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Esteves BB, Melo-Braga MN, Gorshkov V, Verano-Braga T, Larsen MR, Gontijo CMF, Quaresma PF, Andrade HM. Characterization of Differentially Abundant Proteins Among Leishmania (Viannia) braziliensis Strains Isolated From Atypical or Typical Lesions. Front Cell Infect Microbiol 2022; 12:824968. [PMID: 35242720 PMCID: PMC8886221 DOI: 10.3389/fcimb.2022.824968] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
Leishmania (Viannia) braziliensis is the main etiological agent of cutaneous and mucocutaneous leishmaniasis in Latin America. Non-ulcerated atypical tegumentary leishmaniasis cases caused by L. braziliensis have been reported in several regions of the American continent, including the Xacriabá indigenous reserve in São João das Missões/Minas Gerais, Brazil. Parasites isolated from these atypical clinical lesions are resistant to antimony-based therapeutics. In the present study, proteins displaying differential abundance in two strains of L. braziliensis isolated from patients with atypical lesions compared with four strains isolated from patients with typical lesions were identified using a quantitative proteomics approach based on tandem mass tag labeling (TMT) and mass spectrometry. A total of 532 (P<0.05) differentially abundant proteins were identified (298 upregulated and 234 downregulated) in strains from atypical lesions compared to strains from typical lesions. Prominent positively regulated proteins in atypical strains included those that may confer greater survival inside macrophages, proteins related to antimony resistance, and proteins associated with higher peroxidase activity. Additionally, we identified proteins showing potential as new drug and vaccine targets. Our findings contribute to the characterization of these intriguing L. braziliensis strains and provide a novel perspective on Atypical Cutaneous Leishmaniasis (ACL) cases that have been associated with therapeutic failures.
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Affiliation(s)
- Bárbara B. Esteves
- Laboratório de Leishmanioses, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcella N. Melo-Braga
- Laboratório de Biologia Sintética e Biomiméticos, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vladimir Gorshkov
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Thiago Verano-Braga
- Núcleo de Proteômica Funcional, Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Martin R. Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Célia M. F. Gontijo
- Study Group in Leishmaniosis, Instituto René Rachou (IRR) –Fundação Oswaldo Cruz (FIOCRUZ/MG) Belo Horizonte, Belo Horizonte, Brazil
| | - Patricia F. Quaresma
- Departamento de Microbiologia Imunologia e Parasitologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Helida M. Andrade
- Laboratório de Leishmanioses, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- *Correspondence: Helida M. Andrade,
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Valencia BM, Lau R, Kariyawasam R, Jara M, Ramos AP, Chantry M, Lana JT, Boggild AK, Llanos-Cuentas A. Leishmania RNA virus-1 is similarly detected among metastatic and non-metastatic phenotypes in a prospective cohort of American Tegumentary Leishmaniasis. PLoS Negl Trop Dis 2022; 16:e0010162. [PMID: 35089930 PMCID: PMC8827429 DOI: 10.1371/journal.pntd.0010162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/09/2022] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
American Tegumentary Leishmaniasis (ATL) is an endemic and neglected disease of South America. Here, mucosal leishmaniasis (ML) disproportionately affects up to 20% of subjects with current or previous localised cutaneous leishmaniasis (LCL). Preclinical and clinical reports have implicated the Leishmania RNA virus-1 (LRV1) as a possible determinant of progression to ML and other severe manifestations such as extensive cutaneous and mucosal disease and treatment failure and relapse. However, these associations were not consistently found in other observational studies and are exclusively based on cross-sectional designs. In the present study, 56 subjects with confirmed ATL were assessed and followed out for 24-months post-treatment. Lesion biopsy specimens were processed for molecular detection and quantification of Leishmania parasites, species identification, and LRV1 detection. Among individuals presenting LRV1 positive lesions, 40% harboured metastatic phenotypes; comparatively 58.1% of patients with LRV1 negative lesions harboured metastatic phenotypes (p = 0.299). We found treatment failure (p = 0.575) and frequency of severe metastatic phenotypes (p = 0.667) to be similarly independent of the LRV1. Parasite loads did not differ according to the LRV1 status (p = 0.330), nor did Leishmanin skin induration size (p = 0.907) or histopathologic patterns (p = 0.780). This study did not find clinical, parasitological, or immunological evidence supporting the hypothesis that LRV1 is a significant determinant of the pathobiology of ATL. The Leishmania RNA virus-1 (LRV1) has been implicated as a possible modulator agent in the pathogenesis of leishmaniasis. In-vivo and in-vitro studies have depicted specific mechanisms of how LRV1 could lead to metastasis. Clinical studies and epidemiological evidence have both supported and rejected the hypothesis that LRV1 is a relevant determinant of progression, treatment failure and clinical severity of American Tegumentary Leishmaniasis (ATL). This lack of consistency between preclinical and clinical reports requires further longitudinal studies to clarify the role of LRV1 in ATL. Due to the complex nature of ATL, as other frequent human diseases, these studies should tackle multiple determinants of pathogenicity, including LRV1 status, parasite features, immune status, and prevalent comorbidities affecting individuals in endemic settings. Also, critical methodological aspects allowing for the reliable identification and quantification of LRV1 should be guaranteed.
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Affiliation(s)
- Braulio Mark Valencia
- Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, Australia
- * E-mail:
| | - Rachel Lau
- Public Health Ontario Laboratory, Toronto, Canada
| | | | - Marlene Jara
- Institute of Tropical Medicine of Antwerp, Antwerp, Belgium
| | - Ana Pilar Ramos
- Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Nacional Cayetano Heredia, Lima, Peru
| | | | - Justin T. Lana
- Nicholas School of the Environment, Duke University, Durham, North Carolina, United States of America
| | - Andrea K. Boggild
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Tropical Disease Unit, Toronto General Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Nacional Cayetano Heredia, Lima, Peru
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Bezemer JM, van der Ende J, Limpens J, de Vries HJC, Schallig HDFH. Safety and efficacy of allylamines in the treatment of cutaneous and mucocutaneous leishmaniasis: A systematic review. PLoS One 2021; 16:e0249628. [PMID: 33826660 PMCID: PMC8026199 DOI: 10.1371/journal.pone.0249628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/22/2021] [Indexed: 12/28/2022] Open
Abstract
Cutaneous and mucocutaneous leishmaniasis affect a million people yearly, leading to skin lesions and potentially disfiguring mucosal disease. Current treatments can have severe side effects. Allylamine drugs, like terbinafine, are safe, including during pregnancy. This review assesses efficacy and safety of allylamines for the treatment of cutaneous and mucocutaneous leishmaniasis. It followed the PRISMA statement for reporting and was preregistered in PROSPERO(CRD4201809068). MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, Web of Science, Google Scholar, and clinical trial registers were searched from their creation to May 24th, 2020. All original human, animal, and in vitro studies concerning allylamines and cutaneous or mucocutaneous leishmaniasis were eligible for inclusion. Comparators—if any—included both placebo or alternative cutaneous or mucocutaneous leishmaniasis treatments. Complete cure, growth inhibition, or adverse events served as outcomes. The search identified 312 publications, of which 22 were included in this systematic review. There were one uncontrolled and two randomised controlled trials. The only well-designed randomised controlled trial that compared the treatment efficacy of oral terbinafine versus intramuscular meglumine antimoniate in 80 Leismania tropica infected patients showed a non-significant lower cure rate for terbinafine vs meglumine antimoniate (38% vs 53%). A meta-analysis could not be performed due to the small number of studies, their heterogeneity, and low quality. This systematic review shows that there is no evidence of efficacy of allylamine monotherapy against cutaneous and mucocutaneous leishmaniasis. Further trials of allylamines should be carefully considered as the outcomes of an adequately designed trial were disappointing and in vitro studies indicate minimal effective concentrations that are not achieved in the skin during standard doses. However, the in vitro synergistic effects of allylamines combined with triazole drugs warrant further exploration.
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Affiliation(s)
- Jacob M. Bezemer
- Experimental Parasitology Unit, Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Fundación Misión Cristiana de Salud, Shell, Pastaza, Ecuador
- * E-mail:
| | - Jacob van der Ende
- Fundación Quina Care Ecuador, Puerto el Carmen de Putumayo, Sucumbíos, Ecuador
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry J. C. de Vries
- Department of Dermatology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk D. F. H. Schallig
- Experimental Parasitology Unit, Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Bracamonte ME, Álvarez AM, Sosa AM, Hoyos CL, Lauthier JJ, Cajal SP, Juarez M, Uncos RE, Sánchez-Valdéz FJ, Acuña L, Diosque P, Basombrío MA, Nasser JR, Hashiguchi Y, Korenaga M, Barroso PA, Marco JD. High performance of an enzyme linked immunosorbent assay for American tegumentary leishmaniasis diagnosis with Leishmania (Viannia) braziliensis amastigotes membrane crude antigens. PLoS One 2020; 15:e0232829. [PMID: 32379842 PMCID: PMC7205302 DOI: 10.1371/journal.pone.0232829] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/22/2020] [Indexed: 11/26/2022] Open
Abstract
The diagnosis of American tegumentary leishmaniasis (ATL) still requires the design of more effective tools. Leishmania (Viannia) braziliensis is the causal agent of the 90% of Argentinean ATL cases. Considering the current knowledge, an ELISA based crude antigen (CA) for the diagnosis was designed. Ninety-nine subjects diagnosed as ATL, 27 as no-ATL, and 84 donors from non-ATL-endemic areas were included in this study. The current ATL diagnosis was based four techniques, dermal smear microscopic examination (parasitological test), PCR, Leishmanin skin test, and clinical records. We obtained CA extracts from promastigotes and amastigotes from macrophage cultures of different zymodemes of endemic Leishmania species circulating in the study area. Crude antigens from the ‘local’ main zymodeme of L. (V.) braziliensis showed the highest reactivity against anti-Leishmania antibodies compared to the other included species. The CA of amastigotes of this zymodeme was 3.4 fold more reactive than promastigotes one. Moreover, amastigote-membrane CA (MCA) were 3.6 fold more reactive than the soluble antigens. The MCA-ELISA reached a sensitivity and specificity of 98% (CI = 94.7%-100%) and 63.6% (53.9–73.1), respectively. When anti-Trypanosoma cruzi reactive sera were excluded, the specificity reached 98.4% (94.4–100), while the sensitivity was similar, with a positive predictive value (PV) of 98.6% (94.6–100) and negative PV of 96.3% (91.6–100). The performance of the MCA-ELISA results strongly contribute to the final diagnostic decision, since a non-reactive serological result almost discards the suspected ATL, because of its high negative PV. The developed MCA-ELISA showed a high diagnostic performance, which makes it a good candidate for ATL diagnosis, for seroprevalence studies, or for monitoring treatments efficacy.
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Affiliation(s)
- María E. Bracamonte
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Agustín Moya Álvarez
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Andrea M. Sosa
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Carlos L. Hoyos
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Juan J. Lauthier
- Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Silvana P. Cajal
- Instituto de Investigaciones en Enfermedades Tropicales (IIET), Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina
| | - Marisa Juarez
- Instituto de Investigaciones en Enfermedades Tropicales (IIET), Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina
| | - Renato E. Uncos
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Fernando J. Sánchez-Valdéz
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Leonardo Acuña
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Patricio Diosque
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Miguel A. Basombrío
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Julio R. Nasser
- Laboratorio de Química Biológica y Biología Molecular (LQByBM), Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina
| | - Yoshihisa Hashiguchi
- Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Masataka Korenaga
- Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
- Faculty of Health Sciences, Kochi Gakuen University, Kochi, Kochi, Japan
| | - Paola A. Barroso
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Jorge D. Marco
- Facultad de Ciencias de la Salud, Instituto de Patología Experimental, Universidad Nacional de Salta / Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
- * E-mail:
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5
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de Carvalho RVH, Lima-Junior DS, da Silva MVG, Dilucca M, Rodrigues TS, Horta CV, Silva ALN, da Silva PF, Frantz FG, Lorenzon LB, Souza MM, Almeida F, Cantanhêde LM, Ferreira RDGM, Cruz AK, Zamboni DS. Leishmania RNA virus exacerbates Leishmaniasis by subverting innate immunity via TLR3-mediated NLRP3 inflammasome inhibition. Nat Commun 2019; 10:5273. [PMID: 31754185 PMCID: PMC6872735 DOI: 10.1038/s41467-019-13356-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 02/20/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022] Open
Abstract
Leishmania RNA virus (LRV) is an important virulence factor associated with the development of mucocutaneous Leishmaniasis, a severe form of the disease. LRV-mediated disease exacerbation relies on TLR3 activation, but downstream mechanisms remain largely unexplored. Here, we combine human and mouse data to demonstrate that LRV triggers TLR3 and TRIF to induce type I IFN production, which induces autophagy. This process results in ATG5-mediated degradation of NLRP3 and ASC, thereby limiting NLRP3 inflammasome activation in macrophages. Consistent with the known restricting role of NLRP3 for Leishmania replication, the signaling pathway triggered by LRV results in increased parasite survival and disease progression. In support of this data, we find that lesions in patients infected with LRV+ Leishmania are associated with reduced inflammasome activation and the development of mucocutaneous disease. Our findings reveal the mechanisms triggered by LRV that contribute to the development of the debilitating mucocutaneous form of Leishmaniasis.
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Affiliation(s)
- Renan V H de Carvalho
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Djalma S Lima-Junior
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marcus Vinícius G da Silva
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marisa Dilucca
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Tamara S Rodrigues
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Catarina V Horta
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre L N Silva
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Patrick F da Silva
- Laboratório de Imunologia e Epigenética, Departamento de Análises Clínicas, Toxicológicas e Bromatologia, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Fabiani G Frantz
- Laboratório de Imunologia e Epigenética, Departamento de Análises Clínicas, Toxicológicas e Bromatologia, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Lucas B Lorenzon
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marcos Michel Souza
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fausto Almeida
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Angela K Cruz
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Dario S Zamboni
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Castillo-Rodríguez L, Ovalle-Bracho C, Díaz-Jiménez D, Sánchez-Vanegas G, Muvdi-Arenas S, Castañeda-Orjuela C. Cost-effectiveness analysis of Mucosal Leishmaniasis diagnosis with PCR-based vs parasitological tests in Colombia. PLoS One 2019; 14:e0224351. [PMID: 31682606 PMCID: PMC6827906 DOI: 10.1371/journal.pone.0224351] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 09/26/2019] [Indexed: 11/25/2022] Open
Abstract
To estimate the cost-effectiveness of available diagnosis alternatives for Mucosal Leishmaniasis (ML) in Colombian suspected patients. A simulation model of the disease's natural history was built with a decision tree and Markov models. The model´s parameters were identified by systematic review and validated by expert consensus. A bottom-up cost analysis to estimate the costs of diagnostic strategies and treatment per case was performed by reviewing 48 clinical records of patients diagnosed with ML. The diagnostic strategies compared were as follows: 1) no diagnosis; 2) parasite culture, biopsy, indirect immunofluorescence assay (IFA), and Montenegro skin test (MST) combined ; 3) parasite culture, biopsy, and IFA combined; 4) PCR-miniexon; and 5) PCR-kDNA. Three scenarios were modeled in patients with ML clinical suspicion, according to ML prevalence scenarios: high, medium and low. Adjusted sensitivity and specificity parameters of a combination of diagnostic tests were estimated with a discrete event simulation (DES) model. For each alternative, the costs and health outcomes were estimated. The time horizon was life expectancy, considering the average age at diagnosis of 31 years. Incremental cost-effectiveness ratios (ICERs) were calculated per Disability Life Year (DALY) avoided, and deterministic and probabilistic sensitivity analyses were performed. A threshold of willingness to pay (WTP) of three-time gross domestic product per capita (GDPpc) (US$ 15,795) and a discount rate of 3% was considered. The analysis perspective was the third payer (Health System). All costs were reported in American dollars as of 2015. PCR- kDNA was the cost-effective alternative in clinical suspicion levels: low, medium and high with ICERs of US$ 7,909.39, US$ 5,559.33 and US$ 4,458.92 per DALY avoided, respectively. ML diagnostic tests based on PCR are cost-effective strategies, regardless of the level of clinical suspicion. PCR-kDNA was the most cost-effective strategy in the competitive scenario with the parameters included in the present model.
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Affiliation(s)
| | | | - Diana Díaz-Jiménez
- Observatorio Nacional de Salud, Instituto Nacional de Salud, Bogotá, D.C., Colombia
| | | | - Sandra Muvdi-Arenas
- Hospital Universitario Dermatológico Federico Lleras Acosta, Bogotá, D.C., Colombia
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Kato H, Gomez EA, Seki C, Furumoto H, Martini-Robles L, Muzzio J, Calvopiña M, Velez L, Kubo M, Tabbabi A, Yamamoto DS, Hashiguchi Y. PCR-RFLP analyses of Leishmania species causing cutaneous and mucocutaneous leishmaniasis revealed distribution of genetically complex strains with hybrid and mito-nuclear discordance in Ecuador. PLoS Negl Trop Dis 2019; 13:e0007403. [PMID: 31059516 PMCID: PMC6522058 DOI: 10.1371/journal.pntd.0007403] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/16/2019] [Accepted: 04/22/2019] [Indexed: 01/19/2023] Open
Abstract
PCR-Restriction Fragment Length Polymorphism (RFLP) analyses targeting multiple nuclear genes were established for the simple and practical identification of Leishmania species without using expensive equipment. This method was applied to 92 clinical samples collected at 33 sites in 14 provinces of Ecuador, which have been identified at the species level by the kinetoplast cytochrome b (cyt b) gene sequence analysis, and the results obtained by the two analyses were compared. Although most results corresponded between the two analyses, PCR-RFLP analyses revealed distribution of hybrid strains between Leishmania (Viannia) guyanensis and L. (V.) braziliensis and between L. (V.) guyanensis and L. (V.) panamensis, of which the latter was firstly identified in Ecuador. Moreover, unexpected parasite strains having the kinetoplast cyt b gene of L. (V.) braziliensis and nuclear genes of L. (V.) guyanensis, L. (V.) panamensis, or a hybrid between L. (V.) guyanensis and L. (V.) panamensis were identified. This is the first report of the distribution of a protozoan parasite having mismatches between kinetoplast and nuclear genes, known as mito-nuclear discordance. The result demonstrated that genetically complex Leishmania strains are present in Ecuador. Since genetic exchanges such as hybrid formation were suggested to cause higher pathogenicity in Leishmania and may be transmitted by more species of sand flies, further country-wide epidemiological studies on clinical symptoms, as well as transmissible vectors, will be necessary. Leishmaniasis caused by intracellular protozoa of the genus Leishmania is a neglected tropical disease widely distributing worldwide, especially in tropical and subtropical areas. Approximately 20 species are known to be pathogenic to humans, of which eight species have been recorded as causative agents of cutaneous and mucocutaneous leishmaniases in Ecuador. Since infecting species are the major determinant of clinical outcomes, identification at the species level is important for the treatment and prognosis. The parasite species have been identified conventionally by multilocus enzyme electrophoresis (MLEE) and recently by genetic analysis such as sequencing and genotyping. In the present study, PCR-Restriction Fragment Length Polymorphism (RFLP) targeting multiple nuclear genes was employed, and the results were compared with those obtained by kinetoplast cytochrome b (cyt b) gene sequence analysis, which is widely applied to species identification. Although most results corresponded between the two analyses, PCR-RFLP revealed presence of unexpected genetically complex Leishmania strains having characteristics of hybrid and mito-nuclear discordance. Since hybrid strains of Leishmania were suggested to increase disease severity and may be transmitted by a wider range of sand fly species, careful epidemiological research, including clinical courses and vector research, will be needed.
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Affiliation(s)
- Hirotomo Kato
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
- * E-mail:
| | - Eduardo A. Gomez
- Departamento de Parasitologia y Medicina Tropical, Facultad de Ciencias Medicas, Universidad Catolica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Chisato Seki
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
| | - Hayato Furumoto
- Laboratory of Parasitology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Luiggi Martini-Robles
- Hospital de Especialidades Guayaquil “Dr. Abel Gilberto Pinton”, Ministerio de Salud Publica, Guayaquil, Ecuador
| | - Jenny Muzzio
- Departamento de Parasitologia, Insitituto de Investigacion de Salud Publica, Guayaquil, Ecuador
| | - Manuel Calvopiña
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad De Las Américas (UDLA), Quito, Ecuador
| | - Lenin Velez
- Departamento de Parasitologia y Medicina Tropical, Facultad de Ciencias Medicas, Universidad Catolica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Makoto Kubo
- Division of Immunology, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Ahmed Tabbabi
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
| | - Daisuke S. Yamamoto
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
| | - Yoshihisa Hashiguchi
- Departamento de Parasitologia y Medicina Tropical, Facultad de Ciencias Medicas, Universidad Catolica de Santiago de Guayaquil, Guayaquil, Ecuador
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8
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Ovalle-Bracho C, Londoño-Barbosa D, Salgado-Almario J, González C. Evaluating the spatial distribution of Leishmania parasites in Colombia from clinical samples and human isolates (1999 to 2016). PLoS One 2019; 14:e0214124. [PMID: 30917177 PMCID: PMC6436702 DOI: 10.1371/journal.pone.0214124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/07/2019] [Indexed: 11/18/2022] Open
Abstract
In Colombia, nine species of parasites of the genus Leishmania circulate in more than 20 sand fly species, putting at risk of contracting the disease approximately 60% of the population. The Federico Lleras Acosta Dermatological Center, a reference center in Colombia, has been treating patients with cutaneous and mucosal leishmaniasis for more than 15 years, identifying the infecting Leishmania species from different clinical samples, and recording systematically all the epidemiological and geographic information related to each diagnosed patient. With this valuable information, the objective of this work was to perform a long term and large-scale study, aiming to identify the Leishmania species circulating in Colombia from clinical samples from 1999 to 2016, and to assess their current and potential spatial distribution. In all, four Leishmania species were identified in 688 samples from 183 municipalities distributed in 28 of the 32 departments of the country, and 387 records were georeferenced, from 20 departments. The most widespread species was L. (V.) braziliensis, showing new collection records, and the species related to areas with highest leishmaniasis transmission was L. (V.) panamensis. Ecological niche models were built for the three species that had more than 20 georeferenced records, showing a potential distribution for L. (V.) braziliensis on 42% of the national territory mainly in the interandean valleys, and the Orinoquia and Amazon regions. Leishmania (V.) guyanensis potential distribution covers 36% of Colombia continental territory with a spatial distribution similar to that of L. (V.) braziliensis. There was a marked tendency of L. (V.) panamensis to be distributed in the northwest of the country occupying 35% of the national area and mainly in areas of transformed ecosystems. Species were identified in patients from areas where the occurrence of cases was unprecedented, which suggests that the distribution of Leishmania may be greater than currently known. To improve the predictive capacity of the models, we suggest incorporating, in future studies, Leishmania samples from vectors and reservoirs that have a greater dependence on environmental variables. Our results are an important tool for health systems because they allow potential areas of transmission and information gaps to be identified.
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Affiliation(s)
- Clemencia Ovalle-Bracho
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta–E.S.E., Bogotá, Colombia
- * E-mail:
| | - Diana Londoño-Barbosa
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta–E.S.E., Bogotá, Colombia
| | - Jussep Salgado-Almario
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta–E.S.E., Bogotá, Colombia
| | - Camila González
- Centro de Investigaciones en Microbiología y Parasitología Tropical (CIMPAT), Facultad de Ciencias, Universidad de los Andes, Bogotá, Colombia
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9
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Ávila LR, Gomes CM, Oliveira PG, Gomes RS, Vinaud MC, Dorta ML, Uliana SRB, Ribeiro-Dias F, Oliveira MAP. Promastigote parasites cultured from the lesions of patients with mucosal leishmaniasis are more resistant to oxidative stress than promastigotes from a cutaneous lesion. Free Radic Biol Med 2018; 129:35-45. [PMID: 30196081 DOI: 10.1016/j.freeradbiomed.2018.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 01/03/2023]
Abstract
Human leishmaniasis caused by Leishmania (Viannia) braziliensis can be presented as localized cutaneous leishmaniasis (LCL) or mucosal leishmaniasis (ML). Macrophages kill parasites using nitric oxide (NO) and reactive oxygen species (ROS). The aim of this study was to evaluate the ability of parasites obtained from patients with LCL or ML to produce and resist NO or ROS. Promastigotes and amastigotes from LCL or ML isolates produced similar amounts of NO in culture. Promastigotes from ML isolates were more resistant to NO and H2O2 than LCL parasites in a stationary phase, whereas amastigotes from LCL isolates were more resistant to NO. In addition, in the stationary phase, promastigote isolates from patients with ML expressed more thiol-specific antioxidant protein (TSA) than LCL isolates. Therefore it is suggested that infective promastigotes from ML isolates are more resistant to microbicidal mechanisms in the initial phase of infection. Subsequently, amastigotes lose this resistance. This behavior of ML parasites can decrease the number of parasites capable of stimulating the host immune response shortly after the infection establishment.
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MESH Headings
- Animals
- Antioxidants/chemistry
- Antioxidants/metabolism
- Antiprotozoal Agents/pharmacology
- Culture Media/chemistry
- Female
- Host-Parasite Interactions
- Humans
- Hydrogen Peroxide/pharmacology
- Immunity, Innate
- Leishmania braziliensis/drug effects
- Leishmania braziliensis/growth & development
- Leishmania braziliensis/isolation & purification
- Leishmania braziliensis/metabolism
- Leishmaniasis, Diffuse Cutaneous/immunology
- Leishmaniasis, Diffuse Cutaneous/metabolism
- Leishmaniasis, Diffuse Cutaneous/parasitology
- Leishmaniasis, Mucocutaneous/immunology
- Leishmaniasis, Mucocutaneous/metabolism
- Leishmaniasis, Mucocutaneous/parasitology
- Life Cycle Stages/drug effects
- Life Cycle Stages/physiology
- Male
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Knockout
- Nitric Oxide/metabolism
- Nitric Oxide/pharmacology
- Nitric Oxide Donors/pharmacology
- Nitroprusside/pharmacology
- Protozoan Proteins/genetics
- Protozoan Proteins/metabolism
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Affiliation(s)
- Lucilla Ribeiro Ávila
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N, Goiânia, Goiás 74605-050, Brazil
| | - Clayson Moura Gomes
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N, Goiânia, Goiás 74605-050, Brazil; Pontifícia Universidade Católica de Goiás, Av, Universitária 1069, Setor Universitário, Goiânia, Goiás 74605-010, Brazil
| | - Pollyana Guimarães Oliveira
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N, Goiânia, Goiás 74605-050, Brazil
| | - Rodrigo Saar Gomes
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N, Goiânia, Goiás 74605-050, Brazil
| | - Marina Clare Vinaud
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N, Goiânia, Goiás 74605-050, Brazil
| | - Miriam Leandro Dorta
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N, Goiânia, Goiás 74605-050, Brazil
| | - Silvia Reni Bortolin Uliana
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, Av. Prof. Lineu Prestes 1374, São Paulo, SP 05508-000, Brazil
| | - Fátima Ribeiro-Dias
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N, Goiânia, Goiás 74605-050, Brazil
| | - Milton Adriano Pelli Oliveira
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N, Goiânia, Goiás 74605-050, Brazil.
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10
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Guery R, Henry B, Martin-Blondel G, Rouzaud C, Cordoliani F, Harms G, Gangneux JP, Foulet F, Bourrat E, Baccard M, Morizot G, Consigny PH, Berry A, Blum J, Lortholary O, Buffet P. Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. PLoS Negl Trop Dis 2017; 11:e0006094. [PMID: 29155816 PMCID: PMC5714383 DOI: 10.1371/journal.pntd.0006094] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 09/01/2017] [Revised: 12/04/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Background Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication. Methods We conducted a retrospective analysis of data from a French centralized referral treatment program and from the “LeishMan” European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines. Results From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28–803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3–27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03–32]) while infection with other species had no impact on outcome. Conclusion In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease. Cutaneous and muco-cutaneous leishmaniasis (CL/MCL) are disfiguring diseases caused by a worldwide distributed parasite called Leishmania and its 20 species. Clinical manifestations span a wide continuum from single nodular lesion to disseminated form with mucosal involvement. Though local treatment with cryotherapy and intralesionnal antimony or topical formulations of paromomycin is generally adequate in most of situations, some patients with complex CL/MCL require systemic therapy. No convenient regimen has been proved to be safe and effective for all infecting species, all clinical forms and all patients (e.g. children, pregnant women, adults with comorbidities or immunosuppression). In this study, the authors examined in returning travelers with CL/MCL the effectiveness of an antifungal agent “liposomal amphotericin B” (L-AmB), which is highly effective in visceral leishmaniasis. Surprisingly, rates of healing were lower than in previous reports in this unselected population that reflects clinical practice in non-endemic countries. The observations also suggest that some Leishmania species (namely, L. infantum) may be more susceptible to L-AmB than others. Occurrence of adverse events should raises the question of the benefit-risk balance of L-AmB in CL/MCL. Careful attention to comorbidities and adoption of strict protocols for administration are pre-requisites for the use of L-AmB in patients with CL/MCL.
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Affiliation(s)
- Romain Guery
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- * E-mail: (PB); (RG)
| | - Benoit Henry
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, INSERM U1043—CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Claire Rouzaud
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Florence Cordoliani
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Jean-Pierre Gangneux
- Service de Parasitologie-Mycologie, CHU de Rennes, INSERM U1085, Université Rennes 1, Rennes, France
| | - Françoise Foulet
- Unité de Mycologie, Département de Biologie-Pathologie, CHU Henri Mondor, DHU VIC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Emmanuelle Bourrat
- Service de Pédiatrie Général, Hôpital Robert Debré, Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | - Michel Baccard
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | | | - Paul-Henri Consigny
- Centre Médical de l'Institut Pasteur, Consultation de Maladies Infectieuses, Tropicales et de Médecine des Voyages, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
| | - Antoine Berry
- Service de Parasitologie-Mycologie, CHU de Toulouse, INSERM U1043—CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Buffet
- INTS, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence GR-Ex, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
- * E-mail: (PB); (RG)
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11
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Galvão EL, Rabello A, Cota GF. Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS One 2017; 12:e0186117. [PMID: 29016694 PMCID: PMC5633178 DOI: 10.1371/journal.pone.0186117] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Several controlled and uncontrolled studies addressing azole antifungal drugs for cutaneous and mucosal leishmaniasis have been published with inconclusive results. We conducted a systematic literature review of studies evaluating the efficacy and toxicity associated with azole therapy for tegumentary leishmaniasis. Methodology PRISMA guidelines for systematic reviews and the Cochrane manual were followed, and the review methodology was registered (PROSPERO; CRD42016048668). Sources included the EMBASE, Web of Science, MEDLINE, LILACS, and IBECS databases along with a manual search of references from evaluated studies. Additional resources such as Google Scholar and clinicaltrials.gov were also searched. We included all studies reporting cure rate after cutaneous or mucosal leishmaniasis treatment with systemic azole drugs, regardless of their design. R software was used to estimate global rates of success and adverse events with each drug. The main outcome of interest was clinical cure, defined as complete re-epithelialization of all lesions. Results A total of 37 studies involving 1259 patients that reported outcomes after fluconazole (9), ketoconazole (14) and itraconazole (15) treatments were included. Only 14 (38%) were randomized controlled trials (RCT). The pooled azole final efficacy rate was 64% (CI95%: 57–70%) for all studies and 60% (CI95%: 50–70%) (p = 0.41) if only RCTs studies were considered. Twenty-four studies were conducted in the Old World and 13 studies in the Americas. The final efficacy rate according to New and Old World were 62% (CI95%: 43–77%) and 66% (CI95%: 58–73%), respectively. The final efficacy rate of azoles according to species were 89% (CI95%: 50–98%) for L. mexicana; 88% for L. infantum (CI95%: 27–99%); 80% for L. donovani; 53% (CI95%: 29–76%) for L. major; 49% for L. braziliensis (CI95%: 21–78%); and 15% (CI95%: 1–84%) for L. tropica. The cure rates were similar among the fluconazole, ketoconazole and itraconazole group arms (p = 0.89), specifically 61% (CI95%: 48–72%), 64% (CI95%: 44–80%) 65% (CI95%: 56–72%), respectively. Adverse events during fluconazole, itraconazole and ketoconazole therapy were reported in 7% (CI95%: 3–14%), 12% (CI95% 8–19%) and 13% (CI95%: 6–29%) of treated patients, respectively, without difference among them (p = 0.35). This systematic review included studies with small samples and both non-comparative and non-randomized studies and the main limitation was the low quality of the available studies. Conclusions Available evidence suggests that fluconazole, ketoconazole and itraconazole have similar and modest efficacy rates for tegumentary leishmaniasis treatment. There is insufficient evidence to support the exclusive use of azole therapy as a single agent for leishmaniasis treatment.
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Affiliation(s)
- Endi Lanza Galvão
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Ana Rabello
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Fernandes Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
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12
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Cincurá C, de Lima CMF, Machado PRL, Oliveira-Filho J, Glesby MJ, Lessa MM, Carvalho EM. Mucosal leishmaniasis: A Retrospective Study of 327 Cases from an Endemic Area of Leishmania ( Viannia) braziliensis. Am J Trop Med Hyg 2017; 97:761-766. [PMID: 28722607 PMCID: PMC5590558 DOI: 10.4269/ajtmh.16-0349] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/10/2017] [Indexed: 11/07/2022] Open
Abstract
Mucosal leishmaniasis (ML) is observed only in about 3% of patients with American tegumentary leishmaniasis (ATL) but has a high potential for destructive, disfiguring, and disabling sequelae. Prior reports of clinical and epidemiologic features of ML are limited by small numbers of cases. In this study, we evaluated changes in the demographic features and clinical presentation of ML in an endemic area of Leishmania braziliensis transmission over a period of 20 years. The charts of 327 patients with ML diagnosed between 1995 and 2014 were reviewed. The majority of patients (67%) were male. Age ranged from 8 months to 103 years, with a median age of 38.5 years (interquartile range: 22-58 years). The greatest number of patients was between 19 and 39 years (31%). Over the study period, there was an increase in patients with ML more than 60 years of age, an increase in ML with concomitant cutaneous lesions, a decrease in the period of time between the documentation of cutaneous lesions and the diagnosis of mucosal disease, and an increase in the frequency of patients presenting with stage I and V of ML. Moreover, there was a positive correlation between severity of mucosal disease and both age and the period of time between cutaneous lesion and mucosal disease. Response to therapy of ML remained similar over a period of 20 years. Despite the improvement in medical care during the study period, the prevalence of ML did not change and severe disease continues to be a major challenge for the management of these patients.
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Affiliation(s)
- Carolina Cincurá
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Clara Mônica F. de Lima
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Paulo R. L. Machado
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Jamary Oliveira-Filho
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Marshall J. Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, New York
| | - Marcus M. Lessa
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Edgar M. Carvalho
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Gonçalo Moniz Research Center, Fiocruz, Bahia, Brazil
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13
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Affiliation(s)
- Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
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14
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García Bustos MF, González-Prieto G, Ramos F, Mora MC, Hashiguchi Y, Parodi C, Basombrío MA, Moreno S, Monroig S, Beckar J, Jaime D, Sajama J, Yeo M, Marco JD, Locatelli FM, Barrio A. Clinical and epidemiological features of leishmaniasis in northwestern-Argentina through a retrospective analysis of recent cases. Acta Trop 2016; 154:125-32. [PMID: 26611809 DOI: 10.1016/j.actatropica.2015.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 05/14/2015] [Revised: 10/27/2015] [Accepted: 11/13/2015] [Indexed: 11/18/2022]
Abstract
Leishmaniasis is a parasitic disease caused by hemoflagellates of the genus Leishmania and is transmitted to humans by the bite of infected phlebotomine sandflies. Depending on the Leishmania species, the disease has different clinical forms including cutaneous, mucocutaneous, and visceral manifestations. Previous studies performed in endemic zones of northwestern-Argentina, during epidemic outbreaks, have been important for detecting patients suffering from the acute phase of the disease, but have not given a complete representation of the clinical and epidemiological features in the region. Furthermore, due to the resurgence of leishmaniasis worldwide and in particular the large increase of international tourism to the region, it seems pertinent to update the current epidemiological and clinical profile of leishmaniasis in northwestern-Argentina. Here we present a retrospective analysis of 95 Leishmania positive cases, presenting between 2000 and 2014. Patients were derived from hospitals and diagnosed in our lab at the University of Salta, located in a non-endemic area in Salta, Argentina. We detected numerous extensive mucocutaneous cases (34/95, 35.8%) distinct from mucosal affected patients, some instances originating in locations with no previously reported human cases. Additionally patients suffering from concomitant diseases, besides leishmaniasis, were assessed. These included Chagas disease, syphilis, deep mycoses, tuberculosis, toxoplasmosis and intestinal parasitosis. This study updates the clinical and epidemiological features of leishmaniasis in northwestern-Argentina, and discusses the implications and management strategy for patients who acquire the disease in this region.
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MESH Headings
- Adolescent
- Adult
- Animals
- Antibodies, Protozoan/immunology
- Argentina/epidemiology
- Chagas Disease/epidemiology
- Child
- Child, Preschool
- Comorbidity
- Disease Outbreaks
- Female
- Humans
- Infant
- Leishmania
- Leishmania braziliensis
- Leishmania infantum
- Leishmaniasis, Cutaneous/epidemiology
- Leishmaniasis, Cutaneous/immunology
- Leishmaniasis, Cutaneous/parasitology
- Leishmaniasis, Mucocutaneous/epidemiology
- Leishmaniasis, Mucocutaneous/immunology
- Leishmaniasis, Mucocutaneous/parasitology
- Leishmaniasis, Visceral/epidemiology
- Leishmaniasis, Visceral/immunology
- Leishmaniasis, Visceral/parasitology
- Male
- Middle Aged
- Mycoses/epidemiology
- Psychodidae/parasitology
- Retrospective Studies
- Syphilis/epidemiology
- Toxoplasmosis/epidemiology
- Tuberculosis/epidemiology
- Young Adult
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Affiliation(s)
- María F García Bustos
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina; Consejo de Investigación, Universidad Nacional de Salta, Salta, Argentina
| | | | - Federico Ramos
- Consejo de Investigación, Universidad Nacional de Salta, Salta, Argentina
| | - María C Mora
- Consejo de Investigación, Universidad Nacional de Salta, Salta, Argentina
| | - Yoshihisa Hashiguchi
- Centro de Biomedicina, Universidad Central del Ecuador y Proyecto Prometeo, SNESCYT, Ecuador; Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Cecilia Parodi
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Miguel A Basombrío
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | | | | | | | - Daniela Jaime
- Hospital Joaquín Castellanos, Güemes, Salta, Argentina
| | - Jesús Sajama
- Facultad de Ciencias Naturales, Universidad Nacional de Salta, Salta, Argentina
| | - Matthew Yeo
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jorge D Marco
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Fabricio M Locatelli
- Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Alejandra Barrio
- Consejo de Investigación, Universidad Nacional de Salta, Salta, Argentina.
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15
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Cantanhêde LM, da Silva Júnior CF, Ito MM, Felipin KP, Nicolete R, Salcedo JMV, Porrozzi R, Cupolillo E, Ferreira RDGM. Further Evidence of an Association between the Presence of Leishmania RNA Virus 1 and the Mucosal Manifestations in Tegumentary Leishmaniasis Patients. PLoS Negl Trop Dis 2015; 9:e0004079. [PMID: 26372217 PMCID: PMC4570810 DOI: 10.1371/journal.pntd.0004079] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 08/21/2015] [Indexed: 01/08/2023] Open
Abstract
Tegumentary Leishmaniasis (TL) is endemic in Latin America, and Brazil contributes approximately 20 thousand cases per year. The pathogenesis of TL, however, is still not fully understood. Clinical manifestations vary from cutaneous leishmaniasis (CL) to more severe outcomes, such as disseminated leishmaniasis (DL), mucosal leishmaniasis (ML) and diffuse cutaneous leishmaniasis (DCL). Many factors have been associated with the severity of the disease and the development of lesions. Recent studies have reported that the presence of Leishmania RNA virus 1 infecting Leishmania (Leishmania RNA virus 1, LRV1) is an important factor associated with the severity of ML in experimental animal models. In the present study, 156 patients who attended Rondonia's Hospital of Tropical Medicine with both leishmaniasis clinical diagnoses (109 CL; 38 ML; 5 CL+ML; 3 DL and 1 DCL) and molecular diagnoses were investigated. The clinical diagnosis were confirmed by PCR by targeting hsp70 and kDNA DNA sequences and the species causing the infection were determined by HSP70 PCR-RFPL. The presence of LVR1 was tested by RT-PCR. Five Leishmania species were detected: 121 (77.6%) samples were positive for Leishmania (Viannia) braziliensis, 18 (11.5%) were positive for Leishmania (V.) guyanensis, 3 (1.8%) for Leishmania (V.) lainsoni, 2 (1.3%) for Leishmania (Leishmania) amazonensis and 2 (1.3%) for Leishmania (V.) shawi. Six (3.9%) samples were positive for Leishmania sp. but the species could not be determined, and 4 (2.6%) samples were suggestive of mixed infection by L. (V.) braziliensis and L. (V.) guyanensis. The virus was detected in L. braziliensis (N = 54), L. guyanensis (N = 5), L. amazonensis (N = 2), L. lainsoni (N = 1) and inconclusive samples (N = 6). Patients presenting with CL+ML, DL and DCL were excluded from further analysis. Association between the presence of the virus and the disease outcome were tested among the remaining 147 patients (CL = 109 and ML = 38). Of them, 71.1% (n = 27) mucosal lesions were positive for LRV1, and 28.9% (n = 11) were negative. In cutaneous lesions, 36.7% (n = 40) were positive and 63.3% (n = 69) were negative for LRV1. The ratio P(ML|LRV1+)/P(ML|LRV1-) was 2.93 (CI95% 1.57…5.46; p<0.001), thus corroborating the hypothesis of the association between LRV1 and the occurrence of mucosal leishmaniasis, as previously described in animal models; it also indicates that LRV1 is not the only factor contributing to the disease outcome. Leishmaniasis is an infectious disease caused by protozoa of the genus Leishmania. Tegumentary Leishmaniasis (TL) is characterized by a variety of clinical forms, ranging from simple skin lesions to more severe lesions with mucosal destruction. The mechanisms by which some patients develop a severe form of the disease remain unclear. It is already known that the immune statuses of the host and parasite species are key factors influencing the clinical outcome of the disease, but is not known which are the factors that influence the parasite’s tropism to the mucosal regions. Recently, a virus found infecting Leishmania, Leishmania RNA virus 1 (LRV1), has also been reported as one important factor contributing to the disease severity. The present article reports, among 147 investigated patients from the Brazilian Western Amazon, a higher frequency of LRV1 among patients with mucosal lesions compared to patients with cutaneous lesions, statistically demonstrating that the virus is related to the worsening of the disease, increasing the risk of developing mucosal injury by almost 3 times.
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Affiliation(s)
| | | | - Marcos Massayuki Ito
- Secretaria de Saúde, Governo do Estado de Rondonia, Porto Velho, Rondonia, Brazil
| | | | - Roberto Nicolete
- Fundação Oswaldo Cruz, Unidade Rondonia, Porto Velho, Rondonia, Brazil
| | | | - Renato Porrozzi
- Laboratório de Pesquisa em Leishmaniose, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Elisa Cupolillo
- Laboratório de Pesquisa em Leishmaniose, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
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16
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da Costa DCS, Palmeiro MR, Moreira JS, Martins ACDC, da Silva AF, de Fátima Madeira M, Quintella LP, Confort EM, de Oliveira Schubach A, da Conceição Silva F, Valete-Rosalino CM. Oral manifestations in the American tegumentary leishmaniasis. PLoS One 2014; 9:e109790. [PMID: 25386857 PMCID: PMC4227643 DOI: 10.1371/journal.pone.0109790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 04/17/2014] [Accepted: 09/10/2014] [Indexed: 11/27/2022] Open
Abstract
Introduction American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis – MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing. Objectives Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities. Methods A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant. Results The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites. Conclusion Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.
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Affiliation(s)
- Daniel Cesar Silva da Costa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - Mariana Reuter Palmeiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - João Soares Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | | | - Aline Fagundes da Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - Maria de Fátima Madeira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - Leonardo Pereira Quintella
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - Eliame Mouta Confort
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | | | - Fátima da Conceição Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
- * E-mail: (CMVR); (FCS)
| | - Cláudia Maria Valete-Rosalino
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
- Department of Otorhinolaryngology and Ophthalmology, Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil
- * E-mail: (CMVR); (FCS)
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17
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Gökmen TG, Haytoglu S, Güran M, Kusçu F, Köksal F. A multidisciplinary approach to an uncommon case of laryngeal leishmaniasis in Turkey. J Vector Borne Dis 2014; 51:140-143. [PMID: 24947223] [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: 06/03/2023] Open
Affiliation(s)
| | | | - Mümtaz Güran
- Department of Medical Microbiology, Faculty of Medicine, Eastern Mediterranean University, Mersin, Turkey
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18
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Marra F, Chiappetta MC, Vincenti V. Ear, nose and throat manifestations of mucocutaneous Leishmaniasis: a literature review. Acta Biomed 2014; 85:3-7. [PMID: 24897964] [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] [Received: 12/27/2013] [Accepted: 03/11/2014] [Indexed: 06/03/2023]
Abstract
Leishmaniasis comprises a group of diseases caused by a protozoan parasite belonging to the genus Leishmania and transmitted by the bite of infected female sand flies. Leishmaniasis is endemic in 88 countries and causes significant morbidity and mortality worldwide. Phenomena such as globalization and human migration, as well as the increased volume of international travel have extended its prevalence in developed countries. In addition, the incidence of leishmaniasis as an opportunistic disease has increased in recent years because of the growing number of patients with immune depression secondary to chronic illness, neoplasm, transplant and HIV infection, thereby constituting a public health problem. In humans, there are three possible clinical syndromes of leishmaniasis: cutaneous, mucocutaneous and visceral. Mucocutaneous disease is due to extension of local skin disease into the mucosal tissue via direct extension, bloodstream or lymphatics. Lesions interest mainly the oral and nasal mucosa and occasionally the laryngeal and pharyngeal mucosa. If not recognized and adequately treated, MCL may disfigure the patient because of the chronic local destruction of tissue of the nose, pharynx and palate. Because of the invariable involvement of the areas pertaining otorhinolaryngologists, it is important for ENT specialists and family physicians to have awareness of this condition and its clinical manifestations, particularly in presence of a history positive for travel to endemic areas. If mucocutaneous leishmaniasis is suspected, otorhinolaryngologic examination is very helpful in establishing a correct diagnosis, preventing inappropriate treatment.
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Affiliation(s)
- Francesca Marra
- Department of Clinical and Experimental Medicine, University of Parma.
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19
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Bermúdez H, Rojas E, Garcia L, Desjeux P, Dujardin JC, Boelaert M, Chappuis F. Generic sodium stibogluconate is as safe and effective as branded meglumine antimoniate, for the treatment of tegumentary leishmaniasis in Isiboro Secure Park, Bolivia. Annals of Tropical Medicine & Parasitology 2013; 100:591-600. [PMID: 16989685 DOI: 10.1179/136485906x118495] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Human cutaneous leishmaniasis (CL) and mucous leishmaniasis (ML) are highly endemic in Isiboro Secure Park, which lies in the Bolivian department of Cochabamba--an area where branded meglumine antimoniate (Glucantime) is expensive and poorly distributed. The safety and efficacy of generic sodium stibogluconate (SSG), from Albert David Ltd, was therefore explored, in CL and ML cases from the park, who were treated with 20 mg/kg.day for 20 and 30 days, respectively. A questionnaire recording adverse effects was completed by a physician in each treatment centre. Efficacy of treatment was assessed at the end of treatment and at follow-ups 1 month and 3, 6 and 12 months later. Overall, 146 patients completed treatment with SSG in 2003-2004. No fatalities or severe adverse effects were reported but mild to moderate adverse effects were noted in 41 (28%) of the patients. The incidence of adverse effects was significantly higher among the cases of ML than among the cases of CL. Of the 86 patients with CL who completed 6 months of follow-up, 81 (94.2%) were considered to have been clinically cured; a comparable cohort of 69 CL cases who had been treated with Glucantime in 2001-2002 showed a similar frequency of clinical cure (90%). Generic SSG was shown to be safe and efficacious for the treatment of tegumentary leishmaniasis in Bolivia. Being several times cheaper than Glucantime, it could contribute to improving the access of CL and ML patients to treatment, not only in Bolivia but also in other countries of Latin America.
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MESH Headings
- Adult
- Antimony Sodium Gluconate/administration & dosage
- Antimony Sodium Gluconate/adverse effects
- Antiprotozoal Agents/administration & dosage
- Antiprotozoal Agents/adverse effects
- Bolivia/epidemiology
- Drugs, Generic/administration & dosage
- Drugs, Generic/adverse effects
- Female
- Humans
- Injections, Intramuscular
- Injections, Intravenous
- Leishmaniasis, Cutaneous/drug therapy
- Leishmaniasis, Cutaneous/epidemiology
- Leishmaniasis, Cutaneous/parasitology
- Leishmaniasis, Mucocutaneous/drug therapy
- Leishmaniasis, Mucocutaneous/epidemiology
- Leishmaniasis, Mucocutaneous/parasitology
- Male
- Meglumine/administration & dosage
- Meglumine/adverse effects
- Meglumine Antimoniate
- Organometallic Compounds/administration & dosage
- Organometallic Compounds/adverse effects
- Treatment Outcome
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Affiliation(s)
- H Bermúdez
- Faculty of Medicine, Universidad Mayor San Simon, P.O. Box 4866, Cochabamba, Bolivia
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20
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Leite PM, Gomes RS, Figueiredo AB, Serafim TD, Tafuri WL, de Souza CC, Moura SAL, Fietto JLR, Melo MN, Ribeiro-Dias F, Oliveira MAP, Rabello A, Afonso LCC. Ecto-nucleotidase activities of promastigotes from Leishmania (Viannia) braziliensis relates to parasite infectivity and disease clinical outcome. PLoS Negl Trop Dis 2012; 6:e1850. [PMID: 23071853 PMCID: PMC3469556 DOI: 10.1371/journal.pntd.0001850] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [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: 01/16/2012] [Accepted: 08/22/2012] [Indexed: 12/22/2022] Open
Abstract
Background Leishmania (Viannia) braziliensis has been associated with a broad range of clinical manifestations ranging from a simple cutaneous ulcer to destructive mucosal lesions. Factors leading to this diversity of clinical presentations are not clear, but parasite factors have lately been recognized as important in determining disease progression. Given the fact that the activity of ecto-nucleotidases correlates with parasitism and the development of infection, we evaluated the activity of these enzymes in promastigotes from 23 L. braziliensis isolates as a possible parasite-related factor that could influence the clinical outcome of the disease. Methodology/Principal Findings Our results show that the isolates differ in their ability to hydrolyze adenine nucleotides. Furthermore, we observed a positive correlation between the time for peak of lesion development in C57BL/6J mice and enzymatic activity and clinical manifestation of the isolate. In addition, we found that L. (V.) braziliensis isolates obtained from mucosal lesions hydrolyze higher amounts of adenine nucleotides than isolates obtained from skin lesions. One isolate with high (PPS6m) and another with low (SSF) ecto-nucleotidase activity were chosen for further studies. Mice inoculated with PPS6m show delayed lesion development and present larger parasite loads than animals inoculated with the SSF isolate. In addition, PPS6m modulates the host immune response by inhibiting dendritic cell activation and NO production by activated J774 macrophages. Finally, we observed that the amastigote forms from PPS6m and SSF isolates present low enzymatic activity that does not interfere with NO production and parasite survival in macrophages. Conclusions/Significance Our data suggest that ecto-nucleotidases present on the promastigote forms of the parasite may interfere with the establishment of the immune response with consequent impaired ability to control parasite dissemination and this may be an important factor in determining the clinical outcome of leishmaniasis. Cutaneous leishmaniasis is a widespread tropical disease caused by different species of Leishmania protozoa that are transmitted by infected sandflies. Clinical presentations are extremely diverse and dependent on a variety of parasite and host factors that are poorly understood. Leishmania (V.) braziliensis infection may result in a devastating disease manifestation characterized by the development of destructive lesions in the oral, nasal, and pharyngeal mucosal. Ecto-nucleotidases are enzymes that are involved in the hydrolysis of extracellular nucleotides. These enzymes have been shown to correlate with virulence of Leishmania parasites. In this work, we evaluated the ecto-nucleotidase activity of promastigotes from the twenty three different L. braziliensis isolates. We demonstrated that isolates obtained from mucosal lesions present higher levels of ecto-nucleotidase activity than those from cutaneous lesions. In addition, we show that in the murine model of cutaneous leishmaniasis, promastigote forms of parasite with higher activity induce a delayed/decreased immune response that may correlate with spreading of the parasites throughout the body. Thus, we propose that the level of ecto-nucleotidase activity of promastigotes may be a marker for the development of severe clinical forms of cutaneous leishmaniasis and also a possible target for future therapeutic intervention.
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Affiliation(s)
- Pauline M. Leite
- Laboratório de Imunoparasitologia, DECBI/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - Rodrigo S. Gomes
- Laboratório de Imunoparasitologia, DECBI/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - Amanda B. Figueiredo
- Laboratório de Imunoparasitologia, DECBI/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - Tiago D. Serafim
- Laboratório de Imunoparasitologia, DECBI/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - Wagner L. Tafuri
- Departamento de Patologia Geral, ICB, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina C. de Souza
- Departamento de Patologia Geral, ICB, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra A. L. Moura
- Laboratório de Imunoparasitologia, DECBI/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - Juliana L. R. Fietto
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Maria N. Melo
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fátima Ribeiro-Dias
- Instituto de Patologia Tropical e Saúde Publica, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Milton A. P. Oliveira
- Instituto de Patologia Tropical e Saúde Publica, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Ana Rabello
- Centro de Pesquisas René Rachou- FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Luís C. C. Afonso
- Laboratório de Imunoparasitologia, DECBI/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
- * E-mail:
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21
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Pulimood SA, Rupali P, Ajjampur SSR, Thomas M, Mehrotra S, Sundar S. Atypical mucocutaneous involvement with Leishmania donovani. Natl Med J India 2012; 25:148-150. [PMID: 22963292] [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: 06/01/2023]
Abstract
Mucocutaneous leishmaniasis has rarely been reported from India. The usual causative organisms of this infection are Leishmania braziliensis and L. tropica. Another species, L. donovani, which usually causes visceral leishmaniasis, has recently been reported to cause mucocutaneous disease in a few patients from Sri Lanka. We report two patients who had undiagnosed chronic skin lesions for several years. Skin biopsies revealed Leishmania and the species was characterized as L. donovani in both patients. There was considerable improvement in the skin lesions following treatment with liposomal amphotericin B.
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Affiliation(s)
- S A Pulimood
- Department of Dermatology and Venereology, Christian Medical College, Vellore, Tamil Nadu, India.
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22
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Affiliation(s)
- Phillip Scott
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA
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23
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Simon I, Wissing KM, Del Marmol V, Antinori S, Remmelink M, Nilufer Broeders E, Nortier JL, Corbellino M, Abramowicz D, Cascio A. Recurrent leishmaniasis in kidney transplant recipients: report of 2 cases and systematic review of the literature. Transpl Infect Dis 2011; 13:397-406. [PMID: 21281418 DOI: 10.1111/j.1399-3062.2011.00598.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
MESH Headings
- Antibodies, Protozoan/blood
- Female
- Humans
- Kidney Transplantation/adverse effects
- Leg Ulcer/parasitology
- Leg Ulcer/pathology
- Leishmania/genetics
- Leishmania/immunology
- Leishmania/isolation & purification
- Leishmania donovani/genetics
- Leishmania donovani/immunology
- Leishmania donovani/isolation & purification
- Leishmaniasis, Cutaneous/diagnosis
- Leishmaniasis, Cutaneous/parasitology
- Leishmaniasis, Cutaneous/pathology
- Leishmaniasis, Mucocutaneous/diagnosis
- Leishmaniasis, Mucocutaneous/parasitology
- Leishmaniasis, Mucocutaneous/pathology
- Leishmaniasis, Visceral/diagnosis
- Leishmaniasis, Visceral/parasitology
- Leishmaniasis, Visceral/pathology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Recurrence
- Tongue/parasitology
- Tongue/pathology
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Affiliation(s)
- I Simon
- Department of Nephrology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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24
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Kaltoft M, Munch-Petersen HR, Møller H. [Leishmaniasis isolated to the larynx as cause of chronic laryngitis]. Ugeskr Laeger 2010; 172:2898-2899. [PMID: 21040662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Mucosal leishmaniasis is uncommon outside Central and South America, where it is commonly caused by Leishmania (L.) braziliensis. We present a case of isolated laryngeal leishmaniasis detected in a 78-year-old male, who presented with chronic hoarseness. Histologic examination of biopsies taken from the larynx showed L. amastigotes. An L.-specific indirect fluorescent antibody test was positive. Polymerase chain reaction showed infection with L. donovani, L. infantum or L. tropica, species which do not normally cause isolated mucosal infection. This is the first reported case from Scandinavia.
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Affiliation(s)
- Mikkel Kaltoft
- Gentofte Hospital, Øre-naese-halskirurgisk Afdeling E, Denmark.
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25
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Recalcati S, Vezzoli P, Girgenti V, Venegoni L, Veraldi S, Berti E. Cutaneous lymphoid hyperplasia associated with Leishmania panamensis infection. Acta Derm Venereol 2010; 90:418-9. [PMID: 20574614 DOI: 10.2340/00015555-0893] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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Matta NE, Nogueira RS, Franco AMR, de Souza E Souza I, Mattos MS, Oliveira-Neto MP, Coutinho SG, Leon LL, Da-Cruz AM. Leishmania (Viannia) guyanensis induces low immunologic responsiveness in leishmaniasis patients from an endemic area of the Brazilian Amazon Highland. Am J Trop Med Hyg 2009; 80:339-344. [PMID: 19270278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Cutaneous leishmaniasis caused by Leishmania (Viannia) guyanensis (CL-Lguy) is endemic in the Brazilian Amazon, differing from L. braziliensis infection in clinical, diagnostic, and therapeutic aspects. T-cell reactivity to leishmanial antigens possibly involved in the pathogenesis of CL-Lguy was studied herein. Variable lymphoproliferative responses (LPRs) to Leishmania antigens were found among the 23 studied patients, and 50% of them showed low or no response to these antigens. Active disease was associated with an enrichment of leishmanial-reactive T lymphocytes, mainly TCD4(+). High and low interferon (IFN)-gamma producers were observed. TNF-alpha, interleukin (IL)-10, and IL-5 were consistently detected. CL-Lguy displayed low antibody response in comparison to L. braziliensis patients. CL caused by L. braziliensis presented positive LPRs and higher IFN-gamma production but undetectable IL-5. L. guyanensis seems to induce a down-regulation of the immune system compared with L. braziliensis. This finding could explain some aspects of clinical presentation of CL-Lguy, such as high tissue parasite burden and frequent resistance to therapy.
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Affiliation(s)
- Nubia Estela Matta
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
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28
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Amato VS, Tuon FF, Bacha HA, Neto VA, Nicodemo AC. Mucosal leishmaniasis . Current scenario and prospects for treatment. Acta Trop 2008; 105:1-9. [PMID: 17884002 DOI: 10.1016/j.actatropica.2007.08.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 08/14/2007] [Accepted: 08/14/2007] [Indexed: 11/27/2022]
Abstract
Leishmaniasis causes significant morbidity and mortality and thus constitutes a serious public health problem. Even though it has long been endemic in developing countries, in recent years the economic globalization and the increased volume of international travel have extended its prevalence in developed countries. In addition, native populations may be exposed to the infection through blood transfusion and the use of blood products produced from infected asymptomatic individuals. Mucosal leishmaniasis (ML) is a chronic form of this infection, which attacks the mucosa. In most cases this form of leishmaniasis results from the metastatic spread of Leishmania (Viannia) braziliensis from cutaneous lesions. It is a healthcare issue because of its wide demographic distribution, its association with significant morbidity levels, and because of the pressing concern that tourists who travel to endemic areas might present the disease even years later. The treatment currently available for ML is based on drugs such as pentavalent antimony-containing compounds, amphotericin B deoxycholate and pentamidine and often guarantees a satisfactory clinical response. Nevertheless, it also frequently provokes serious side effects. This review offers a critical analysis of the drugs now available for the treatment of ML as also of the future prospects for the treatment of the disease.
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Affiliation(s)
- Valdir Sabbaga Amato
- Infectious and Parasitic Diseases Clinic, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, 05403-010, São Paulo, Brazil.
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Amato VS, Tuon FF, Siqueira AM, Nicodemo AC, Neto VA. Treatment of mucosal leishmaniasis in Latin America: systematic review. Am J Trop Med Hyg 2007; 77:266-74. [PMID: 17690398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Mucosal leishmaniasis (ML) is an important endemic disease and public-health problem in underdeveloped countries because of its significant morbidity and mortality. Increases in ecological tourism have extended this problem to developed countries. This form of leishmaniasis, caused by reactivation after primary cutaneous lesion, has a natural history of progressive destruction of the nasal septa and soft and hard palates, causing facial disfiguration and leading to respiratory disturbances. Treatment of ML, based on several therapies, depends on use of toxic compounds, and few drugs have emerged over the past 40 years. Drug resistance has increased, and the cure rate is no better than 70% in the largest studies. Despite these data, there has been no systematic review of therapies used to treat this important tropical disease. The aim of this study is to determine the best drug management for treatment of ML in Latin America based on the best studies offered by the medical literature. The MEDLINE, LILACS, EMBASE, Web of Science, and Cochrane Library databases were searched to identify articles related to ML and therapy. The studies were independently selected by 2 authors. Articles with sufficient data for cure and treatment failures, internal and external validity information, and > 4 patients in each treatment were included. Validation of this systematic review was based on guidelines to guarantee quality; 22 articles met our inclusion criteria. Stibogluconate achieved a 51% cure rate (76/150 patients), and 88% of patients treated with meglumine were cured (121 patients). Pentamidine and amphotericin were as effective as meglumine. Use of itraconazole and other therapies (pentoxifylline, allopurinol, or interferon-gamma) was controversial, and numbers of patients in some studies were insufficient for statistical analysis. Meglumine may be the drug of choice in the treatment of ML, as it offers similar cure rates when compared with amphotericin B and pentamidine. Cost, adverse effects, local experience, and availability of drugs to treat ML are strong points to be considered before determining the best management of this disease, especially in developing countries.
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Affiliation(s)
- Valdir Sabbaga Amato
- Infectious and Parasitic Clinic, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
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Salay G, Dorta ML, Santos NM, Mortara RA, Brodskyn C, Oliveira CI, Barbiéri CL, Rodrigues MM. Testing of four Leishmania vaccine candidates in a mouse model of infection with Leishmania (Viannia) braziliensis, the main causative agent of cutaneous leishmaniasis in the New World. Clin Vaccine Immunol 2007; 14:1173-81. [PMID: 17626159 PMCID: PMC2043302 DOI: 10.1128/cvi.00060-07] [Citation(s) in RCA: 34] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We evaluated whether four recombinant antigens previously used for vaccination against experimental infection with Leishmania (Leishmania) major could also induce protective immunity against a challenge with Leishmania (Viannia) braziliensis, the species responsible for 90% of the 28,712 annual cases of cutaneous and mucocutaneous leishmaniasis recorded in Brazil during the year of 2004. Initially, we isolated the homolog genes encoding four L. (V.) braziliensis antigens: (i) homologue of receptor for activated C kinase, (ii) thiol-specific antioxidant, (iii) Leishmania elongation and initiation factor, and (iv) L. (L.) major stress-inducible protein 1. At the deduced amino acid level, all four open reading frames had a high degree of identity with the previously described genes of L. (L.) major being expressed on promastigotes and amastigotes of L. (V.) braziliensis. These genes were inserted into the vector pcDNA3 or expressed as bacterial recombinant proteins. After immunization with recombinant plasmids or proteins, BALB/c mice generated specific antibody or cell-mediated immune responses (gamma interferon production). After an intradermal challenge with L. (V.) braziliensis infective promastigotes, no significant reduction on the lesions was detected. We conclude that the protective immunity afforded by these four vaccine candidates against experimental cutaneous leishmaniasis caused by L. (L.) major could not be reproduced against a challenge with L. (V.) braziliensis. Although negative, we consider our results important since they suggest that studies aimed at the development of an effective vaccine against L. (V.) braziliensis, the main causative agent of cutaneous leishmaniasis in the New World, should be redirected toward distinct antigens or different vaccination strategies.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Protozoan/biosynthesis
- Antibodies, Protozoan/immunology
- Antigens, Protozoan/biosynthesis
- Antigens, Protozoan/genetics
- Antigens, Protozoan/immunology
- Disease Models, Animal
- Heat-Shock Proteins/biosynthesis
- Heat-Shock Proteins/genetics
- Heat-Shock Proteins/immunology
- Humans
- Immunoassay/methods
- Leishmania braziliensis/genetics
- Leishmania braziliensis/immunology
- Leishmaniasis, Cutaneous/immunology
- Leishmaniasis, Cutaneous/parasitology
- Leishmaniasis, Cutaneous/prevention & control
- Leishmaniasis, Mucocutaneous/immunology
- Leishmaniasis, Mucocutaneous/parasitology
- Leishmaniasis, Mucocutaneous/prevention & control
- Life Cycle Stages
- Male
- Mice
- Mice, Inbred BALB C
- Molecular Sequence Data
- Open Reading Frames
- Peptide Initiation Factors/biosynthesis
- Peptide Initiation Factors/genetics
- Peptide Initiation Factors/immunology
- Protozoan Proteins/biosynthesis
- Protozoan Proteins/genetics
- Protozoan Proteins/immunology
- Protozoan Vaccines/genetics
- Protozoan Vaccines/immunology
- Protozoan Vaccines/pharmacology
- Vaccines, Synthetic/genetics
- Vaccines, Synthetic/immunology
- Vaccines, Synthetic/pharmacology
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Affiliation(s)
- G Salay
- Centro Interdisciplinar de Terapia Gênica, UNIFESP-EPM, Rua Mirassol, 207, São Paulo, SP 04044-010, Brazil
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Ovalle Bracho C, Porras de Quintana L, Muvdi Arenas S, Rios Parra M. Polymerase chain reaction with two molecular targets in mucosal leishmaniasis' diagnosis: a validation study. Mem Inst Oswaldo Cruz 2007; 102:549-54. [PMID: 17710297 DOI: 10.1590/s0074-02762007005000061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 04/24/2007] [Indexed: 11/22/2022] Open
Abstract
We validated the polymerase chain reaction (PCR) with a composite reference standard in 61 patients clinically suspected of having mucosal leishmaniasis, 36 of which were cases and 25 were non-cases according to this reference standard. Patient classification and test application were carried out independently by two blind observers. One pair of primers was used to amplify a fragment of 120 bp in the conserved region of kDNA and another pair was used to amplify the internal transcript spacers (ITS) rDNA. PCR showed 68.6% (95% CI 59.2-72.6) sensitivity and 92% (95% CI 78.9-97.7) specificity; positive likelihood ratio: 8.6 (95% CI 2.8-31.3) and negative likelihood ratio: 0.3 (95% CI 0.3-0.5), when kDNA molecular target was amplified. The test performed better on sensitivity using this target compared to the ITS rDNA molecular target which showed 40% (95% CI 31.5-42.3) sensitivity and 96% (95% CI 84.1-99.3) specificity; positive likelihood ratio: 10 (95% CI 2.0-58.8) and negative likelihood ratio: 0.6 (95% CI 0.6-0.8). The inter-observer agreement was excellent for both tests. Based upon results obtained and due to low performance of conventional methods for diagnosing mucosal leishmaniasis, we consider PCR with kDNA as molecular target is a useful diagnostic test and the ITS rDNA molecular target is useful when the aim is to identify species.
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Affiliation(s)
- Clemencia Ovalle Bracho
- Tropical Dermatology Research Group, National Institute of Dermatology, Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia
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Abstract
Leishmaniasis is a parasitic disease with diverse clinical manifestations, and considered a public health problem in endemic countries such as Brazil. Mucosal lesions usually involve the upper respiratory tract, with a predilection for nose and larynx. Oral involvement is unusual and in most cases it becomes evident after several years of resolution of the original cutaneous lesions. Oral lesions classically appear as mucosal ulcerations, mainly in the hard or soft palate. This report describes the clinicopathological data of 11 cases of mucocutaneous leishmaniasis with oral manifestations. Two cases of Leishmania (Viannia) braziliensis and one case of Leishmania (Leishmania) amazonensis were confirmed by polymerase chain reaction-restriction fragment length polymorphism or DNA sequencing in mucosal samples.
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Affiliation(s)
- A C F Motta
- Division of Dermatology, Department of Medical Clinics, Faculty of Medicine of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
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Llanos-Cuentas A, Echevarria J, Seas C, Chang E, Cruz M, Alvarez E, Rosales E, Campos P, Bryceson A. Parenteral aminosidine is not effective for Peruvian mucocutaneous leishmaniasis. Am J Trop Med Hyg 2007; 76:1128-31. [PMID: 17556623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Few therapeutic options are available for mucocutaneous leishmaniasis (MCL). We conducted a randomized open trial to evaluate the efficacy, safety, and tolerance of parenteral aminosidine sulphate (AS) 14 mg/kg/d for 21 days compared with intravenous meglumine antimonate (MA) 20 mg/kg/d for 28 days in patients with moderate MCL in Cuzco, Peru. Cure was defined as complete healing with re-epithelialization within 1 year of follow-up. The trial was stopped after 38 patients were enrolled (17 in the MA group and 21 in the AS group) because of marked differences in response. Study groups were comparable in baseline characteristics. Cure rates were 0/21 in the AS group compared with 8/17 (47%, 95% confidence interval: 23-71%) in the MA group (P < 0.001). Side effects and laboratory abnormalities were mild in both groups. We conclude that parenteral AS given on its own is not effective for MCL in Peru.
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Affiliation(s)
- Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
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35
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Bourreau E, Ronet C, Couppié P, Sainte-Marie D, Tacchini-Cottier F, Launois P. IL-10 producing CD8+ T cells in human infection with Leishmania guyanensis. Microbes Infect 2007; 9:1034-41. [PMID: 17544800 DOI: 10.1016/j.micinf.2007.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 03/08/2007] [Accepted: 04/16/2007] [Indexed: 11/26/2022]
Abstract
Cytokines are increasingly recognized as important components of the cellular immune responses to intracellular pathogens. In this study, we analyzed the production of TGF-beta, IL-10 and IFN-gamma by PBMC of unexposed naïve subjects and LCL patients after stimulation with live Leishmania guyanensis (L.g.). We demonstrated that IFN-gamma is produced in controls and LCL patients, IL-10 only in LCL patients and TGF-beta only in naïve subjects. Furthermore, in naive subjects, neutralization of TGF-beta induced IL-10 production. IL-10 produced in naïve subjects when TGF-beta is neutralized or in LCL patients did not modify the IFN-gamma production but inhibit reactive nitrogen species production. Analysis of the phenotype of IL-10 producing cells in naive subjects when TGF-beta is neutralized clearly showed that they are memory CD45RA- CD8+ T cells. In LCL patients, IL-10 producing cells are both CD45RA- CD4 and CD8+ T cells. The role of these IL-10 producing CD8+ T cells in the development of the diseases should be carefully evaluated.
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Affiliation(s)
- Eliane Bourreau
- Immunologie des Leishmanioses, Institut Pasteur de la Guyane, 97306 Cayenne, French Guiana
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36
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Nolder D, Roncal N, Davies CR, Llanos-Cuentas A, Miles MA. Multiple hybrid genotypes of Leishmania (viannia) in a focus of mucocutaneous Leishmaniasis. Am J Trop Med Hyg 2007; 76:573-8. [PMID: 17360886] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
The principal agent of mucocutaneous leishmaniasis (MCL) is the South American protozoan parasite Leishmania (Viannia) braziliensis. This organism is generally considered to be clonal, that is, it does not to undergo genetic exchange. Nevertheless, apparent hybrids between several Leishmania species have been reported in the New World and the Old World. When we characterized isolates of Leishmania (Viannia) from a single focus of cutaneous leishmaniasis (CL) and MCL, we found a remarkable phenotypic and genotypic diversity, with 12 zymodemes and 20 microsatellite genotypes. Furthermore, 26 of the 59 isolates were L. braziliensis/L. peruviana phenotypic hybrids that displayed 7 different microsatellite genotypes. A hybrid genotype was the only organism isolated from 4 patients with MCL. Thus hybrids must be included among the potential agents of MCL. Despite the propensity for clonality, hybrids are also an important feature of Leishmania (Viannia) and may give rise to epidemiologically important emergent genotypes.
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Affiliation(s)
- Debbie Nolder
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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Giudice A, Camada I, Leopoldo PTG, Pereira JMB, Riley LW, Wilson ME, Ho JL, de Jesus AR, Carvalho EM, Almeida RP. Resistance of Leishmania (Leishmania) amazonensis and Leishmania (Viannia) braziliensis to nitric oxide correlates with disease severity in Tegumentary Leishmaniasis. BMC Infect Dis 2007; 7:7. [PMID: 17316450 PMCID: PMC1810296 DOI: 10.1186/1471-2334-7-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 02/22/2007] [Indexed: 11/18/2022] Open
Abstract
Background Nitric oxide (NO•) plays a pivotal role as a leishmanicidal agent in mouse macrophages. NO• resistant Escherichia coli and Mycobacterium tuberculosis have been associated with a severe outcome of these diseases. Methods In this study we evaluated the in vitro toxicity of nitric oxide for the promastigote stages of Leishmania (Viannia) braziliensis and Leishmania (Leishmania) amazonensis parasites, and the infectivity of the amastigote stage for human macrophages. Parasites were isolated from patients with cutaneous, mucosal or disseminated leishmaniasis, and NO• resistance was correlated with clinical presentation. Results Seventeen isolates of L. (L.) amazonensis or L. (V.) braziliensis promastigotes were killed by up to 8 mM of more of NaNO2 (pH 5.0) and therefore were defined as nitric oxide-susceptible. In contrast, eleven isolates that survived exposure to 16 mM NaNO2 were defined as nitric oxide-resistant. Patients infected with nitric oxide-resistant Leishmania had significantly larger lesions than patients infected with nitric oxide-susceptible isolates. Furthermore, nitric oxide-resistant L. (L.) amazonensis and L. (V.) braziliensis multiplied significantly better in human macrophages than nitric oxide-susceptible isolates. Conclusion These data suggest that nitric oxide-resistance of Leishmania isolates confers a survival benefit for the parasites inside the macrophage, and possibly exacerbates the clinical course of human leishmaniasis.
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Affiliation(s)
- Angela Giudice
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Instituto de Investigação em Imunologia (iii), Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Ilza Camada
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Instituto de Investigação em Imunologia (iii), Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Paulo TG Leopoldo
- Departamento de Fisiologia, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
| | - Júlia MB Pereira
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Instituto de Investigação em Imunologia (iii), Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Lee W Riley
- Division of Infectious Diseases, School of Public Health, University of California, Berkeley, CA, USA
| | - Mary E Wilson
- Department of Internal Medicine, Microbiology, University of Iowa College of Medicine, Iowa City, IA, USA
| | - John L Ho
- Department of Medicine, Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, New York, NY, USA
| | - Amelia Ribeiro de Jesus
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Instituto de Investigação em Imunologia (iii), Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Edgar M Carvalho
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Instituto de Investigação em Imunologia (iii), Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Roque P Almeida
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Instituto de Investigação em Imunologia (iii), Universidade Federal da Bahia, Salvador, Bahia, Brazil
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de Oliveira Camera P, Junger J, do Espírito Santo Silva Pires F, Mattos M, Oliveira-Neto MP, Fernandes O, Pirmez C. Haematogenous dissemination of Leishmania (Viannia) braziliensis in human American tegumentary leishmaniasis. Trans R Soc Trop Med Hyg 2006; 100:1112-7. [PMID: 16765391 DOI: 10.1016/j.trstmh.2006.02.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 02/16/2006] [Accepted: 02/17/2006] [Indexed: 11/21/2022] Open
Abstract
One of the potential dangers of American tegumentary leishmaniasis (ATL) caused by Leishmania (Viannia) braziliensis is the development of mucosal lesions. Haematogenous dissemination of the parasite is the most likely mechanism to explain this occurrence, but most attempts to isolate the parasite from blood have so far been unsuccessful. The presence of Leishmania in peripheral blood was therefore evaluated by PCR using DNA samples isolated from patients presenting active cutaneous or mucosal disease, and from individuals cured by antimonial treatment as well as individuals without a past history of leishmaniasis but with a positive Montenegro skin test, all living in L. (V.) braziliensis-endemic areas. Leishmania DNA was found not only in those patients presenting active cutaneous (24.8%) or mucosal (35%) lesions, but also in samples isolated from healed individuals (27.3%) as well as in asymptomatic skin-test-positive residents of endemic areas (37.5%). Overall, PCR showed the presence of parasite DNA in the blood of 26.2% of the 225 examined samples. These data suggest that persistence of parasites within the host may last for many years and, rather than being a risk factor, might be important in maintaining the protective response in those living in endemic areas.
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Affiliation(s)
- Patricia de Oliveira Camera
- Department of Biochemistry & Molecular Biology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Av Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
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Acestor N, Masina S, Ives A, Walker J, Saravia NG, Fasel N. Resistance to oxidative stress is associated with metastasis in mucocutaneous leishmaniasis. J Infect Dis 2006; 194:1160-7. [PMID: 16991092 DOI: 10.1086/507646] [Citation(s) in RCA: 35] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 05/26/2006] [Indexed: 11/03/2022] Open
Abstract
Mucocutaneous leishmaniasis (MCL) in South and Central America is characterized by the dissemination (metastasis) of Leishmania Viannia subgenus parasites from a cutaneous lesion to nasopharyngeal tissues. Little is known about the pathogenesis of MCL, especially with regard to the virulence of the parasites and the process of metastatic dissemination. We previously examined the functional relationship between cytoplasmic peroxiredoxin and metastatic phenotype using highly, infrequently, and nonmetastatic clones isolated from an L. (V.) guyanensis strain previously shown to be highly metastatic in golden hamsters. Distinct forms of cytoplasmic peroxiredoxin were identified and found to be associated with the metastatic phenotype. We report here that peroxidase activity in the presence of hydrogen peroxide and infectivity differs between metastatic and nonmetastatic L. (V.) guyanensis clones. After hydrogen peroxide treatment or heat shock, peroxiredoxin was detected preferentially as dimers in metastatic L. (V.) guyanensis clones and in L. (V.) panamensis strains from patients with MCL, compared with nonmetastatic parasites. These data provide evidence that resistance to the first microbicidal response of the host cell by Leishmania promastigotes is linked to peroxiredoxin conformation and may be relevant to intracellular survival and persistence, which are prerequisites for the development of metastatic disease.
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Affiliation(s)
- Nathalie Acestor
- Department of Biochemistry, University of Lausanne, Epalinges, CH-1066 Epalinges, Switzerland
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Rotureau B, Ravel C, Nacher M, Couppié P, Curtet I, Dedet JP, Carme B. Molecular epidemiology of Leishmania (Viannia) guyanensis in French Guiana. J Clin Microbiol 2006; 44:468-73. [PMID: 16455900 PMCID: PMC1392701 DOI: 10.1128/jcm.44.2.468-473.2006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [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: 11/20/2022] Open
Abstract
Little information is available about the genetic variability of Leishmania populations and the possible correlations with ecoepidemiological features of leishmaniases. The present study was carried out in French Guiana, a country where cutaneous leishmaniases (CL) are endemic over the whole territory. The genetic polymorphism of a nuclear sequence encompassing the end of the ribosomal small subunit and the internal transcribed spacer 1 of 265 isolates from patients with CL was examined by restriction fragment length polymorphism analysis. Genotypes based on the fingerprinting phenetic integration were compared to epidemiological, clinical, and geographical data. In agreement with previous reports, five different Leishmania species were identified, but Leishmania (Viannia) guyanensis represented 95.8% of the samples. Two distinct L. (V.) guyanensis populations were found to originate in two ecologically characterized regions. Higher lesional parasite densities and the need for additional treatments were significantly linked to genotype group I. Parasites of genotype group II were more likely to cause chronic and disseminated cutaneous forms in patients. L. (V.) guyanensis was previously said not to be very polymorphic; however, the present analysis resulted in a significant degree of discrimination among L. (V.) guyanensis isolates from diverse ecological areas and with different clinical implications.
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Affiliation(s)
- Brice Rotureau
- Laboratoire Hospitalo-universitaire de Parasitologie et Mycologie Médicale, Equipe EA 3593, UFR de Médecine de l'Université des Antilles et de la Guyane, Campus Saint-Denis, BP 718, 97336 Cayenne, Guyane Française
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da Silva LJ. Vianna and the discovery of Leishmania braziliensis: the role of Brazilian parasitologists in the identification of Bauru's ulcer as American leishmaniasis. Parassitologia 2005; 47:335-41. [PMID: 16866039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The description of a new species of Leishmania spp. and the comprehensive study of a yet incompletely understood disease, mucocutaneous leishmaniasis, was a significant accomplishment of the then emerging Brazilian medical and public health science in the early decades of the 20th century. Gaspar Vianna and a group of academic-minded physicians in São Paulo brought forth a task still largely ignored, the complete description of a new nosological entity, in the process forming the core of a parasitological school that would bridge the 20th century with important contributions to medical science and public health. This article analyses the conditions surrounding this group in São Paulo and the major landmarks of their contributions.
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Madeira MDF, Schubach ADO, Schubach TMP, Serra CMB, Pereira SA, Figueiredo FB, Confort EM, Quintella LP, Marzochi MCA. Is Leishmania (Viannia) braziliensis preferentially restricted to the cutaneous lesions of naturally infected dogs? Parasitol Res 2005; 97:73-6. [PMID: 15986254 DOI: 10.1007/s00436-005-1374-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 03/16/2005] [Indexed: 11/30/2022]
Abstract
Nineteen dogs naturally infected with Leishmania (Viannia) braziliensis were studied in order to determine the presence of the parasite outside cutaneous lesions. Eleven (57.9%) animals showed single cutaneous or mucosal lesions and eight (42.1%) presented two or three lesions. Twenty-eight active lesions were biopsied. Isolation in culture and characterization by enzyme electrophoresis were possible in 100% of cases and amastigote forms were visualized upon histopathological examination in three samples (n=25, 12%). Isolation of the parasite in culture from peripheral blood and intact skin fragments obtained from the scapular region was negative in all animals, as was the histopathological analysis of skin from this region. Serological reactivity determined by an immunofluorescent antibody test and/or enzyme-linked immunosorbent assay was demonstrated in 15 animals. The results obtained suggest that L. braziliensis preferentially remains at the site of lesion, in contrast to the systemic distribution of parasites observed in dogs infected with L. (Leishmania) chagasi. A better understanding of this aspect may help direct diagnostic and control strategies applicable to areas characterized by the simultaneous occurrence of the cutaneous and visceral forms of leishmaniasis, as is the case for the Municipality of Rio de Janeiro, Brazil.
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Affiliation(s)
- Maria de Fátima Madeira
- Instituto de Pesquisa Clínica Evandro Chagas, Serviço de Parasitologia, Fundação Oswaldo Cruz. Av. Brasil 4365, 21040-900 Rio de Janeiro, Brasil.
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Affiliation(s)
- Taghi Azizi
- Department of Pathology and Oral Medicine, Baghiatallah Hospital, Tehran, Iran
| | | | - Aliasghar Roohi
- Department of Pathology and Oral Medicine, Baghiatallah Hospital, Tehran, Iran
| | - Yalda Nilipour
- Department of Pathology, Iran University Medical Sciences, Tehran, Iran
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Garcia AL, Kindt A, Quispe-Tintaya KW, Bermudez H, Llanos A, Arevalo J, Bañuls AL, De Doncker S, Le Ray D, Dujardin JC. American tegumentary leishmaniasis: antigen-gene polymorphism, taxonomy and clinical pleomorphism. Infection, Genetics and Evolution 2005; 5:109-16. [PMID: 15639742 DOI: 10.1016/j.meegid.2004.07.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Revised: 07/01/2004] [Accepted: 07/01/2004] [Indexed: 10/26/2022]
Abstract
Multi-locus enzyme electrophoresis is the current gold standard for the genetic characterisation of Leishmania. However, this method is time-consuming and, more importantly, cannot be directly applied to parasites present in host tissue. PCR-based methods represent an ideal alternative but, to date, a multi-locus analysis has not been applied to the same sample. This has now been achieved with a sample of 55 neotropical isolates (Leishmania (Viannia) braziliensis, L. (V.) peruviana, L. (V.) guyanensis, L. (V.) lainsoni and L. (L.) amazonensis), using five different genes as targets, four of which encoded major Leishmania antigens (gp63, Hsp70, H2B and Cpb). Our multi-locus approach strongly supports the current taxonomy and demonstrates a highly robust method of distinguishing different strains. Within L. (V.) braziliensis, we did not encounter so far specific genetic differences between parasites isolated from cutaneous and mucosal lesions. Interestingly, results provided by each of the different antigen-genes in the species considered, were different, suggesting different selective pressures. Our work emphasises the need for a multi-disciplinary approach to study the clinical pleomorphism of leishmaniasis.
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Affiliation(s)
- A L Garcia
- Centro Universitario de Medicina Tropical, Casilla 3119, Cochabamba, Bolivia
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Weller PF, Durand ML, Pilch BZ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 4-2005. A 35-year-old man with nasal congestion, swelling, and pain. N Engl J Med 2005; 352:609-15. [PMID: 15703426 DOI: 10.1056/nejmcpc049035] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Peter F Weller
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, USA
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Mahdi M, Elamin EM, Melville SE, Musa AM, Blackwell JM, Mukhtar MM, Elhassan AM, Ibrahim ME. Sudanese mucosal leishmaniasis: isolation of a parasite within the Leishmania donovani complex that differs genotypically from L. donovani causing classical visceral leishmaniasis. Infection, Genetics and Evolution 2005; 5:29-33. [PMID: 15567136 DOI: 10.1016/j.meegid.2004.05.008] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Received: 11/11/2003] [Revised: 05/27/2004] [Accepted: 05/27/2004] [Indexed: 11/29/2022]
Abstract
Mucosal leishmaniasis, which is a sporadic disease in the Sudan, was shown by isoenzyme characterization and PCR to be caused by Leishmania donovani. However, it was not clear if the parasite was exactly the same strain as that causing visceral leishmaniasis (VL), or of a different strain. We utilized a new generation of molecular DNA markers, minisatellites and kinetoplast DNA, for rapid characterization of the parasite. The results show that the genotypes of some of the parasites causing VL are different from those causing mucosal leishmaniasis. The L. donovani isolates causing visceral disease, as well as post-kala-azar mucosal leishmaniasis (PKML), have been shown to possess characteristic haplotypes. However, sequencing of a portion of the cytochrome oxidase II (COII) gene indicates that the parasite that invades the oral mucosa is divergent from other parasites causing VL. It appears to possess features of a more ancestral parasite with pronounced sequence homology to L. major. This agrees with earlier studies where isolates of mucosal leishmaniasis have been shown to possess an isoenzyme profile distinct from L. donovani and a different geographical distribution, albeit often overlapping with that of L. donovani.
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Affiliation(s)
- Muzamil Mahdi
- Institute of Endemic Diseases, University of Khartoum, P.O. Box 102, Khartoum, Sudan
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Lawn SD, Whetham J, Chiodini PL, Kanagalingam J, Watson J, Behrens RH, Lockwood DNJ. New world mucosal and cutaneous leishmaniasis: an emerging health problem among British travellers. QJM 2004; 97:781-8. [PMID: 15569809 DOI: 10.1093/qjmed/hch127] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Mucosal leishmaniasis (ML) is an important complication of new world cutaneous leishmaniasis (CL) caused by species of the Leishmania Viannia subgenus. Previous reports of ML among travellers to Latin America are few. AIMS To determine the annual number of cases of CL due to L. Viannia species diagnosed at this institution and to correlate this with changing patterns of travel. Secondly, to document the clinical presentation, diagnosis, treatment and outcome of ML at this institution. DESIGN Retrospective observational study. METHODS Data were collected from a clinical database, laboratory records, patient case notes and an international passenger survey. RESULTS Between 1995 and 2003, the annual number of cases of CL (total 79) steadily increased from 4 per year to 18 per year; the estimated number of travellers from the UK to Latin America increased 3.5-fold. Six cases of ML were diagnosed among British travellers in 1995 (1), 1997 (1) and 2002 (4). These infections were acquired in Bolivia (3), Colombia (2) and Belize (1). Nasopharyngeal symptoms developed 0-15 months after returning to the UK. Four patients had concurrent CL at diagnosis. Diagnosis of ML was delayed up to 6 months from the onset of symptoms. Mucosal biopsies from all 6 patients were PCR-positive for L. (Viannia) DNA; microscopy and culture were less sensitive. ML relapsed in one patient following treatment. DISCUSSION Increasing travel to Latin America from the UK was associated with an increasing number of diagnoses of L. Viannia CL. ML is likely to emerge as a more frequently imported infection among such travellers. Familiarity with these diseases is important for prompt diagnosis and optimal management.
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Affiliation(s)
- S D Lawn
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT.
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Cuervo P, Cupolillo E, Nehme N, Hernandez V, Saravia N, Fernandes O. Leishmania (Viannia): genetic analysis of cutaneous and mucosal strains isolated from the same patient. Exp Parasitol 2004; 108:59-66. [PMID: 15491550 DOI: 10.1016/j.exppara.2004.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 12/19/2003] [Revised: 05/20/2004] [Accepted: 07/14/2004] [Indexed: 10/26/2022]
Abstract
Ten pairs of Leishmania (Viannia) strains isolated from mucosal and cutaneous lesions of the same patient were analyzed genotypically in order to determine whether populations that had metastasized to mucosal sites differed from those in the cutaneous lesion. The strains were previously characterized by multi locus enzyme electrophoresis and/or monoclonal antibodies reactivity, and, for this study, only isolates from the same patient which were identified as the same species were employed. PCR-RFLP of internal transcribed spacer (ITS) rDNA, random amplified polymorphic DNA (RAPD), and schizodeme analyses were conducted. All genotyping methods revealed microheterogeneity between cutaneous and mucosal isolates from the same patient. The PCR-RFLP of the ITS rDNA and RAPD analysis were numerically analyzed through similarity coefficients and dendrograms were generated. All phenograms clustered cutaneous and mucosal strains of the same patient in one branch with a high degree of similarity, and phenetic analysis matched between them. Schizodeme analysis revealed differences between strains that composed some pairs. Genetic analyses indicate that some populations that metastasize to mucosal sites are distinguishable from the population in cutaneous lesions, however, other approaches will be required to associate genetic polymorphisms with the cutaneous or mucosal phenotype of strains.
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Affiliation(s)
- Patricia Cuervo
- Department of Tropical Medicine, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
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Abstract
Leishmania species can cause a wide spectrum of cutaneous disease in HIV-positive patients: asymptomatic, localized cutaneous, mucosal, muco-cutaneous, diffuse cutaneous or post-kala-azar leishmaniasis. In such cases, which are usually severely immunocompromised, the leishmanial parasites reach the skin of the human host by dissemination after either a new infection (resulting from the bite of infected sandfly or, probably, the sharing of contaminated syringes by intravenous-drug users) or the re-activation of a latent infection. Recent experience and past observations on the dermatology of leishmaniasis in those with Leishmania/HIV co-infection are reviewed here.
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Affiliation(s)
- L Puig
- Departamento de Dermatología, Hospital de la Santa Creu I Sant Pau, Avenida de Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
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Teva A, Porrozzi R, Cupolillo E, Pirmez C, Oliveira-Neto MP, Grimaldi G. Leishmania (Viannia) braziliensis-induced chronic granulomatous cutaneous lesions affecting the nasal mucosa in the rhesus monkey (Macaca mulatta) model. Parasitology 2004; 127:437-47. [PMID: 14653533 DOI: 10.1017/s0031182003004037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/07/2022]
Abstract
The present studies on infections with Leishmania (Viannia) braziliensis in rhesus macaques were made to characterize the evolution of different parasite strains and the immune responses they elicited in this experimental host. A standardized inoculum of promastigotes was injected intradermally either above the eyelid or on the forearm of each monkey. Sixteen infected monkeys developed longstanding infections which lasted until the end of the observation period (33 months). The time required for lesion development was very variable, not only for the isolates showing molecular differences but also for individual animals in groups infected with the same parasite strain. The inocula produced lesions of variable severity, ranging from localized cutaneous leishmaniasis (CL) with a tendency to spontaneous healing to non-healing disease. One infected animal developed persistent metastatic skin and mucosal lesions. Anti-Leishmania antibodies and parasite-specific T-cell responses were induced by the experimental infections. As the granulomatous inflammatory response found at the lesions in L. (V.) braziliensis-infected M. mulatta was similar to that in patients with CL, this primate model could be useful for studying the pathophysiology and immunoregulatory events associated with disease evolution, as well as for the evaluation of new drugs or candidate vaccines.
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MESH Headings
- Animals
- Antibodies, Protozoan/blood
- DNA, Protozoan/chemistry
- DNA, Protozoan/genetics
- Disease Models, Animal
- Enzyme-Linked Immunosorbent Assay
- Female
- Genetic Variation
- Genotype
- Granuloma/immunology
- Granuloma/parasitology
- Granuloma/pathology
- Histocytochemistry
- Hypersensitivity, Delayed/immunology
- Hypersensitivity, Delayed/parasitology
- Hypersensitivity, Delayed/pathology
- Interferon-gamma/blood
- Leishmania braziliensis/genetics
- Leishmania braziliensis/immunology
- Leishmaniasis, Mucocutaneous/immunology
- Leishmaniasis, Mucocutaneous/parasitology
- Leishmaniasis, Mucocutaneous/pathology
- Macaca mulatta
- Male
- Nasal Mucosa/immunology
- Nasal Mucosa/parasitology
- Nasal Mucosa/pathology
- Polymerase Chain Reaction
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Affiliation(s)
- A Teva
- Department of Immunology, Instituto Oswaldo Cruz, Rio de Janeiro RJ, CEP 21045-900, Brazil
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