcutta National Medical College, 32, Gorachand Road, Kolkata 700014, India
| | - Syamal Roy
- Department of Infectious Diseases & Immunology, Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata 700032, India
| | - Madhumita Manna
- Department of Zoology, Barasat Govt. College, 10, K.N.C Road, Kolkata 700124, India.
| |
Collapse
|
34
|
Ejazi SA, Bhattacharya P, Bakhteyar MAK, Mumtaz AA, Pandey K, Das VNR, Das P, Rahaman M, Goswami RP, Ali N. Noninvasive Diagnosis of Visceral Leishmaniasis: Development and Evaluation of Two Urine-Based Immunoassays for Detection of Leishmania donovani Infection in India. PLoS Negl Trop Dis 2016; 10:e0005035. [PMID: 27741241 PMCID: PMC5065134 DOI: 10.1371/journal.pntd.0005035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/12/2016] [Indexed: 12/19/2022] Open
Abstract
Background Visceral Leishmaniasis (VL), a severe parasitic disease, could be fatal if diagnosis and treatment is delayed. Post kala-azar dermal leishmaniasis (PKDL), a skin related outcome, is a potential reservoir for the spread of VL. Diagnostic tests available for VL such as tissue aspiration are invasive and painful although they are capable of evaluating the treatment response. Serological tests although less invasive than tissue aspiration are incompetent to assess cure. Parasitological examination of slit-skin smear along with the clinical symptoms is routinely used for diagnosis of PKDL. Therefore, a noninvasive test with acceptable sensitivity and competency, additionally, to decide cure would be an asset in disease management and control. Methodology/principal findings We describe here, the development of antibody-capture ELISA and field adaptable dipstick test as noninvasive diagnostic tools for VL and PKDL and as a test of cure in VL treatment. Sensitivity and specificity of urine-ELISA were 97.94% (95/97) and 100% (75/75) respectively, for VL. Importantly, dipstick test demonstrated 100% sensitivity (97/97) and specificity (75/75) in VL diagnosis. Degree of agreement of the two methods with tissue aspiration was 98.83% (κ = 0.97) and 100% (κ = 1), for ELISA and dipstick test, respectively. Both the tests had 100% positivity for PKDL (14/14) cases. ELISA and dipstick test illustrated treatment efficacy in about 90% (16/18) VL cases when eventually turned negative after six months of treatment. Conclusions/significance ELISA and dipstick test found immensely effective for diagnosis of VL and PKDL through urine samples thus, may substitute the existing invasive diagnostics. Utility of these tests as indirect methods of monitoring parasite clearance can define infected versus cured. Urine-based dipstick test is simple, sensitive and above all noninvasive method that may help not only in active VL case detection but also to ascertain treatment response. It can therefore, be deployed widely for interventions in disease management of VL particularly in poor resource outskirts. Visceral leishmaniasis (VL), one of the most prevalent parasitic diseases in the developing world causes serious health concerns. Post kala-azar dermal leishmaniasis (PKDL) is a skin disease which occurs after treatment as a sequel to VL. Parasitological diagnosis involves invasive tissue aspiration which is tedious and painful. Commercially available immunochromatographic rapid diagnostic test such as rK39-RDT is used for field diagnosis of VL, detects antibodies in serum samples. Urine sample is however, much easier in collection, storage and handling than serum and would be a better alternative where collection of tissue aspirate or blood is impractical. In this study, we have developed and evaluated the performance of two urine-based diagnostic assays, ELISA and dipstick test, and compared the results with serological rK39-RDT. Our study shows the capability of urine-based tests in detecting anti-Leishmania antibodies effectively for both VL and PKDL diagnosis. The ability of dipstick test to demonstrate negative results after six months in 90% of the VL cases after treatment could be useful as a test of clinical cure. Urine-based tests can therefore replace the need for invasive practices and ensure better diagnosis under filed settings.
Collapse
Affiliation(s)
- Sarfaraz Ahmad Ejazi
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, Kolkata, India
| | - Pradyot Bhattacharya
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, Kolkata, India
| | | | - Aquil Ahmad Mumtaz
- Department of Medicine, Shri Krishna Medical College and Hospital, Muzaffarpur, India
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Vidya Nand Ravi Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Pradeep Das
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Mehebubar Rahaman
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Rama Prosad Goswami
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Nahid Ali
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, Kolkata, India
- * E-mail:
| |
Collapse
|
35
|
Santiago-Rodriguez TM, Fornaciari G, Luciani S, Dowd SE, Toranzos GA, Marota I, Cano RJ. Taxonomic and predicted metabolic profiles of the human gut microbiome in pre-Columbian mummies. FEMS Microbiol Ecol 2016; 92:fiw182. [PMID: 27559027 DOI: 10.1093/femsec/fiw182] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/15/2022] Open
Abstract
Characterization of naturally mummified human gut remains could potentially provide insights into the preservation and evolution of commensal and pathogenic microorganisms, and metabolic profiles. We characterized the gut microbiome of two pre-Columbian Andean mummies dating to the 10-15th centuries using 16S rRNA gene high-throughput sequencing and metagenomics, and compared them to a previously characterized gut microbiome of an 11th century AD pre-Columbian Andean mummy. Our previous study showed that the Clostridiales represented the majority of the bacterial communities in the mummified gut remains, but that other microbial communities were also preserved during the process of natural mummification, as shown with the metagenomics analyses. The gut microbiome of the other two mummies were mainly comprised by Clostridiales or Bacillales, as demonstrated with 16S rRNA gene amplicon sequencing, many of which are facultative anaerobes, possibly consistent with the process of natural mummification requiring low oxygen levels. Metagenome analyses showed the presence of other microbial groups that were positively or negatively correlated with specific metabolic profiles. The presence of sequences similar to both Trypanosoma cruzi and Leishmania donovani could suggest that these pathogens were prevalent in pre-Columbian individuals. Taxonomic and functional profiling of mummified human gut remains will aid in the understanding of the microbial ecology of the process of natural mummification.
Collapse
Affiliation(s)
- Tasha M Santiago-Rodriguez
- Center for Applications in Biotechnology, California Polytechnic State University, San Luis Obispo, CA 93407, USA Department of Biology, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - Gino Fornaciari
- Department of Translational Research on New Technologies in Medicine and Surgery, Division of Paleopathology, University of Pisa, Pisa 56126, Italy Center for Anthropological, Paleopathological and Historical Studies of the Sardinian and Mediterranean Populations, Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy
| | - Stefania Luciani
- Laboratory of Molecular Archaeo-Anthropology/ancient DNA, School of Biosciences and Veterinary Medicine, University of Camerino, Camerino 62032, Italy
| | - Scot E Dowd
- Molecular Research LP (MR DNA), Shallowater, Texas 79363, USA
| | - Gary A Toranzos
- Department of Biology, University of Puerto Rico, Julio Garcia Diaz Building, San Juan 00931, Puerto Rico
| | - Isolina Marota
- Laboratory of Molecular Archaeo-Anthropology/ancient DNA, School of Biosciences and Veterinary Medicine, University of Camerino, Camerino 62032, Italy
| | - Raul J Cano
- Center for Applications in Biotechnology, California Polytechnic State University, San Luis Obispo, CA 93407, USA Department of Biology, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| |
Collapse
|
36
|
Affiliation(s)
- Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
| | | | | |
Collapse
|
37
|
Tasew G, Gadisa E, Abera A, Zewude A, Chanyalew M, Aseffa A, Abebe M, Ritter U, van Zandbergen G, Laskay T, Tafess K. In vitro permissiveness of bovine neutrophils and monocyte derived macrophages to Leishmania donovani of Ethiopian isolate. Parasit Vectors 2016; 9:218. [PMID: 27090082 PMCID: PMC4836163 DOI: 10.1186/s13071-016-1441-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/09/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Epidemiological studies in Ethiopia have documented that the risk of visceral leishmaniasis (VL, Kala-azar) is higher among people living with domestic animals. The recent report on isolation of Leishmania donovani complex DNA and the detected high prevalence of anti-leishmanial antibodies in the blood of domestic animals further strengthen the potential role of domestic animals in the epidemiology of VL in Ethiopia. In mammalian hosts polymorphonuclear cells (PMN) and macrophages are the key immune cells influencing susceptibility or control of Leishmania infection. Thus to substantiate the possible role of cattle in VL transmission we investigate the permissiveness of bovine PMN and monocyte derived macrophages (MDM) for Leishmania (L.) donovani infection. METHODS Whole blood was collected from pure Zebu (Boss indicus) and their cross with Holstein Friesian cattle. L. donovani (MHOM/ET/67/HU3) wild and episomal green fluorescent protein (eGFP) labelled stationary stage promastigotes were co-incubated with whole blood and MDM to determine infection of these cells. Engulfment of promastigotes by the cells and their transformation to amastigote forms in MDM was studied with direct microscopy. Microscopy and flow cytometry were used to measure the infection rate while PCR-RLFP was used to confirm the infecting parasite. RESULTS L. donovani infected bovine whole blood PMN in the presence of plasma factors and all cellular elements. Morphological examinations of stained cytospin smears revealed that PMN engulfed promastigotes. Similarly, we were able to show that bovine MDM can be infected by L. donovani, which transformed to amastigote forms in the cells. CONCLUSIONS The in vitro infection of bovine PMN and MDM by L. donovani further strengthens the possibility that cattle might serve as source of L. donovani infection for humans.
Collapse
Affiliation(s)
- Geremew Tasew
- />Ethiopia Public Health Institute, Leishmaniasis Research Laboratory, P.O. Box 1242, Addis Ababa, Ethiopia
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Endalamaw Gadisa
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Adugna Abera
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Aboma Zewude
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Menberework Chanyalew
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Markos Abebe
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Uwe Ritter
- />Department of Immunology, University of Regensburg, Franz-Josef-Strauß-Allee 11, D-93042 Regensburg, Germany
| | - Ger van Zandbergen
- />Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Tamás Laskay
- />Institute for Medical Microbiology and Hygiene, University of Lübeck, Ratzeburger Allee 160, D-23560 Lübeck, Germany
| | - Ketema Tafess
- />Department of Medical Laboratory Science, College of Health Sciences, Arsi University, P.O. Box 193, Asella, Ethiopia
| |
Collapse
|
38
|
Mahdy MAK, Al-Mekhlafi AM, Abdul-Ghani R, Saif-Ali R, Al-Mekhlafi HM, Al-Eryani SM, Lim YAL, Mahmud R. First Molecular Characterization of Leishmania Species Causing Visceral Leishmaniasis among Children in Yemen. PLoS One 2016; 11:e0151265. [PMID: 26966902 PMCID: PMC4788415 DOI: 10.1371/journal.pone.0151265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/25/2016] [Indexed: 11/19/2022] Open
Abstract
Visceral leishmaniasis (VL) is a debilitating, often fatal disease caused by Leishmania donovani complex; however, it is a neglected tropical disease. L. donovani complex comprises two closely related species, L. donovani that is mostly anthroponotic and L. infantum that is zoonotic. Differentiation between these two species is critical due to the differences in their epidemiology and pathology. However, they cannot be differentiated morphologically, and their speciation using isoenzyme-based methods poses a difficult task and may be unreliable. Molecular characterization is now the most reliable method to differentiate between them and to determine their phylogenetic relationships. The present study aims to characterize Leishmania species isolated from bone marrows of Yemeni pediatric patients using sequence analysis of the ribosomal internal transcribed spacer-1 (ITS1) gene. Out of 41 isolates from Giemsa-stained bone marrow smears, 25 isolates were successfully amplified by nested polymerase chain reaction and sequenced in both directions. Phylogenetic analysis using neighbor joining method placed all study isolates in one cluster with L. donovani complex (99% bootstrap). The analysis of ITS1 for microsatellite repeat numbers identified L. infantum in 11 isolates and L. donovani in 14 isolates. These data suggest the possibility of both anthroponotic and zoonotic transmission of VL-causing Leishmania species in Yemen. Exploring the possible animal reservoir hosts is therefore needed for effective control to be achieved.
Collapse
Affiliation(s)
- Mohammed A. K. Mahdy
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana’a, Yemen
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
- * E-mail:
| | - Abdulsalam M. Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana’a, Yemen
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Reyadh Saif-Ali
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Hesham M. Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Samira M. Al-Eryani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Yvonne A. L. Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rohela Mahmud
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| |
Collapse
|
39
|
Senanayake SASC, Abeyewicreme W, Dotson EM, Karunaweera ND. CHARACTERISTICS OF PHLEBOTOMINE SANDFLIES IN SELECTED AREAS OF SRI LANKA. Southeast Asian J Trop Med Public Health 2015; 46:994-1004. [PMID: 26867357 PMCID: PMC6206496] [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] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cutaneous leishmaniasis (CL) is an endemic disease in Sri Lanka. Studies on vector aspects, although important for better understanding of disease transmission dynamics, are still limited. The present study describes the species distribution and behavioral patterns of sandflies within selected disease-prevalent zones in the country. Adult sandflies were collected from several field sites over a two-year duration in Sri Lanka using cattle-baited net traps, CDC light traps and manual methods. Species identification was performed using standard keys. Leishmania donovani and source of blood meal in blood-fed female sandflies DNA were identified using PCR-based methods. Aggregation period of adult sandflies during overnight collections was also noted. The collected sandflies were identified as Phlebotomus argentipes glaucus (previously known as morphospecies A) and a non-vector species, Sergentomyia zeylanica. Presence of L. donovani DNA was found in 2/634 female sandflies. The parasite ITS1 region of SSU rDNA had 99% sequence similarity with L. donovani from Bangladesh and India. The peak aggregation period of sandflies within cattle-traps was between 8:00 PM to 11:00 PM, indicating that vector control strategies could be conducted during this time period. As Sergentomyia zeylanica is likely to be merely a biting nuisance and showed more of an anthropophilic behavior, whereas the probable vector of CL in Sri Lanka (P. argentipes glaucus) demonstrated zoophilic behavior, has implications for the planning of future vector control strategies.
Collapse
Affiliation(s)
- SASC Senanayake
- Department of Parasitology, Faculty of Medicine, University of Colombo
| | - W Abeyewicreme
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - EM Dotson
- Entomology Division, Center for Disease Control and Prevention, Atlanta, USA
| | - ND Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo
| |
Collapse
|
40
|
Hendrickx S, Leemans A, Mondelaers A, Rijal S, Khanal B, Dujardin JC, Delputte P, Cos P, Maes L. Comparative Fitness of a Parent Leishmania donovani Clinical Isolate and Its Experimentally Derived Paromomycin-Resistant Strain. PLoS One 2015; 10:e0140139. [PMID: 26469696 PMCID: PMC4607421 DOI: 10.1371/journal.pone.0140139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022] Open
Abstract
Paromomycin has recently been introduced for the treatment of visceral leishmaniasis and emergence of drug resistance can only be appropriately judged upon its long term routine use in the field. Understanding alterations in parasite behavior linked to paromomycin-resistance may be essential to assess the propensity for emergence and spread of resistant strains. A standardized and integrated laboratory approach was adopted to define and assess parasite fitness of both promastigotes and amastigotes using an experimentally induced paromomycin-resistant Leishmania donovani strain and its paromomycin-susceptible parent wild-type clinical isolate. Primary focus was placed on parasite growth and virulence, two major components of parasite fitness. The combination of in vitro and in vivo approaches enabled detailed comparison of wild-type and resistant strains for which no differences could be demonstrated with regard to promastigote growth, metacyclogenesis, in vitro infectivity, multiplication in primary peritoneal mouse macrophages and infectivity for Balb/c mice upon infection with 2 x 107 metacyclic promastigotes. Monitoring of in vitro intracellular amastigote multiplication revealed a consistent decrease in parasite burden over time for both wild-type and resistant parasites, an observation that was subsequently also confirmed in a larger set of L. donovani clinical isolates. Though the impact of these findings should be further explored, the study results suggest that the epidemiological implications of acquired paromomycin-resistance may remain minimal other than the loss of one of the last remaining drugs effective against visceral leishmaniasis.
Collapse
Affiliation(s)
- Sarah Hendrickx
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Annelies Leemans
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Annelies Mondelaers
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Suman Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Jean-Claude Dujardin
- Molecular Parasitology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Louis Maes
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
- * E-mail:
| |
Collapse
|
41
|
Rudavina TI, Averyanova NI, Sosnin DY, Skoblina NA, Domnina NA, Guseva SV, Volkova SV, Banko NV. [VISCERAL LEISHMANIASIS IN A THREE-YEAR-OLD CHILD]. Med Parazitol (Mosk) 2015:41-44. [PMID: 26827588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The paper describes a clinical case of visceral leishmaniasis in a three-year-old child who Was born and is a permanent resident in Penm. Its clinical symptomatology; laboratory and instrumental findings; stages of a diagnostic search for fever of unknown origin concurrent with hepatosplenomegaly and pancytopenia; differential diagnosis with hemoblastosis; and an epidemiological history are detailed. Visceral leishmaniasis was diagnosed at examination of bone marrow specimens. The paper presents the positive results of combination etiopathogenetic treatment, which are confirmed by the time course of clinical changes and laboratory findings.
Collapse
|
42
|
Kassahun A, Sadlova J, Dvorak V, Kostalova T, Rohousova I, Frynta D, Aghova T, Yasur-Landau D, Lemma W, Hailu A, Baneth G, Warburg A, Volf P, Votypka J. Detection of Leishmania donovani and L. tropica in Ethiopian wild rodents. Acta Trop 2015; 145:39-44. [PMID: 25700710 DOI: 10.1016/j.actatropica.2015.02.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/03/2015] [Accepted: 02/07/2015] [Indexed: 11/29/2022]
Abstract
Human visceral (VL, also known as Kala-azar) and cutaneous (CL) leishmaniasis are important infectious diseases affecting countries in East Africa that remain endemic in several regions of Ethiopia. The transmission and epidemiology of the disease is complicated due to the complex life cycle of the parasites and the involvement of various Leishmania spp., sand fly vectors, and reservoir animals besides human hosts. Particularly in East Africa, the role of animals as reservoirs for human VL remains unclear. Isolation of Leishmania donovani parasites from naturally infected rodents has been reported in several endemic countries; however, the status of rodents as reservoirs in Ethiopia remains unclear. Here, we demonstrated natural Leishmania infections in rodents. Animals were trapped in 41 localities of endemic and non-endemic areas in eight geographical regions of Ethiopia and DNA was isolated from spleens of 586 rodents belonging to 21 genera and 38 species. Leishmania infection was evaluated by real-time PCR of kinetoplast (k)DNA and confirmed by sequencing of the PCR products. Subsequently, parasite species identification was confirmed by PCR and DNA sequencing of the 18S ribosomal RNA internal transcribed spacer one (ITS1) gene. Out of fifty (8.2%) rodent specimens positive for Leishmania kDNA-PCR and sequencing, 10 were subsequently identified by sequencing of the ITS1 showing that five belonged to the L. donovani complex and five to L. tropica. Forty nine kDNA-positive rodents were found in the endemic localities of southern and eastern Ethiopia while only one was identified from northwestern Ethiopia. Moreover, all the ten ITS1-positive rodents were captured in areas where human leishmaniasis cases have been reported and potential sand fly vectors occur. Our findings suggest the eco-epidemiological importance of rodents in these foci of leishmaniasis and indicate that rodents are likely to play a role in the transmission of leishmaniasis in Ethiopia, possibly as reservoir hosts.
Collapse
Affiliation(s)
- Aysheshm Kassahun
- Department of Parasitology, Faculty of Science, Charles University in Prague, Vinicna 7, 128 44 Prague 2, Czech Republic.
| | - Jovana Sadlova
- Department of Parasitology, Faculty of Science, Charles University in Prague, Vinicna 7, 128 44 Prague 2, Czech Republic.
| | - Vit Dvorak
- Department of Parasitology, Faculty of Science, Charles University in Prague, Vinicna 7, 128 44 Prague 2, Czech Republic.
| | - Tatiana Kostalova
- Department of Parasitology, Faculty of Science, Charles University in Prague, Vinicna 7, 128 44 Prague 2, Czech Republic.
| | - Iva Rohousova
- Department of Parasitology, Faculty of Science, Charles University in Prague, Vinicna 7, 128 44 Prague 2, Czech Republic.
| | - Daniel Frynta
- Department of Zoology, Faculty of Science, Charles University in Prague, Vinicna 7, 128 44 Prague 2, Czech Republic.
| | - Tatiana Aghova
- Institute of Vertebrate Biology, Academy of Sciences of the Czech Republic, 675 02 Studenec 122, Czech Republic.
| | - Daniel Yasur-Landau
- School of Veterinary Medicine, Hebrew University, P.O. Box 12, Rehovot 76100, Israel.
| | - Wessenseged Lemma
- Department of Zoological Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Asrat Hailu
- Department of Microbiology, Immunology & Parasitology, Faculty of Medicine, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Gad Baneth
- School of Veterinary Medicine, Hebrew University, P.O. Box 12, Rehovot 76100, Israel.
| | - Alon Warburg
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research Israel-Canada, The Kuvin Centre for the Study of Infectious and Tropical Diseases, The Hebrew University Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem 91120, Israel.
| | - Petr Volf
- Department of Parasitology, Faculty of Science, Charles University in Prague, Vinicna 7, 128 44 Prague 2, Czech Republic.
| | - Jan Votypka
- Department of Parasitology, Faculty of Science, Charles University in Prague, Vinicna 7, 128 44 Prague 2, Czech Republic.
| |
Collapse
|
43
|
Karaoğlan İ, Ekşi F, Haydaroğlu Şahin H, Pehlivan M, Tekin Şahin S, Keçik Boşnak V, Bilici M, Namıduru M, Karslıgil T. [Two cases of visceral leishmaniasis from Kahramanmaraş, Turkey]. MIKROBIYOL BUL 2015; 49:295-298. [PMID: 26167831] [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: 06/04/2023]
Abstract
Turkey is an endemic area for cutaneous leishmaniasis (CL) according to the data of World Health Organization. CL is more widely distributed in Sanliurfa region (located at south-eastern part of Anatolia) of Turkey, while visceral leishmaniasis (VL) is reported sporadically from all parts of Turkey, especially in pediatric cases. However VL has not been reported from our region yet. Here we report two cases of VL from Kahramanmaraş region (located at eastern part of South Anatolia), one of which was a 57-year-old immuncompromised patient and the other was a 18-year-old immunocompetent patient. The common symptoms of the patients were high fever, hepatosplenomegaly and pancytopenia. The diagnosis of both patients was made by demonstration of the amastigotes of parasite in Giemsa-stained smears prepared from bone marrow aspiration samples, and isolation of promastigotes from cultures in NNN medium. The isolates were identified as Leishmania donovani with PCR and sequencing methods. Both of the patients were treated successfully with liposomal amphotericin B, resulting in complete cure. In conclusion, cases with fever of unknown origin, hepatosplenomegaly, pancytopenia and hypergammaglobulinemia should be considered in terms of VL especially in Kahramanmaraş region.
Collapse
Affiliation(s)
- İlkay Karaoğlan
- Gaziantep University Faculty of Medicine, Department of Infectious Diseases, Gaziantep, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
|
45
|
Miller E, Warburg A, Novikov I, Hailu A, Volf P, Seblova V, Huppert A. Quantifying the contribution of hosts with different parasite concentrations to the transmission of visceral leishmaniasis in Ethiopia. PLoS Negl Trop Dis 2014; 8:e3288. [PMID: 25356795 PMCID: PMC4214667 DOI: 10.1371/journal.pntd.0003288] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/23/2014] [Indexed: 12/03/2022] Open
Abstract
Background An important factor influencing the transmission dynamics of vector-borne diseases is the contribution of hosts with different parasitemia (no. of parasites per ml of blood) to the infected vector population. Today, estimation of this contribution is often impractical since it relies exclusively on limited-scale xenodiagnostic or artificial feeding experiments (i.e., measuring the proportion of vectors that become infected after feeding on infected blood/host). Methodology We developed a novel mechanistic model that facilitates the quantification of the contribution of hosts with different parasitemias to the infection of the vectors from data on the distribution of these parasitemias within the host population. We applied the model to an ample data set of Leishmania donovani carriers, the causative agent of visceral leishmaniasis in Ethiopia. Results Calculations facilitated by the model quantified the host parasitemias that are mostly responsible for the infection of vector, the sand fly Phlebotomus orientalis. Our findings indicate that a 3.2% of the most infected people were responsible for the infection of between 53% and 79% (mean – 62%) of the infected sand fly vector population. Significance Our modeling framework can easily be extended to facilitate the calculation of the contribution of other host groups (such as different host species, hosts with different ages) to the infected vector population. Identifying the hosts that contribute most towards infection of the vectors is crucial for understanding the transmission dynamics, and planning targeted intervention policy of visceral leishmaniasis as well as other vector borne infectious diseases (e.g., West Nile Fever). An important factor influencing the transmission dynamics of vector-borne diseases is the contribution of hosts with different parasitemia (no. of parasites per ml of blood) to the infected vector population. In this study we developed a novel mechanistic model that facilitates the quantification of this contribution and applied it to an ample data set of people infected with visceral leishmaniasis in Ethiopia. Among vector borne diseases, visceral leishmaniasis is the second most important killer after malaria. It is caused by infection with Leishmania parasites with most cases (∼90%) occurring in the Indian sub-continent, East Africa, and South America. The disease is transmitted between people and other mammalian hosts by blood-sucking sand flies. Our findings indicate that a 3.2% of the most infected people were responsible for the infection of about 65% of the infected sand fly vector population. Identifying the hosts that contribute most towards infection of the vectors is crucial for understanding the transmission dynamics, and planning targeted intervention policy of visceral leishmaniasis, as well as other vector borne infectious diseases (e.g., Dengue, West Nile Fever).
Collapse
Affiliation(s)
- Ezer Miller
- The Kuvin Center for the Study of Infectious & Tropical Diseases, Department of Microbiology & Molecular Genetics, The Institute of Medical Research, Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- * E-mail:
| | - Alon Warburg
- The Kuvin Center for the Study of Infectious & Tropical Diseases, Department of Microbiology & Molecular Genetics, The Institute of Medical Research, Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilya Novikov
- The Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Asrat Hailu
- Department of Microbiology, Immunology & Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Petr Volf
- Department of Parasitology, Faculty of Sciences, Charles University, Prague, Czech Republic
| | - Veronika Seblova
- Department of Parasitology, Faculty of Sciences, Charles University, Prague, Czech Republic
| | - Amit Huppert
- The Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| |
Collapse
|
46
|
Pratap Singh K, Zaidi A, Anwar S, Bimal S, Das P, Ali V. Reactive oxygen species regulates expression of iron-sulfur cluster assembly protein IscS of Leishmania donovani. Free Radic Biol Med 2014; 75:195-209. [PMID: 25062827 DOI: 10.1016/j.freeradbiomed.2014.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 01/18/2023]
Abstract
The cysteine desulfurase, IscS, is a highly conserved and essential component of the mitochondrial iron-sulfur cluster (ISC) system that serves as a sulfur donor for Fe-S clusters biogenesis. Fe-S clusters are versatile and labile cofactors of proteins that orchestrate a wide array of essential metabolic processes, such as energy generation and ribosome biogenesis. However, no information regarding the role of IscS or its regulation is available in Leishmania, an evolving pathogen model with rapidly developing drug resistance. In this study, we characterized LdIscS to investigate the ISC system in AmpB-sensitive vs resistant isolates of L. donovani and to understand its regulation. We observed an upregulated Fe-S protein activity in AmpB-resistant isolates but, in contrast to our expectations, LdIscS expression was upregulated in the sensitive strain. However, further investigations showed that LdIscS expression is positively correlated with ROS level and negatively correlated with Fe-S protein activity, independent of strain sensitivity. Thus, our results suggested that LdIscS expression is regulated by ROS level with Fe-S clusters/proteins acting as ROS sensors. Moreover, the direct evidence of a mechanism, in support of our results, is provided by dose-dependent induction of LdIscS-GFP as well as endogenous LdIscS in L. donovani promastigotes by three different ROS inducers: H2O2, menadione, and Amphotericin B. We postulate that LdIscS is upregulated for de novo synthesis or repair of ROS damaged Fe-S clusters. Our results reveal a novel mechanism for regulation of IscS expression that may help parasite survival under oxidative stress conditions encountered during infection of macrophages and suggest a cross talk between two seemingly unrelated metabolic pathways, the ISC system and redox metabolism in L. donovani.
Collapse
Affiliation(s)
- Krishn Pratap Singh
- Laboratory of Molecular Biochemistry and Cell Biology, Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India 800007
| | - Amir Zaidi
- Laboratory of Molecular Biochemistry and Cell Biology, Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India 800007
| | - Shadab Anwar
- Laboratory of Molecular Biochemistry and Cell Biology, Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India 800007
| | - Sanjeev Bimal
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India 800007
| | - Pradeep Das
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India 800007
| | - Vahab Ali
- Laboratory of Molecular Biochemistry and Cell Biology, Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna, India 800007.
| |
Collapse
|
47
|
Baharia RK, Tandon R, Sahasrabuddhe AA, Sundar S, Dube A. Nucleosomal histone proteins of L. donovani: a combination of recombinant H2A, H2B, H3 and H4 proteins were highly immunogenic and offered optimum prophylactic efficacy against Leishmania challenge in hamsters. PLoS One 2014; 9:e97911. [PMID: 24926878 PMCID: PMC4057088 DOI: 10.1371/journal.pone.0097911] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 04/26/2014] [Indexed: 11/18/2022] Open
Abstract
The present study includes cloning and expression of recombinant Leishmania donovani histone proteins (rLdH2B, rLdH3, rLdH2A and rLdH4), assessment of their immunogenicity in Leishmania infected cured patients/endemic contacts as well as in cured hamsters and finally evaluation of their prophylactic efficacy in hamsters against L. donovani challenge. All recombinant proteins were expressed and purified from the heterologous bacterial host system. Leishmania infected cured patients/endemic contacts as well as cured hamsters exhibited significantly higher proliferative responses to individual recombinant histones and their pooled combination (rLdH2B+rLdH3+rLdH2A+rLdH4) than those of L.donovani infected hosts. The L.donovani soluble antigens (SLD) stimulated PBMCs of cured/exposed and Leishmania patients to produce a mixed Thl/Th2-type cytokine profile, whereas rLdH2B, rLdH3, rLdH2A, rLdH4 and pooled combination (rLdH2-4) stimulated the production of Th1 cytokines IFN-γ, IL-12 and TNF-α but not Th2 cytokines IL-4 or IL-10. The immunogenicity of these histone proteins along with their combination was also checked in cured hamsters where they stimulated higher lymphoproliferation and Nitric oxide production in lymphocytes of cured hamsters than that of infected controls. Moreover, significantly increased IgG2 response, an indicative of cell mediated immunity, was observed in cured hamsters against these individual proteins and their combination as compared to infected hamsters. Further, it was demonstrated that rLdH2B, rLdH3, rLdH2A and rLdH4 and pooled combination were able to provide considerable protection for hamsters against L. donovani challenge. The efficacy was supported by the increased inducible Nitric Oxide Synthase (iNOS) mRNA transcripts and Th1-type cytokines--IFN-γ, IL-12 and TNF-α and down-regulation of IL-4, IL-10 and TGF-β. Hence, it is inferred that pooled rLdH2-4 elicits Thl-type of immune responses exclusively and confer considerable protection against experimental Visceral Leishmaniasis.
Collapse
Affiliation(s)
| | - Rati Tandon
- Division of Parasitology, Central Drug Research Institute, Lucknow, India
| | - Amogh A. Sahasrabuddhe
- Division of Molecular and structural Biology, Central Drug Research Institute, Lucknow, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anuradha Dube
- Division of Parasitology, Central Drug Research Institute, Lucknow, India
- * E-mail:
| |
Collapse
|
48
|
Siah TW, Lavender T, Charlton F, Wahie S, Schwab U. An unusual erysipelas-like presentation. Dermatol Online J 2014; 20:21255. [PMID: 24456958] [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] [Received: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 06/03/2023] Open
Abstract
A 61-year-old man presented with erysipelas-like cutaneous leishmaniasis.
Collapse
|
49
|
Burza S, Sinha PK, Mahajan R, Sanz MG, Lima MA, Mitra G, Verma N, Das P. Post Kala-Azar dermal leishmaniasis following treatment with 20 mg/kg liposomal amphotericin B (Ambisome) for primary visceral leishmaniasis in Bihar, India. PLoS Negl Trop Dis 2014; 8:e2611. [PMID: 24392171 PMCID: PMC3879248 DOI: 10.1371/journal.pntd.0002611] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/14/2013] [Indexed: 11/19/2022] Open
Abstract
Background The skin disorder Post Kala-Azar Dermal Leishmaniasis (PKDL) occurs in up to 10% of patients treated for visceral leishmaniasis (VL) in India. The pathogenesis of PKDL is not yet fully understood. Cases have been reported in India following therapy with most available treatments, but rarely in those treated with liposomal amphotericin B (Ambisome). Between July 2007 and August 2012 with the support of the Rajendra Memorial Research Institute (RMRI), Médecins Sans Frontières (MSF) supported a VL treatment programme in Bihar, India—an area highly endemic for Leishmania donovani—in which 8749 patients received 20 mg/kg intravenous Ambisome as first-line treatment. This study describes the characteristics of patients who returned to the MSF supported treatment programme with PKDL. Methods and Principal Findings Over a 5-year period, Ambisome was administered to 8749 patients with laboratory-confirmed VL (clinical signs, rK39 positive, with/without parasite confirmation) in four intravenous doses of 5 mg/kg to a total of 20 mg/kg, with a high initial-cure rate (99.3%) and low default rate (0.3%). All patients received health education highlighting the possibility and symptoms of developing PKDL, and advice to return to the MSF programme if these symptoms developed. This is an observational retrospective cohort study of the programme outcomes. Of the 8311 patients completing treatment for their first episode of VL, 24 (0.3%) returned passively to the programme complaining of symptoms subsequently confirmed as PKDL, diagnosed from clinical history, appearance consistent with PKDL, and slit-skin smear examination. Of the 24 patients, 89% had macular lesions, with a median time (interquartile range) to development of 1.2 (0.8–2.2) years following treatment. Comparison of the demographic and clinical characteristics of the VL patients treated with Ambisome who later developed PKDL, with those of the remaining cohort did not identify any significant risk factors for PKDL. However, the time to developing PKDL was significantly shorter with Ambisome than in a subset of patients presenting to the programme with PKDL following previous sodium stibogluconate treatment for VL. Conclusions In this large cohort of patients with VL in Bihar who were treated with 20 mg/kg Ambisome, PKDL following treatment appears to be infrequent with no predictive risk factors. The shorter median time to developing symptoms of PKDL compared with that after conventional VL treatments should be taken into account when counseling patients treated with regimens including Ambisome. Visceral leishmaniasis (VL), also known as Kala-azar, is caused by the parasite L.donovani. Half of cases worldwide occur in India, with up to 90% of these in Bihar state. Post Kala-azar dermal leishmaniasis (PKDL) is a difficult to treat skin condition that develops in up to 10% of VL cases following treatment in the Indian subcontinent. Although often mild, PKDL can be severe and disfiguring. Patients are otherwise healthy. PKDL is considered a reservoir of L.donovani and requires treating to support disease elimination. Between 2007–2012, 8311 patients diagnosed with a first episode of VL completed treatment with 20 mg/kg intravenous liposomal amphotericin B (Ambisome) in a Médecins Sans Frontières (MSF) programme supported by the Rajendra Memorial Research Institute (RMRI) in Bihar. Ambisome is a safe and effective treatment that is recommended by the WHO for first-line use in the Indian subcontinent; although not yet included in the Indian guidelines. PKDL has been described following all VL treatments, but so far in only two patients treated with Ambisome. Here, we describe 24 patients treated with Ambisome who returned to the MSF treatment programme with confirmed PKDL. We found no risk factors for PKDL following treatment; however, the average time to development of PKDL was much shorter than that seen following older treatments.
Collapse
Affiliation(s)
- Sakib Burza
- Médecins Sans Frontières, New Delhi, India
- * E-mail:
| | - Prabhat Kumar Sinha
- Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | | | | | | | | | - Neena Verma
- Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
50
|
Alexa T, Luca A, Crăcană I, Merticariu A, Dănăilă C. Leishmaniasis--an unusual cause of splenomegaly in Romania. Rev Med Chir Soc Med Nat Iasi 2014; 118:101-106. [PMID: 24741784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Leishmaniasis is a parasitic infection caused by protozoans classified as Leishmania species. Romania is not considered an endemic country and there are only few reports of sporadic cases in the last 100 years. However, studies suggest that the disease is spreading north. We present the case of a 44 year old female that presented with asthenia, perspirations, vertigo, weight loss and menometrorhagias in small to medium quantity. Clinical exam revealed the presence of splenomegaly and her blood tests indicated she had pancitopenia; differential diagnosis included myeloproliferative or lymphoproliferative disorders, infections that evolve with spleen enlargement, autoimmune-related splenomegaly and hepatic--all tests were negative. She refused the bone marrow aspiration. Three months later, her condition worsened and the menometrorragias became more severe. Bone marrow aspiration revealed the presence of numerous intra and extracellular Leishmania spp. amastigotes. A detailed anamnesis showed that she had worked for six months in Italy as a care-giver nine months ago. She was transferred to Bucharest where she received optimal treatment. However, due to the continuous bleeding, the evolution was unfavourable. This is an alarm sign for physicians that should take into account the fact that, due to population migration and global warming, tropical infectious diseases are becoming more and more common. The signs and symptoms, as well as the treatment in leishmaniasis are reviewed, as well as a brief history of leishmaniasis in Romania.
Collapse
|