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Torrico MC, Ballart C, Fernández-Arévalo A, Solano M, Rojas E, Abras A, Gonzales F, Mamani Y, Arnau A, Lozano D, Gascón J, Picado A, Torrico F, Muñoz C, Gállego M. The need for culture in tegumentary leishmaniasis diagnosis in Bolivia: A comparative evaluation of four parasitological techniques using two sampling methods. Acta Trop 2024; 250:107092. [PMID: 38065375 DOI: 10.1016/j.actatropica.2023.107092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
Leishmaniases are zoonotic diseases caused by protozoa of the genus Leishmania. In Bolivia, leishmaniasis occurs mainly in the cutaneous form (CL) followed by the mucosal or mucocutaneous form (ML or MCL), grouped as tegumentary leishmaniosis (TL), while cases of visceral leishmaniasis (VL) are rare. The cases of TL are routinely diagnosed by parasitological methods: Direct Parasitological Exam (DPE) and axenic culture, the latter being performed only by specialized laboratories. The aim of the present study was to optimize the parasitological diagnosis of TL in Bolivia, using two sampling methods. Samples from 117 patients with suspected TL, obtained by aspiration (n = 121) and scraping (n = 121) of the edge of the lesion were tested by: direct parasitological exam, culture in TSTB medium, and miniculture and microculture in Schneider's medium. A positive laboratory result by any of the four techniques evaluated using either of the two sampling methods was considered the gold standard. Of the 117 suspected patients included, TL was confirmed in 96 (82 %), corresponding 79 of the confirmed cases (82.3 %) to CL and 16 (16.7 %) to ML. Parasitological techniques specificity was 100 % and their analytical sensitivity was greater with scraping samples in TSTB culture (98 %). Scraping samples in TSTB and miniculture correlated well with the reference (Cohen's kappa coefficient=0.88) and showed good reliability (Cronbach's alpha coefficient ≥0.91). Microculture provided positive results earlier than the other culture methods (mean day 4.5). By day 14, 98 % of positive cultures had been detected. Scraping sampling and miniculture were associated with higher culture contamination (6 % and 17 %, respectively). Bacterial contamination predominated, regardless of the sampling and culture method, while filamentous fungi and mixed contamination were more frequently observed in cultures from scraping samples. In conclusion: (i) scraping samples proved more suitable for the diagnosis of TL as they increased analytical sensitivity, are less traumatic for the patient and are safer for laboratory personnel than aspirates; (ii) culture, mainly in TSBT medium, should be used for the diagnosis of TL due to its high sensitivity (doubling the number of cases diagnosed by DPE) and its low cost compared to other culture media.
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Affiliation(s)
- Mary Cruz Torrico
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia; Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain; Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia.
| | - Cristina Ballart
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain; Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Anna Fernández-Arévalo
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Marco Solano
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Ernesto Rojas
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Alba Abras
- Departament de Biologia, Universitat de Girona, Girona, Spain
| | - Fabiola Gonzales
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Yercin Mamani
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia; Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Albert Arnau
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain; Departament de Biologia, Universitat de Girona, Girona, Spain
| | - Daniel Lozano
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia; Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia
| | - Joaquim Gascón
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain; CIBERINFEC, ISCIII- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain
| | - Albert Picado
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Faustino Torrico
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia; Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau Barcelona, Barcelona, Spain; Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Montserrat Gállego
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain; Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain; CIBERINFEC, ISCIII- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain.
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Antillon M, Huang CI, Sutherland SA, Crump RE, Bessell PR, Shaw APM, Tirados I, Picado A, Biéler S, Brown PE, Solano P, Mbainda S, Darnas J, Wang-Steverding X, Crowley EH, Peka M, Tediosi F, Rock KS. Health economic evaluation of strategies to eliminate gambiense human African trypanosomiasis in the Mandoul disease focus of Chad. PLoS Negl Trop Dis 2023; 17:e0011396. [PMID: 37498938 PMCID: PMC10409297 DOI: 10.1371/journal.pntd.0011396] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/08/2023] [Accepted: 05/22/2023] [Indexed: 07/29/2023] Open
Abstract
Human African trypanosomiasis, caused by the gambiense subspecies of Trypanosoma brucei (gHAT), is a deadly parasitic disease transmitted by tsetse. Partners worldwide have stepped up efforts to eliminate the disease, and the Chadian government has focused on the previously high-prevalence setting of Mandoul. In this study, we evaluate the economic efficiency of the intensified strategy that was put in place in 2014 aimed at interrupting the transmission of gHAT, and we make recommendations on the best way forward based on both epidemiological projections and cost-effectiveness. In our analysis, we use a dynamic transmission model fit to epidemiological data from Mandoul to evaluate the cost-effectiveness of combinations of active screening, improved passive screening (defined as an expansion of the number of health posts capable of screening for gHAT), and vector control activities (the deployment of Tiny Targets to control the tsetse vector). For cost-effectiveness analyses, our primary outcome is disease burden, denominated in disability-adjusted life-years (DALYs), and costs, denominated in 2020 US$. Although active and passive screening have enabled more rapid diagnosis and accessible treatment in Mandoul, the addition of vector control provided good value-for-money (at less than $750/DALY averted) which substantially increased the probability of reaching the 2030 elimination target for gHAT as set by the World Health Organization. Our transmission modelling and economic evaluation suggest that the gains that have been made could be maintained by passive screening. Our analysis speaks to comparative efficiency, and it does not take into account all possible considerations; for instance, any cessation of ongoing active screening should first consider that substantial surveillance activities will be critical to verify the elimination of transmission and to protect against the possible importation of infection from neighbouring endemic foci.
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Affiliation(s)
- Marina Antillon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ching-I Huang
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Samuel A. Sutherland
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ronald E. Crump
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | | | - Alexandra P. M. Shaw
- Infection Medicine, Deanery of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
- AP Consultants, Walworth Enterprise Centre, Andover, United Kingdom
| | - Iñaki Tirados
- Department of Vector Biology, Liverpool School of Tropical Medicine, United Kingdom
| | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Paul E. Brown
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Philippe Solano
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Université de Montpellier, Montpellier, France
| | - Severin Mbainda
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad
| | - Justin Darnas
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad
| | - Xia Wang-Steverding
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Emily H. Crowley
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Mallaye Peka
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kat S. Rock
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
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Torrico MC, Fernández-Arévalo A, Ballart C, Solano M, Rojas E, Abras A, Gonzales F, Arnau A, Tebar S, Llovet T, Lozano D, Ariza-Vioque E, Gascón J, Picado A, Torrico F, Muñoz C, Gállego M. Usefulness of Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry in the Characterization of Leishmania Strains Causing Tegumentary Leishmaniasis in Bolivia versus hsp70 Gene Sequencing. Microbiol Spectr 2023; 11:e0347722. [PMID: 36633426 PMCID: PMC9927355 DOI: 10.1128/spectrum.03477-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/23/2022] [Indexed: 01/13/2023] Open
Abstract
Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) is a proteomic technique with proven efficiency in the identification of microorganisms, such as bacteria, fungi, and parasites. The present study aimed to evaluate the usefulness of MALDI-TOF MS for the characterization of Leishmania species circulating in Bolivia using hsp70 gene sequencing as a reference technique. 55 Leishmania strains that were isolated from patients with tegumentary leishmaniasis were analyzed. MALDI-TOF MS identified two species of the L. braziliensis complex (L. braziliensis, n = 26; L. braziliensis outlier, n = 18), one species of the L. guyanensis complex (L. guyanensis, n = 1), one species of the L. lainsoni complex (L. lainsoni, n = 2), and two species of the L. mexicana complex (L. amazonensis, n = 5; and L. garnhami, n = 3). All of the strains were correctly identified at the subgenus, genus, and complex level, but 10 of them (18%) were misidentified as other species within the same complex by the hsp70 gene sequencing, with 7 of these corresponding to possible hybrids. Thus, one L. braziliensis corresponded to L. peruviana, two L. braziliensis corresponded to L. braziliensis/L. peruviana possible hybrids, two L. amazonensis corresponded to L. mexicana, and three L. garnhami and two L. amazonensis corresponded to L. mexicana/L. amazonensis possible hybrids. Accordingly, MALDI-TOF MS could be used as an alternative to molecular techniques for the identification of Leishmania spp., as it is low cost, simple to apply, and able to quickly produce results. In Bolivia, its application would allow for the improvement of the management of patient follow-ups, the updating of the epidemiological data of the Leishmania species, and a contribution to the control of tegumentary leishmaniasis. IMPORTANCE The objective of the study was to evaluate the usefulness of MALDI-TOF MS for the characterization of Leishmania species circulating in Bolivia, in comparison with the sequencing of the hsp70 gene. In our study, all of the isolates could be identified, and no misidentifications were observed at the complex level. Although the equipment implies a high initial investment in our context, MALDI-TOF MS can be used in different areas of microbiology and significantly reduces the cost of testing. Once the parasite culture is obtained, the technique quickly yields information by accessing a free database that is available online. This would allow for the improvement of the management of patients and follow-ups, the updating of the epidemiological data of the species, and a contribution to the control of tegumentary leishmaniasis in Bolivia. Likewise, it can be used to determine a specific treatment to be given, according to the causal species of Leishmania, when there are protocols in this regard in the area.
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Affiliation(s)
- Mary Cruz Torrico
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
- Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Anna Fernández-Arévalo
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Ballart
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Marco Solano
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Ernesto Rojas
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Alba Abras
- Departament de Biologia, Universitat de Girona, Girona, Spain
| | - Fabiola Gonzales
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Albert Arnau
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
- Departament de Biologia, Universitat de Girona, Girona, Spain
| | - Silvia Tebar
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Teresa Llovet
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau Barcelona, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Daniel Lozano
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
- Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia
| | - Eva Ariza-Vioque
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joaquim Gascón
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III
| | - Albert Picado
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Faustino Torrico
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
- Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau Barcelona, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | - Montserrat Gállego
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III
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Flores-Chavez MD, Abras A, Ballart C, Ibáñez-Perez I, Perez-Gordillo P, Gállego M, Muñoz C, Moure Z, Sulleiro E, Nieto J, García Diez E, Simón L, Cruz I, Picado A. Parasitemia Levels in Trypanosoma cruzi Infection in Spain, an Area Where the Disease Is Not Endemic: Trends by Different Molecular Approaches. Microbiol Spectr 2022; 10:e0262822. [PMID: 36190410 PMCID: PMC9603785 DOI: 10.1128/spectrum.02628-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/13/2022] [Indexed: 01/04/2023] Open
Abstract
Trypanosoma cruzi infection has expanded globally through human migration. In Spain, the mother-to-child route is the mode of transmission contributing to autochthonous Chagas disease (CD); however, most people acquired the infection in their country of origin and were diagnosed in the chronic phase (imported chronic CD). In this context, we assessed the quantitative potential of the Loopamp Trypanosoma cruzi detection kit (Sat-TcLAMP) based on satellite DNA (Sat-DNA) to determine parasitemia levels compared to those detected by real-time quantitative PCRs (qPCRs) targeting Sat-DNA (Sat-qPCR) and kinetoplast DNA minicircles (kDNA-qPCR). This study included 173 specimens from 39 autochthonous congenital and 116 imported chronic CD cases diagnosed in Spain. kDNA-qPCR showed higher sensitivity than Sat-qPCR and Sat-TcLAMP. According to all quantitative approaches, parasitemia levels were significantly higher in congenital infection than in chronic CD (1 × 10-1 to 5 × 105 versus >1 × 10-1 to 6 × 103 parasite equivalents/mL, respectively [P < 0.001]). Sat-TcLAMP, Sat-qPCR, and kDNA-qPCR results were equivalent at high levels of parasitemia (P = 0.381). Discrepancies were significant for low levels of parasitemia and older individuals. Differences between Sat-TcLAMP and Sat-qPCR were not qualitatively significant, but estimations of parasitemia using Sat-TcLAMP were closer to those by kDNA-qPCR. Parasitemia changes were assessed in 6 individual cases in follow-up, in which trends showed similar patterns by all quantitative approaches. At high levels of parasitemia, Sat-TcLAMP, Sat-qPCR, and kDNA-qPCR worked similarly, but significant differences were found for the low levels characteristic of late chronic CD. A suitable harmonization strategy needs to be developed for low-level parasitemia detection using Sat-DNA- and kDNA-based tests. IMPORTANCE Currently, molecular equipment has been introduced into many health care centers, even in low-income countries. PCR, qPCR, and loop-mediated isothermal amplification (LAMP) are becoming more accessible for the diagnosis of neglected infectious diseases. Chagas disease (CD) is spreading worldwide, and in countries where the disease is not endemic, such as Spain, the parasite Trypanosoma cruzi is transmitted from mother to child (congenital CD). Here, we explore why LAMP, aimed at detecting T. cruzi parasite DNA, is a reliable option for the diagnosis of congenital CD and the early detection of reactivation in chronic infection. When the parasite load is high, LAMP is equivalent to any qPCR. In addition, the estimations of T. cruzi parasitemia in patients living in Spain, a country where the disease is not endemic, resemble natural evolution in areas of endemicity. If molecular tests are introduced into the diagnostic algorithm for congenital infection, early diagnosis and timely treatment would be accomplished, so the interruption of vertical transmission can be an achievable goal.
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Affiliation(s)
- Maria D. Flores-Chavez
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Fundación Mundo Sano-España, Madrid, Spain
| | - Alba Abras
- Departament de Biologia, Universitat de Girona, Girona, Spain
| | - Cristina Ballart
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Ismael Ibáñez-Perez
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Montserrat Gállego
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Zaira Moure
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Elena Sulleiro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
- Microbiology Department, Vall d’Hebron Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Nieto
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Emilia García Diez
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Lorena Simón
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Cruz
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Schijman AG, Alonso-Padilla J, Longhi SA, Picado A. Parasitological, serological and molecular diagnosis of acute and chronic Chagas disease: from field to laboratory. Mem Inst Oswaldo Cruz 2022; 117:e200444. [PMID: 35613155 PMCID: PMC9164950 DOI: 10.1590/0074-02760200444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
There is no consensus on the diagnostic algorithms for many scenarios of Trypanosoma cruzi infection, which hinders the establishment of governmental guidelines in endemic and non-endemic countries. In the acute phase, parasitological methods are currently employed, and standardised surrogate molecular tests are being introduced to provide higher sensitivity and less operator-dependence. In the chronic phase, IgG-based serological assays are currently used, but if a single assay does not reach the required accuracy, PAHO/WHO recommends at least two immunological tests with different technical principles. Specific algorithms are applied to diagnose congenital infection, screen blood and organ donors or conduct epidemiological surveys. Detecting Chagas disease reactivation in immunosuppressed individuals is an area of increasing interest. Due to its neglect, enhancing access to diagnosis of patients at risk of suffering T. cruzi infection should be a priority at national and regional levels.
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Affiliation(s)
- Alejandro Gabriel Schijman
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular Dr Hector Torres, CONICET, Laboratorio de Biología Molecular de la Enfermedad de Chagas, Ciudad de Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health, University of Barcelona, Hospital Clinic, Barcelona, Spain
| | - Silvia Andrea Longhi
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular Dr Hector Torres, CONICET, Laboratorio de Biología Molecular de la Enfermedad de Chagas, Ciudad de Buenos Aires, Argentina
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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Rock KS, Huang CI, Crump RE, Bessell PR, Brown PE, Tirados I, Solano P, Antillon M, Picado A, Mbainda S, Darnas J, Crowley EH, Torr SJ, Peka M. Update of transmission modelling and projections of gambiense human African trypanosomiasis in the Mandoul focus, Chad. Infect Dis Poverty 2022; 11:11. [PMID: 35074016 PMCID: PMC8785021 DOI: 10.1186/s40249-022-00934-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In recent years, a programme of vector control, screening and treatment of gambiense human African trypanosomiasis (gHAT) infections led to a rapid decline in cases in the Mandoul focus of Chad. To represent the biology of transmission between humans and tsetse, we previously developed a mechanistic transmission model, fitted to data between 2000 and 2013 which suggested that transmission was interrupted by 2015. The present study outlines refinements to the model to: (1) Assess whether elimination of transmission has already been achieved despite low-level case reporting; (2) quantify the role of intensified interventions in transmission reduction; and (3) predict the trajectory of gHAT in Mandoul for the next decade under different strategies. METHOD Our previous gHAT transmission model for Mandoul was updated using human case data (2000-2019) and a series of model refinements. These include how diagnostic specificity is incorporated into the model and improvements to the fitting method (increased variance in observed case reporting and how underreporting and improvements to passive screening are captured). A side-by-side comparison of fitting to case data was performed between the models. RESULTS We estimated that passive detection rates have increased due to improvements in diagnostic availability in fixed health facilities since 2015, by 2.1-fold for stage 1 detection, and 1.5-fold for stage 2. We find that whilst the diagnostic algorithm for active screening is estimated to be highly specific (95% credible interval (CI) 99.9-100%, Specificity = 99.9%), the high screening and low infection levels mean that some recently reported cases with no parasitological confirmation might be false positives. We also find that the focus-wide tsetse reduction estimated through model fitting (95% CI 96.1-99.6%, Reduction = 99.1%) is comparable to the reduction previously measured by the decline in tsetse catches from monitoring traps. In line with previous results, the model suggests that transmission was interrupted in 2015 due to intensified interventions. CONCLUSIONS We recommend that additional confirmatory testing is performed in Mandoul to ensure the endgame can be carefully monitored. More specific measurement of cases, would better inform when it is safe to stop active screening and vector control, provided there is a strong passive surveillance system in place.
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Affiliation(s)
- Kat S Rock
- Mathematics Institute, University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK.
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK.
| | - Ching-I Huang
- Mathematics Institute, University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK
| | - Ronald E Crump
- Mathematics Institute, University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK
| | | | - Paul E Brown
- Mathematics Institute, University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK
| | - Inaki Tirados
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Philippe Solano
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Université de Montpellier, 34398, Montpellier, France
| | - Marina Antillon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Severin Mbainda
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad
| | - Justin Darnas
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad
| | - Emily H Crowley
- Mathematics Institute, University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Academic Loop Road, Coventry, CV4 7AL, UK
| | - Steve J Torr
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mallaye Peka
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad
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7
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de Souza DK, Picado A, Bessell PR, Liban A, Wachira D, Mwiti D, Matendechero SH, Bosch M, Ndung’u JM, Cruz I. Strengthening Visceral Leishmaniasis Diagnosis Capacity to Improve Access to Care in Kenya: The Example of Marsabit County. Front Trop Dis 2022. [DOI: 10.3389/fitd.2021.809757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundVisceral leishmaniasis (VL), also known as kala-azar, is a neglected tropical disease (NTD) that is fatal if not treated early. The WHO targets the elimination of VL as a public health problem in its 2030 NTD road map. However, improving access to VL diagnosis and treatment remains a major challenge in many VL-endemic countries. Kenya is endemic for VL and is among the top 6 high-disease burden countries in the world.MethodsFIND, through its activities in improving the diagnosis of VL and supporting the elimination of the disease in Kenya, has worked with various county ministries of health (MOH) and central MOH over the last couple of years. FIND’s activities in Marsabit county started in 2018. In this work, we present the implementation of activities and the impacts in Marsabit county. We reviewed the data for 2017 and 2019 outbreaks (before and after the implementation of FIND’s activities) and assessed the importance of improving access and community sensitization to VL diagnosis. We assessed the contribution of each facility to the total distance traveled from a perspective of location optimization.ResultsThere was a sharp increase in the number of people tested in the 2017 outbreak compared to the 2019 outbreak. In 2017, 437 people were tested compared to 2,338 in 2019. The county reported 234 and 688 VL cases in 2017 and 2019, respectively. The data revealed a shift in the demographic structures of cases toward the younger population (mean age in 2017 was 17.6 years and 15.3 years in 2019), with more female cases reported in 2019 compared to 2017. In 2017, 44.4% were 10 years of age or under. In 2019, the proportion 10 years or below was 52.2%. The addition of two new diagnosis facilities in 2018 resulted in a decrease in the distance traveled by confirmed VL cases from 28.1 km in 2017 to 10.8 km in 2019. Assessing the impact of facility placement indicated the most optimal facilities to provide VL diagnostic services and minimize the distance traveled by patients. Adding new facilities reduces the travel distance until a point where the addition of a new facility provides no additional impact.ConclusionThe results from this study indicate the need to carefully consider the placement of health facilities in improving access to VL diagnosis and treatment and could serve as an investment case in deciding when to stop adding new facilities in a particular setting. Extending the activities in Kenya to other VL-endemic countries in East Africa will contribute significantly toward the elimination of the disease, addressing the needs of marginalized populations and leaving no one behind.
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8
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Torrico MC, Fernández-Arévalo A, Ballart C, Solano M, Rojas E, Ariza E, Tebar S, Lozano D, Abras A, Gascón J, Picado A, Muñoz C, Torrico F, Gállego M. Tegumentary leishmaniasis by Leishmania braziliensis complex in Cochabamba, Bolivia including the presence of L. braziliensis outlier: Tegumentary leishmaniasis in Cochabamba, Bolivia. Transbound Emerg Dis 2021; 69:2242-2255. [PMID: 34232559 DOI: 10.1111/tbed.14228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/27/2021] [Accepted: 07/05/2021] [Indexed: 01/07/2023]
Abstract
Leishmaniasis is caused by protozoans of the Leishmania genus, which includes more than 20 species capable of infecting humans worldwide. In the Americas, the most widespread specie is L. braziliensis, present in 18 countries including Bolivia. The taxonomic position of the L. braziliensis complex has been a subject of controversy, complicated further by the recent identification of a particular subpopulation named L. braziliensis atypical or outlier. The aim of this study was to carry out a systematic analysis of the L. braziliensis complex in Bolivia and to describe the associated clinical characteristics. Forty-one strains were analyzed by sequencing an amplified 1245 bp fragment of the hsp70 gene, which allowed its identification as: 24 (59%) L. braziliensis, 16 (39%) L. braziliensis outlier, and one (2%) L. peruviana. In a dendrogram constructed, L. braziliensis and L. peruviana are grouped in the same cluster, whilst L. braziliensis outlier appears in a separate branch. Sequence alignment allowed the identification of five non-polymorphic nucleotide positions (288, 297, 642, 993, and 1213) that discriminate L. braziliensis and L. peruviana from L. braziliensis outlier. Moreover, nucleotide positions 51 and 561 enable L. peruviana to be discriminated from the other two taxa. A greater diversity was observed in L. braziliensis outlier than in L. braziliensis-L. peruviana. The 41 strains came from 32 patients with tegumentary leishmaniasis, among which 22 patients (69%) presented cutaneous lesions (11 caused by L. braziliensis and 11 by L. braziliensis outlier) and 10 patients (31%) mucocutaneous lesions (eight caused by L. braziliensis, one by L. braziliensis outlier, and one by L. peruviana). Nine patients (28%) simultaneously provided two isolates, each from a separate lesion, and in each case the same genotype was identified in both. Treatment failure was observed in six patients infected with L. braziliensis and one patient with L. peruviana.
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Affiliation(s)
- Mary Cruz Torrico
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.,Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia.,Secció de Parasitología, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Anna Fernández-Arévalo
- Secció de Parasitología, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | - Cristina Ballart
- Secció de Parasitología, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.,Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Marco Solano
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Ernesto Rojas
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Eva Ariza
- Secció de Parasitología, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | - Silvia Tebar
- Secció de Parasitología, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Lozano
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.,Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia
| | - Alba Abras
- Secció de Parasitología, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain.,Laboratori d'Ictiologia Genètica, Departament de Biologia, Universitat de Girona, Girona, Spain
| | - Joaquim Gascón
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Albert Picado
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain.,Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Carmen Muñoz
- Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain.,Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau Barcelona, Barcelona, Spain.,Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Faustino Torrico
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.,Fundación CEADES y Medio Ambiente, Cochabamba, Bolivia
| | - Montserrat Gállego
- Secció de Parasitología, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.,Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
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9
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Hossain F, Picado A, Owen SI, Ghosh P, Chowdhury R, Maruf S, Khan MAA, Rashid MU, Nath R, Baker J, Ghosh D, Adams ER, Duthie MS, Hossain MS, Basher A, Nath P, Aktar F, Cruz I, Mondal D. Evaluation of Loopamp™ Leishmania Detection Kit and Leishmania Antigen ELISA for Post-Elimination Detection and Management of Visceral Leishmaniasis in Bangladesh. Front Cell Infect Microbiol 2021; 11:670759. [PMID: 33981632 PMCID: PMC8108992 DOI: 10.3389/fcimb.2021.670759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
With reduced prevalence of visceral leishmaniasis (VL) in the Indian subcontinent (ISC), direct and field deployable diagnostic tests are needed to implement an effective diagnostic and surveillance algorithm for post-elimination VL control. In this regard, here we investigated the diagnostic efficacies of a loop-mediated isothermal amplification (LAMP) assay (Loopamp™ Leishmania Detection Kit, Eiken Chemical CO., Ltd, Japan), a real-time quantitative PCR assay (qPCR) and the Leishmania antigen ELISA (CLIN-TECH, UK) with different sampling techniques and evaluated their prospect to incorporate into post-elimination VL control strategies. Eighty clinically and rK39 rapid diagnostic test confirmed VL cases and 80 endemic healthy controls were enrolled in the study. Peripheral blood and dried blood spots (DBS) were collected from all the participants at the time of diagnosis. DNA was extracted from whole blood (WB) and DBS via silica columns (QIAGEN) and boil & spin (B&S) methods and tested with qPCR and Loopamp. Urine was collected from all participants at the time of diagnosis and was directly subjected to the Leishmania antigen ELISA. 41 patients were followed up and urine samples were collected at day 30 and day 180 after treatment and ELISA was performed. The sensitivities of the Loopamp-WB(B&S) and Loopamp-WB(QIA) were 96.2% (95% CI 89·43-99·22) and 95% (95% CI 87·69-98·62) respectively. The sensitivity of Loopamp-DBS(QIA) was 85% (95% CI 75·26- 92·00). The sensitivities of the qPCR-WB(QIA) and qPCR-DBS(QIA) were 93.8% (95% CI 86·01-97·94) and 72.5% (95% CI 61·38-81·90) respectively. The specificity of all molecular assays was 100%. The sensitivity and specificity of the Leishmania antigen ELISA were 97.5% (95% CI 91·47-99·70) and 91.95% (95% CI 84·12-96·70) respectively. The Leishmania antigen ELISA depicted clinical cure at day 180 in all the followed-up cases. Efficacy and sustainability identify the Loopamp-WB(B&S) and the Leishmania antigen ELISA as promising and minimally invasive VL diagnostic tools to support VL diagnostic and surveillance activities respectively in the post-elimination era.
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Affiliation(s)
- Faria Hossain
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Albert Picado
- Neglected Tropical Diseases, Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Sophie I. Owen
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Prakash Ghosh
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rajashree Chowdhury
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shomik Maruf
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Md. Utba Rashid
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rupen Nath
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - James Baker
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Debashis Ghosh
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily R. Adams
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Ariful Basher
- Department of Medicine, Infectious Disease Hospital, Dhaka, Bangladesh
| | - Proggananda Nath
- Infectious diseases and Tropical Medicine, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh
| | - Fatima Aktar
- Research, HDT Bio-Corp., Seattle, WA, United States
| | - Israel Cruz
- Neglected Tropical Diseases, Foundation for Innovative New Diagnostics, Geneva, Switzerland
- International Health Department, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Dinesh Mondal
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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10
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Owen SI, Hossain F, Ghosh P, Chowdhury R, Hossain MS, Jewell C, Cruz I, Picado A, Mondal D, Adams ER. Detection of asymptomatic Leishmania infection in Bangladesh by antibody and antigen diagnostic tools shows an association with post-kala-azar dermal leishmaniasis (PKDL) patients. Parasit Vectors 2021; 14:111. [PMID: 33597000 PMCID: PMC7888088 DOI: 10.1186/s13071-021-04622-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/02/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Asymptomatic Leishmania infections outnumber clinical infections on the Indian subcontinent (ISC), where disease reservoirs are anthroponotic. Diagnostics which detect active asymptomatic infection, which are suitable for monitoring and surveillance, may be of benefit to the visceral leishmaniasis (VL) elimination campaign on the ISC. METHODS Quantitative polymerase chain reaction (qPCR), loop-mediated isothermal amplification (LAMP), and the direct agglutination test (DAT) were carried out on blood samples, and the Leishmania antigen ELISA was carried out on urine samples collected from 720 household and neighbouring contacts of 276 VL and post-kala-azar dermal leishmaniasis (PKDL) index cases, with no symptoms or history of VL or PKDL, in endemic regions of Bangladesh between September 2016 and March 2018. RESULTS Of the 720 contacts of index cases, asymptomatic infection was detected in 69 (9.6%) participants by a combination of qPCR (1.0%), LAMP (2.1%), DAT (3.9%), and Leishmania antigen ELISA (3.3%). Only one (0.1%) participant was detected positive by all four diagnostic tests. Poor agreement between tests was calculated using Cohen's kappa (κ) statistics; however, the Leishmania antigen ELISA and DAT in combination captured all participants as positive by more than one test. We find evidence for a moderately strong association between the index case being a PKDL case (OR 1.94, p = 0.009), specifically macular PKDL (OR 2.12, p = 0.004), and being positive for at least one of the four tests. CONCLUSIONS Leishmania antigen ELISA on urine detects active asymptomatic infection, requires a non-invasive sample, and therefore may be of benefit for monitoring transmission and surveillance in an elimination setting in combination with serology. Development of an antigen detection test in a rapid diagnostic test (RDT) format would be of benefit to the elimination campaign.
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Affiliation(s)
- Sophie I Owen
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Faria Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Prakash Ghosh
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Rajashree Chowdhury
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Md Sakhawat Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Chris Jewell
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Isra Cruz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland.,National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Dinesh Mondal
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Emily R Adams
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK.
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11
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Wehrendt DP, Alonso-Padilla J, Liu B, Rojas Panozo L, Rivera Nina S, Pinto L, Lozano D, Picado A, Abril M, Pinazo MJ, Gascon J, Torrico F, Wong S, Schijman AG. Development and Evaluation of a Three-Dimensional Printer-Based DNA Extraction Method Coupled to Loop Mediated Isothermal Amplification for Point-of-Care Diagnosis of Congenital Chagas Disease in Endemic Regions. J Mol Diagn 2020; 23:389-398. [PMID: 33387697 DOI: 10.1016/j.jmoldx.2020.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/22/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022] Open
Abstract
Vertical transmission of Trypanosomacruzi is the cause of congenital Chagas disease, a re-emerging infectious disease that affects endemic and nonendemic regions alike. An early diagnosis is crucial because prompt treatment achieves a high cure rate, precluding evolution to symptomatic chronic Chagas disease. However, early diagnosis involves low-sensitive parasitologic assays, making necessary serologic confirmation after 9 months of life. With the aim of implementing early diagnostic strategies suitable for minimally equipped laboratories, a T. cruzi-loop-mediated isothermal amplification (LAMP) prototype was coupled with an automated DNA-extraction device repurposed from a three-dimensional printer (PrintrLab). The whole process takes <3 hours to yield a result, with an analytical sensitivity of 0.1 to 2 parasite equivalents per milliliter, depending on the T. cruzi strain. Twenty-five blood samples from neonates born to seropositive mothers were tested blindly. In comparison to quantitative real-time PCR, the PrintrLab-LAMP dual strategy showed high agreement, while both molecular-based methodologies yielded optimal sensitivity and specificity with respect to microscopy-based diagnosis of congenital Chagas disease. PrintrLab-LAMP detected all 10 congenitally transmitted T. cruzi infections, showing promise for point-of-care early diagnosis of congenital Chagas disease.
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Affiliation(s)
- Diana P Wehrendt
- Laboratorio de Biología Molecular de La Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres", Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Bo Liu
- AI Biosciences Inc., College Station, Texas
| | - Lizeth Rojas Panozo
- Fundación Cienciasy Estudios Aplicados para el Desarrollo en Saludy Medio Ambiente, Cochabamba, Bolivia
| | - Silvia Rivera Nina
- Fundación Cienciasy Estudios Aplicados para el Desarrollo en Saludy Medio Ambiente, Cochabamba, Bolivia
| | - Lilian Pinto
- Fundación Cienciasy Estudios Aplicados para el Desarrollo en Saludy Medio Ambiente, Cochabamba, Bolivia
| | - Daniel Lozano
- Fundación Cienciasy Estudios Aplicados para el Desarrollo en Saludy Medio Ambiente, Cochabamba, Bolivia
| | - Albert Picado
- Foundation for Innovative Diagnostics, Geneva, Switzerland
| | | | - Maria J Pinazo
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Joaquim Gascon
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Faustino Torrico
- Fundación Cienciasy Estudios Aplicados para el Desarrollo en Saludy Medio Ambiente, Cochabamba, Bolivia
| | - Season Wong
- AI Biosciences Inc., College Station, Texas.
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de La Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres", Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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12
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Ndung’u JM, Boulangé A, Picado A, Mugenyi A, Mortensen A, Hope A, Mollo BG, Bucheton B, Wamboga C, Waiswa C, Kaba D, Matovu E, Courtin F, Garrod G, Gimonneau G, Bingham GV, Hassane HM, Tirados I, Saldanha I, Kabore J, Rayaisse JB, Bart JM, Lingley J, Esterhuizen J, Longbottom J, Pulford J, Kouakou L, Sanogo L, Cunningham L, Camara M, Koffi M, Stanton M, Lehane M, Kagbadouno MS, Camara O, Bessell P, Mallaye P, Solano P, Selby R, Dunkley S, Torr S, Biéler S, Lejon V, Jamonneau V, Yoni W, Katz Z. Trypa-NO! contributes to the elimination of gambiense human African trypanosomiasis by combining tsetse control with "screen, diagnose and treat" using innovative tools and strategies. PLoS Negl Trop Dis 2020; 14:e0008738. [PMID: 33180776 PMCID: PMC7660505 DOI: 10.1371/journal.pntd.0008738] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Alain Boulangé
- Centre International de Recherche-Développement sur l’Elevage en zone Subhumide (CIRDES), Bobo Dioulasso, Burkina Faso
- Centre International de Recherche Agronomique pour le Développement (CIRAD), UMR INTERTRYP, Montpellier, France
| | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Albert Mugenyi
- Coordinating Office for Control of Trypanosomiasis in Uganda (COCTU), Entebbe, Uganda
| | | | - Andrew Hope
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | | | - Bruno Bucheton
- Institut de Recherche pour le Développement (IRD), INTERTRYP, CIRAD, Université Montpellier, Montpellier, France
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Conakry, Guinea
| | | | - Charles Waiswa
- Coordinating Office for Control of Trypanosomiasis in Uganda (COCTU), Entebbe, Uganda
| | - Dramane Kaba
- Institut Pierre Richet/Institut National de Santé Publique (IPR/INSP), Bouaké, Côte d’Ivoire
| | - Enock Matovu
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | - Fabrice Courtin
- Institut de Recherche pour le Développement (IRD), INTERTRYP, CIRAD, Université Montpellier, Montpellier, France
- Institut Pierre Richet/Institut National de Santé Publique (IPR/INSP), Bouaké, Côte d’Ivoire
| | - Gala Garrod
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Geoffrey Gimonneau
- Centre International de Recherche-Développement sur l’Elevage en zone Subhumide (CIRDES), Bobo Dioulasso, Burkina Faso
- Centre International de Recherche Agronomique pour le Développement (CIRAD), UMR INTERTRYP, Montpellier, France
| | | | | | - Inaki Tirados
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Isabel Saldanha
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Jacques Kabore
- Centre International de Recherche-Développement sur l’Elevage en zone Subhumide (CIRDES), Bobo Dioulasso, Burkina Faso
| | - Jean-Baptiste Rayaisse
- Centre International de Recherche-Développement sur l’Elevage en zone Subhumide (CIRDES), Bobo Dioulasso, Burkina Faso
| | - Jean-Mathieu Bart
- Institut de Recherche pour le Développement (IRD), INTERTRYP, CIRAD, Université Montpellier, Montpellier, France
| | - Jessica Lingley
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Johan Esterhuizen
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Joshua Longbottom
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Justin Pulford
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Lingue Kouakou
- Programme National d'Elimination de la THA (PNETHA), Abidjan, Côte d’Ivoire
| | - Lassina Sanogo
- Centre International de Recherche-Développement sur l’Elevage en zone Subhumide (CIRDES), Bobo Dioulasso, Burkina Faso
| | - Lucas Cunningham
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Mamadou Camara
- Institut de Recherche pour le Développement (IRD), INTERTRYP, CIRAD, Université Montpellier, Montpellier, France
| | - Mathurin Koffi
- Université Jean Lorougnon Guédé (UJLoG), Daloa, Côte d’Ivoire
| | - Michelle Stanton
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Mike Lehane
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Moise Saa Kagbadouno
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Conakry, Guinea
| | - Oumou Camara
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Conakry, Guinea
| | | | - Peka Mallaye
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Chad
| | - Philippe Solano
- Institut de Recherche pour le Développement (IRD), INTERTRYP, CIRAD, Université Montpellier, Montpellier, France
| | - Richard Selby
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Sophie Dunkley
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Steve Torr
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Veerle Lejon
- Institut de Recherche pour le Développement (IRD), INTERTRYP, CIRAD, Université Montpellier, Montpellier, France
| | - Vincent Jamonneau
- Institut de Recherche pour le Développement (IRD), INTERTRYP, CIRAD, Université Montpellier, Montpellier, France
- Ministry of Health (MOH), Kampala, Uganda
| | - Wilfried Yoni
- Centre International de Recherche-Développement sur l’Elevage en zone Subhumide (CIRDES), Bobo Dioulasso, Burkina Faso
| | - Zachary Katz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Affiliation(s)
- Dziedzom K. de Souza
- Neglected Tropical Diseases Programme, Foundation for Innovative New Diagnostics, Geneva, Switzerland
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Albert Picado
- Neglected Tropical Diseases Programme, Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Sylvain Biéler
- Neglected Tropical Diseases Programme, Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Sarah Nogaro
- Neglected Tropical Diseases Programme, Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Joseph Mathu Ndung’u
- Neglected Tropical Diseases Programme, Foundation for Innovative New Diagnostics, Geneva, Switzerland
- * E-mail:
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14
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Besuschio SA, Picado A, Muñoz-Calderón A, Wehrendt DP, Fernández M, Benatar A, Diaz-Bello Z, Irurtia C, Cruz I, Ndung’u JM, Cafferata ML, Montenegro G, Sosa Estani S, Lucero RH, Alarcón de Noya B, Longhi SA, Schijman AG. Trypanosoma cruzi loop-mediated isothermal amplification (Trypanosoma cruzi Loopamp) kit for detection of congenital, acute and Chagas disease reactivation. PLoS Negl Trop Dis 2020; 14:e0008402. [PMID: 32797041 PMCID: PMC7458301 DOI: 10.1371/journal.pntd.0008402] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 08/31/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022] Open
Abstract
A Trypanosoma cruzi Loopamp kit was recently developed as a ready-to-use diagnostic method requiring minimal laboratory facilities. We evaluated its diagnostic accuracy for detection of acute Chagas disease (CD) in different epidemiological and clinical scenarios. In this retrospective study, a convenience series of clinical samples (venous blood treated with EDTA or different stabilizer agents, heel-prick blood in filter paper or cerebrospinal fluid samples (CSF)) from 30 infants born to seropositive mothers (13 with congenital CD and 17 noninfected), four recipients of organs from CD donors, six orally-infected cases after consumption of contaminated guava juice and six CD patients coinfected with HIV at risk of CD reactivation (N = 46 patients, 46 blood samples and 1 CSF sample) were tested by T. cruzi Loopamp kit (Tc LAMP) and standardized quantitative real-time PCR (qPCR). T. cruzi Loopamp accuracy was estimated using the case definition in the different groups as a reference. Cohen's kappa coefficient (κ) was applied to measure the agreement between Tc LAMP (index test) and qPCR (reference test). Sensitivity and specificity of T. cruzi Loopamp kit in blood samples from the pooled clinical groups was 93% (95% CI: 77-99) and 100% (95% CI: 80-100) respectively. The agreement between Tc LAMP and qPCR was almost perfect (κ = 0.92, 95% CI: 0.62-1.00). The T. cruzi Loopamp kit was sensitive and specific for detection of T. cruzi infection. It was carried out from DNA extracted from peripheral blood samples (via frozen EDTA blood, guanidine hydrochloride-EDTA blood, DNAgard blood and dried blood spots), as well as in CSF specimens infected with TcI or TcII/V/VI parasite populations. The T. cruzi Loopamp kit appears potentially useful for rapid detection of T. cruzi infection in congenital, acute and CD reactivation due to HIV infection.
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Affiliation(s)
- Susana A. Besuschio
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres”, (INGEBI-CONICET), Buenos Aires, Argentina
| | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Arturo Muñoz-Calderón
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres”, (INGEBI-CONICET), Buenos Aires, Argentina
| | - Diana P Wehrendt
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres”, (INGEBI-CONICET), Buenos Aires, Argentina
| | - Marisa Fernández
- Hospital de Enfermedades Infecciosas “Dr. Francisco J. Muñiz” Buenos Aires, Argentina
- Instituto Nacional de Parasitología, “Dr Mario Fatala Chabén”, ANLIS CG Malbrán, Buenos Aires, Argentina
| | - Alejandro Benatar
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres”, (INGEBI-CONICET), Buenos Aires, Argentina
| | - Zoraida Diaz-Bello
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela 5
| | - Cecilia Irurtia
- Hospital Nacional “Profesor Alejandro Posadas”, Villa Sarmiento, Buenos Aires, Argentina
| | - Israel Cruz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Joseph M Ndung’u
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - María L Cafferata
- Departamento en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria – Centro de Investigación en Epidemiología y Salud Pública (IECS-CIESP), Buenos Aires, Argentina
| | - Graciela Montenegro
- Hospital Nacional “Profesor Alejandro Posadas”, Villa Sarmiento, Buenos Aires, Argentina
| | - Sergio Sosa Estani
- Instituto Nacional de Parasitología, “Dr Mario Fatala Chabén”, ANLIS CG Malbrán, Buenos Aires, Argentina
| | - Raúl H. Lucero
- Área de Biología Molecular, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
| | | | - Silvia A Longhi
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres”, (INGEBI-CONICET), Buenos Aires, Argentina
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres”, (INGEBI-CONICET), Buenos Aires, Argentina
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15
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Alonso-Padilla J, Abril M, Alarcón de Noya B, Almeida IC, Angheben A, Araujo Jorge T, Chatelain E, Esteva M, Gascón J, Grijalva MJ, Guhl F, Hasslocher-Moreno AM, López MC, Luquetti A, Noya O, Pinazo MJ, Ramsey JM, Ribeiro I, Ruiz AM, Schijman AG, Sosa-Estani S, Thomas MC, Torrico F, Zrein M, Picado A. Target product profile for a test for the early assessment of treatment efficacy in Chagas disease patients: An expert consensus. PLoS Negl Trop Dis 2020; 14:e0008035. [PMID: 32324735 PMCID: PMC7179829 DOI: 10.1371/journal.pntd.0008035] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
| | | | | | - Igor C. Almeida
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, Texas, United States of America
| | - Andrea Angheben
- Department of Infectious–Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Tania Araujo Jorge
- Instituto Oswaldo Cruz, Fundaçao Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Eric Chatelain
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Monica Esteva
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud, Buenos Aires, Argentina
| | - Joaquim Gascón
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
| | - Mario J. Grijalva
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Infectious and Tropical Disease Institute, Biomedical Sciences Department, Ohio University, Athens, Ohio, United States of America
| | - Felipe Guhl
- Centro de Investigaciones en Microbiología y Parasitología Tropical (CIMPAT), Universidad de los Andes, Bogotá, Colombia
| | | | - Manuel Carlos López
- Instituto de Parasitología y Biomedicina López Neyra (IPBLN), Consejo Superior de Investigaciones Científicas (CSIC), Granada, Spain
| | | | - Oscar Noya
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - María Jesús Pinazo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
| | - Janine M. Ramsey
- Instituto Nacional de Salud Pública/CRISP, Tapachula, Chiapas, Mexico
| | - Isabela Ribeiro
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Andres Mariano Ruiz
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud, Buenos Aires, Argentina
| | - Alejandro G. Schijman
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Drugs for Neglected Disease initiative (DNDi) Latin America, Rio de Janeiro, Brazil
- Epidemiology and Public Health Research Center, CONICET, Buenos Aires, Argentina
| | - M. Carmen Thomas
- Instituto de Parasitología y Biomedicina López Neyra (IPBLN), Consejo Superior de Investigaciones Científicas (CSIC), Granada, Spain
| | - Faustino Torrico
- Fundación CEADES; Universidad Mayor de San Simón, Cochabamba, Bolivia
| | | | - Albert Picado
- Foundation for Innovative Diagnostics (FIND), Geneva, Switzerland
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16
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Cloots K, Uranw S, Ostyn B, Bhattarai NR, Le Rutte E, Khanal B, Picado A, Chappuis F, Hasker E, Karki P, Rijal S, Boelaert M. Impact of the visceral leishmaniasis elimination initiative on Leishmania donovani transmission in Nepal: a 10-year repeat survey. The Lancet Global Health 2020; 8:e237-e243. [DOI: 10.1016/s2214-109x(19)30536-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
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17
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Belhassen-Garcia M, Balboa Arregui Ó, Calabuig-Muñoz E, Carmena D, Esteban Velasco MDC, Fuentes Gago M, Fumado Pérez V, García Alonso J, García López Hortelano M, González Fernández LM, Herrero Martínez JM, Iglesias Iglesias MJ, Jiménez López M, López-Vélez R, Muñoz-Bellvis L, Muro A, Pardo-Lledías J, Peñaranda-Vera M, Perteguer-Prieto MJ, Picado A, Quiñones Sampedro JE, Rodríguez-Guardado A, Royo Crespo Í, Salvador F, Sánchez-Montalvá A, Torrús Tendero D, Velasco Pelayo L. Executive Summary of the Consensus Statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP), on the Management of Cystic Echinococcosis. Enferm Infecc Microbiol Clin 2019; 38:283-288. [PMID: 31866064 DOI: 10.1016/j.eimc.2019.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 11/16/2022]
Abstract
The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP) considered it pertinent to issue a consensus statement on the management of cystic echinococcosis (CE) to guide healthcare professionals in the care of patients with CE. Specialists from several fields (clinicians, surgeons, radiologists, microbiologists, and parasitologists) identified the most clinically relevant questions and developed this Consensus Statement, evaluating the available evidence-based data to propose a series of recommendations on the management of this disease. This Consensus Statement is accompanied by the corresponding references on which these recommendations are based. Prior to publication, the manuscript was open for comments and suggestions from the members of the SEIMC and the scientific committees and boards of the various societies involved.
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Affiliation(s)
- Moncef Belhassen-Garcia
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación en Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Salamanca, Spain.
| | - Óscar Balboa Arregui
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Eva Calabuig-Muñoz
- Unidad de Enfermedades Infecciosas del Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Carmena
- Laboratorio de Referencia e Investigación en Parasitología, Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | | | - Marta Fuentes Gago
- Servicio de Cirugía Torácica, CAUSA, IBSAL, Universidad de Salamanca, Salamanca, Spain
| | | | | | - Milagros García López Hortelano
- Servicio de Pediatría, Enfermedades Infecciosa y Tropicales, Unidad de Vacunación Internacional y Niño Viajero, Hospital Universitario Infantil La Paz-Hospital Carlos III, Madrid, Spain
| | | | | | | | - Marcelo Jiménez López
- Servicio de Cirugía Torácica, CAUSA, IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Rogelio López-Vélez
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Luis Muñoz-Bellvis
- Servicio de Cirugía, CAUSA, IBSAL, Centro de Investigación Biomédica en Red de Cáncer, Instituto Salud Carlos III (CIBERONC), Universidad de Salamanca, Spain
| | - Antonio Muro
- Grupo de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), IBSAL, CIETUS, Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Javier Pardo-Lledías
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | | | | | - Albert Picado
- Foundation for Innovative New Diagnostics-FIND, Geneva, Switzerland
| | | | | | - Íñigo Royo Crespo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa, IIS, Aragón, Zaragoza, Spain
| | - Fernando Salvador
- Servicio Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, PROSICS, Barcelona, Spain
| | - Adrian Sánchez-Montalvá
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, PROSICS Barcelona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Diego Torrús Tendero
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL - FISABIO, Alicante, Área de Parasitología, Universidad Miguel Hernández, Spain
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18
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Saboga-Nunes L, Pereira A, Picado A, Moraes Filho E. Health literacy and ehealth tools to improve quality of life. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introdution
The use of smartphones and apps to achieve numerous goals, has reached a vast number of citizens today in the world. Health related apps (HAPPS) (estimated to be 318.500 in 2017) have become popular, but little is known about their real impact in public health. The goal of this research is to understand what are the most common used HAPPS, how health literacy (HL) mediates their use and to what extent do they contribute to quality of life.
Metods
The study is observational, cross-sectional and includes both quantitative and qualitative data from an adult population working in the financial corporation. By the means of a survey (CAWI) data was collected about HL (using the European Health Literacy Survey validated to Portugal ((HLS-EU-PT), the use of apps and their influence on quality of life. The sample (n = 748) includes participants from the different offices of the company in Portugal main land and its autonomous territories.
Results
In this study (58.7% males) 40% of the individuals have between 36 and 45 years old, and 9.2% refer the use of health promotion apps. Of the participants, 7.1% have inadequate, 39.0% problematic, 36.6% sufficient and 17.3% excellent HL (HLS-EU-PT). Content analysis showed the categories most common in this sample were apps for running 44.9% (58.1% males) and health monitoring 26.1% (with 55.6% males). Those who use apps have a slightly higher value of HL than those who don’t use, but this difference is not statistically significant.
Conclusions
In this sample not more than 10% of individuals are using apps to promote their wellbeing. Implementing research focusing HL, quality of life and the use of mhealth tools is a new field in public health and allow researchers to identify trends that may trigger strategies to implement health promoting strategies in the work setting. More research is needed to understand how mhealth shape the everyday lives of prosumers in their quest for wellbeing.
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Affiliation(s)
- L Saboga-Nunes
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Institute of Sociology, University of Education, Freiburg, Germany
| | - A Pereira
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Institute of Implantology Prof Dr. João Caramês, Lisbon, Portugal
| | - A Picado
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- UCI Neurocriticos/Departamento Neurociencias, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - E Moraes Filho
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
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19
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Picado A, Nogaro S, Cruz I, Biéler S, Ruckstuhl L, Bastow J, Ndung’u JM. Access to prompt diagnosis: The missing link in preventing mental health disorders associated with neglected tropical diseases. PLoS Negl Trop Dis 2019; 13:e0007679. [PMID: 31622340 PMCID: PMC6797081 DOI: 10.1371/journal.pntd.0007679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- * E-mail:
| | - Sarah Nogaro
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Laura Ruckstuhl
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Jon Bastow
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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20
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Hasker E, Malaviya P, Cloots K, Picado A, Singh OP, Kansal S, Boelaert M, Sundar S. Visceral Leishmaniasis in the Muzaffapur Demographic Surveillance Site: A Spatiotemporal Analysis. Am J Trop Med Hyg 2019; 99:1555-1561. [PMID: 30298812 PMCID: PMC6283495 DOI: 10.4269/ajtmh.18-0448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In the Indian subcontinent, visceral leishmaniasis (VL) has a strongly clustered distribution. The “index case approach” is promoted both for active case finding and indoor residual spraying (IRS). Uncertainty exists about the optimal radius. Buffer zones of 50–75 m around incident cases have been suggested for active case finding, for IRS the recommendation is to cover a radius of 500 m. Our aim was to establish optimal target areas both for IRS and for (re)active case finding. We plotted incident VL cases on a map per 6-month period (January–June or July–December) and drew buffers of 0 (same household), 50, 75, 100, 200, 300, 400, and 500 m around these cases. We then recorded total population and numbers of VL cases diagnosed over the next 6-month period in each of these buffers and beyond. We calculated incidence rate ratios (IRRs) using the population at more than 500 m from any case as reference category. There was a very strong degree of spatial clustering of VL with IRRs ranging from 45.2 (23.8–85.6) for those living in the same households to 14.6 (10.1–21.2) for those living within 75 m of a case diagnosed, during the previous period. Up to 500 m the IRR was still five times higher than that of the reference category. Our findings corroborate the rationale of screening not just household contacts but also those living within a perimeter of 50–75 m from an index case. For IRS, covering a perimeter of 500 m, appears to be a rational choice.
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Affiliation(s)
- Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Paritosh Malaviya
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Kristien Cloots
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Albert Picado
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Om Prakash Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sangeeta Kansal
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Sunyoto T, Potet J, den Boer M, Ritmeijer K, Postigo JAR, Ravinetto R, Alves F, Picado A, Boelaert M. Exploring global and country-level barriers to an effective supply of leishmaniasis medicines and diagnostics in eastern Africa: a qualitative study. BMJ Open 2019; 9:e029141. [PMID: 31152044 PMCID: PMC6549606 DOI: 10.1136/bmjopen-2019-029141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/14/2019] [Accepted: 04/18/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To understand stakeholders' perceptions of the access barriers to quality-assured diagnostics and medicines for leishmaniasis in the high-burden region of eastern Africa, and to identify key bottlenecks to improve the supply of commodities for neglected tropical diseases. DESIGN Desk reviews and qualitative in-depth interview study with purposive sampling. METHODS A landscape analysis through literature and desk review was performed. Next, 29 representatives from international organisations, non-governmental agencies, national control programmes from six countries (Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) and manufacturers were interviewed between May and July 2018. Participants were selected purposively and expanded through a snowballing technique.Data analysis was aided by NVivo, applying the framework method as a part of the thematic content analysis approach. RESULTS The barriers along the visceral leishmaniasis (VL) supply chain were identified as emerging themes, grouped across supply chain activities and health systems component(s). Stakeholders expressed the perception of progress, but bottlenecks persist. VL medicines, in general, lack multisource production capacity and with small market volume, expansion of suppliers is difficult. Procurement is plagued by forecasting difficulties, complex regulatory policies and procedures, and distribution challenges. Weak communication and coordination across different levels resulted in shortages and loss of trust among different actors. Cross-cutting issues spanned from limited political and resource commitment due to low awareness and limited in-country capacity. However, study respondents were optimistic to pursue several remedies, most importantly to build bridges between supply and demand sides through continued dialogue and collaborations. Diagnostics supply has mostly been overlooked; thus, improved investment in this area is needed. CONCLUSIONS Addressing supply barriers in eastern Africa requires consistent, specific efforts at the global and national levels, progressing from current partnerships and agreements. Priority actions include pooled procurement, improved forecast, and increased commitment and resources. Sustainability remains an elusive goal, yet to be integrated into discussions moving forward.
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Affiliation(s)
- Temmy Sunyoto
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Julien Potet
- Medical Department, Médecins Sans Frontières Access Campaign, Paris, France
| | - Margriet den Boer
- Medical Department, Artsen zonder Grenzen, Amsterdam, The Netherlands
| | - Koert Ritmeijer
- Medical Department, Artsen zonder Grenzen, Amsterdam, The Netherlands
| | - Jose A R Postigo
- Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Raffaella Ravinetto
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Fabiana Alves
- VL Clinical Program, Drugs for Neglected Disease Initiative, Geneva, Switzerland
| | - Albert Picado
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Neglected Tropical Diseases Department, FIND, Geneva, Switzerland
| | - Marleen Boelaert
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
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Gomez SA, Chapman LAC, Dilger E, Courtenay O, Picado A. Correction: Estimating the efficacy of community-wide use of systemic insecticides in dogs to control zoonotic visceral leishmaniasis: A modelling study in a Brazilian scenario. PLoS Negl Trop Dis 2019; 13:e0007452. [PMID: 31136590 PMCID: PMC6538138 DOI: 10.1371/journal.pntd.0007452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Aerts C, Vink M, Pashtoon SJ, Nahzat S, Picado A, Cruz I, Sicuri E. Cost Effectiveness of New Diagnostic Tools for Cutaneous Leishmaniasis in Afghanistan. Appl Health Econ Health Policy 2019; 17:213-230. [PMID: 30465319 PMCID: PMC6439180 DOI: 10.1007/s40258-018-0449-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Cutaneous leishmaniasis is responsible for chronic and disfiguring skin lesions resulting in morbidity and social stigma. The gold standard to diagnose cutaneous leishmaniasis is microscopy but has a variable sensitivity and requires trained personnel. Using four scenarios, the objective of this study is to compare the cost effectiveness of microscopy with two new tools: Loopamp™ Leishmania Detection Kit (LAMP) and CL Detect™ Rapid Test (RDT). METHODS Data related to the cost and accuracy of these tools were collected at the clinic of the National Malaria and Leishmaniasis Control Program in Kabul, Afghanistan. The effectiveness estimates were measured based on the tools' performance but also indirectly, using the disability-adjusted life years. A decision tree was designed in TreeAge Healthcare Pro 2016, combined with a Markov model representing the natural history of cutaneous leishmaniasis. In addition to a deterministic analysis, univariate sensitivity and probabilistic analyses were performed to test the robustness of the results. RESULTS If the tools are compared at the National Malaria and Leishmaniasis Control Program level in a period of low incidence, microscopy remains the preferred option. LAMP becomes more appropriate during cutaneous leishmaniasis seasons or outbreaks when its capacity to process several tests (e.g. up to 48) at a time can be maximised. RDT has a cost similar to microscopy when used at the reference clinic but as it is relatively easy to use, it could be implemented at the peripheral level, which would become cheaper than employing microscopy at the reference clinic. Moreover, combining RDT with microscopy or LAMP at the reference clinic for the negative suspects is economically more interesting than directly performing LAMP or microscopy respectively on all cutaneous leishmaniasis suspects at the reference clinic. CONCLUSIONS When taking advantage of their respective strengths, LAMP and RDT can prove to be cost-effective alternatives to using microscopy alone at the reference clinic.
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Affiliation(s)
- Céline Aerts
- ISGlobal, Hospital-Clínic-Universitat de Barcelona, Carrer Rosselló 132, 08036, Barcelona, Spain.
| | - Martijn Vink
- Health Works (Formerly HealthNet TPO), Amsterdam, The Netherlands
| | | | - Sami Nahzat
- National Malaria and Leishmaniasis Control Program, Ministry of Public Health, Kabul, Afghanistan
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Elisa Sicuri
- ISGlobal, Hospital-Clínic-Universitat de Barcelona, Carrer Rosselló 132, 08036, Barcelona, Spain
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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Schallig HDFH, Hu RVP, Kent AD, van Loenen M, Menting S, Picado A, Oosterling Z, Cruz I. Evaluation of point of care tests for the diagnosis of cutaneous leishmaniasis in Suriname. BMC Infect Dis 2019; 19:25. [PMID: 30616544 PMCID: PMC6323762 DOI: 10.1186/s12879-018-3634-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) is a serious health problem in Suriname. To expand the diagnostic options, two newly developed diagnostic tests, i.e. the rapid diagnostic test CL Detect™ Rapid Test (CL Detect) and the Loopamp™ Leishmania Detection Kit (Loopamp) were evaluated. Methods Diagnostic test performance was compared to the routine diagnostic approach in place, i.e. clinical symptoms combined with microscopy, and to polymerase chain reaction (PCR), which was used as a reference standard. The study population (n = 93) was a typical representation of the CL affected population in Suriname and mainly infected with Leishmania guyanensis. Results CL Detect had a very low sensitivity compared to microscopy (36.7%) or PCR (35.8%), due to a high number of false negative results. The specificity of the CL Detect compared to microscopy and PCR was 85.7 and 83.3% respectively. Loopamp sensitivity was 84.8% compared to microscopy and 91.4% compared to PCR. The Loopamp test had a moderate specificity (42.9%) compared to microscopy, but a good specificity compared to PCR (91.7%). Conclusion The CL Detect is not likely to be a good replacement for the routine diagnostic procedure for CL in Suriname. The high sensitivity of the easy to perform Loopamp enables the implementation of sensitive molecular diagnosis in resource limited settings.
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Affiliation(s)
- Henk D F H Schallig
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Ricardo V P Hu
- Dermatology Service, Ministry of Health, Tourtonnelaan 5, Paramaribo, Suriname
| | - Alida D Kent
- Department of Parasitology, Anton de Kom University, Kernkampweg, Paramaribo, Suriname
| | - Merlin van Loenen
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Sandra Menting
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Zippora Oosterling
- Department of Parasitology, Anton de Kom University, Kernkampweg, Paramaribo, Suriname
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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Gomez SA, Lucientes J, Castillo JA, Peris MP, Delacour S, Ortega P, Oropeza RV, Picado A. A randomized, blinded, controlled trial to assess sand fly mortality of fluralaner administered orally in dogs. Parasit Vectors 2018; 11:627. [PMID: 30518412 PMCID: PMC6282346 DOI: 10.1186/s13071-018-3231-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/23/2018] [Indexed: 12/03/2022] Open
Abstract
Background Leishmania infantum is the parasite responsible for the disease in humans known as zoonotic visceral leishmaniasis (ZVL). Dogs are considered the main domestic reservoir of ZVL and sand flies are the proven vectors. The use of systemic insecticides in dogs has been studied as an alternative strategy to control ZVL in endemic areas. One systemic insecticide in dogs, fluralaner, has a proven anti-sand fly effect in membrane-fed studies. However, the efficacy and duration on sand flies directly feeding from dogs treated with fluralaner remains unknown. Methods Direct feeding bioassays were performed on 10 beagle dogs that had been randomly assigned to two groups: one with five dogs orally treated with Bravecto® (fluralaner) and other five as a control. About 30 females of Phlebotomus papatasi were allowed to directly feed from dogs at seven days before the administration of the treatment and Days 3, 17, 31, 45 and 73 post-treatment. Sand fly mortality after feeding was observed every 24 h for 5 days. The Kaplan-Meyer method, Henderson-Tilton formula and a negative binomial mixed model were used to respectively calculate: (i) mortality and its 95% confidence interval (CI); (ii) efficacy of the insecticide at killing sand flies in 24 h; and (iii) differences in the risk of sand fly death at 24 h after feeding. Results Control sand fly mortality 24 h after feeding was always ≤ 20% and mortality in the fluralaner group ranged from 2% (95% CI: 0–4%) 7 days before treatment to 100% at 3 days post-treatment. Fluralaner efficacy was 100, 93, 94 and 75% at Days 3, 17, 31 and 45, respectively (P < 0.0001). The increase in the risk of sand fly death was 32.9 (95% CI: 4–263), 76 (95% CI: 8–705), 95.8 (95% CI: 9–1029) and 10.6 times (95% CI: 1.43–79) on Days 3, 17, 31 and 45, respectively Conclusions The efficacy of fluralaner, orally administered to dogs, against sand-flies was above 90% for 31 days. Fluralaner administered to dogs should be further evaluated as a control strategy in ZVL endemic areas. Electronic supplementary material The online version of this article (10.1186/s13071-018-3231-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sonia Ares Gomez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - Javier Lucientes
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | - Juan Antonio Castillo
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | - Maria Paz Peris
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | - Sarah Delacour
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | - Paula Ortega
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | - Ronald-Vladimir Oropeza
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | - Albert Picado
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
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Bulstra CA, Le Rutte EA, Malaviya P, Hasker EC, Coffeng LE, Picado A, Singh OP, Boelaert MC, de Vlas SJ, Sundar S. Visceral leishmaniasis: Spatiotemporal heterogeneity and drivers underlying the hotspots in Muzaffarpur, Bihar, India. PLoS Negl Trop Dis 2018; 12:e0006888. [PMID: 30521529 PMCID: PMC6283467 DOI: 10.1371/journal.pntd.0006888] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 04/09/2018] [Accepted: 10/01/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Despite the overall decrease in visceral leishmaniasis (VL) incidence on the Indian subcontinent, there remain spatiotemporal clusters or 'hotspots' of new cases. The characteristics of these hotspots, underlying transmission dynamics, and their importance for shaping control strategies are not yet fully understood and are investigated in this study for a VL endemic area of ~100,000 inhabitants in Bihar, India between 2007-2015. METHODOLOGY/PRINCIPAL FINDINGS VL incidence (cases/10,000/year) dropped from 12.3 in 2007 to 0.9 in 2015, which is just below the World Health Organizations' threshold for elimination as a public health problem. Clustering of VL was assessed between subvillages (hamlets), using multiple geospatial and (spatio)temporal autocorrelation and hotspot analyses. One to three hotspots were identified each year, often persisting for 1-5 successive years with a modal radius of ~500m. The relative risk of having VL was 5-86 times higher for inhabitants of hotspots, compared to those living outside hotspots. Hotspots harbour significantly more households from the two lowest asset quintiles (as proxy for socio-economic status). Overall, children and young adelescents (5-14 years) have the highest risk for VL, but within hotspots and at the start of outbreaks, older age groups (35+ years) show a comparable high risk. CONCLUSIONS/SIGNIFICANCE This study demonstrates significant spatiotemporal heterogeneity in VL incidence at subdistrict level. The association between poverty and hotspots confirms that VL is a disease of 'the poorest of the poor' and age patterns suggest a potential role of waning immunity as underlying driver of hotspots. The recommended insecticide spraying radius of 500m around detected VL cases corresponds to the modal hotspot radius found in this study. Additional data on immunity and asymptomatic infection, and the development of spatiotemporally explicit transmission models that simulate hotspot dynamics and predict the impact of interventions at the smaller geographical scale will be crucial tools in sustaining elimination.
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Affiliation(s)
- Caroline A. Bulstra
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Epke A. Le Rutte
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Paritosh Malaviya
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Epco C. Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Picado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Om Prakash Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Marleen C. Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Vink MMT, Nahzat SM, Rahimi H, Buhler C, Ahmadi BA, Nader M, Zazai FR, Yousufzai AS, van Loenen M, Schallig HDFH, Picado A, Cruz I. Evaluation of point-of-care tests for cutaneous leishmaniasis diagnosis in Kabul, Afghanistan. EBioMedicine 2018; 37:453-460. [PMID: 30396855 PMCID: PMC6286266 DOI: 10.1016/j.ebiom.2018.10.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/01/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background Kabul (Afghanistan) is a major focus of cutaneous leishmaniasis (CL) caused by Leishmania tropica. Microscopy remains the reference test for diagnosis despite its low performance. We evaluated whether Loopamp™ Leishmania Detection Kit (Loopamp) and CL Detect™ Rapid Test (CL Detect), detecting Leishmania DNA and antigen, respectively could improve CL diagnosis. Methods A diagnostic accuracy study with prospective inclusion was conducted in a leishmaniasis reference clinic in Kabul. Slit skin samples from CL suspects were analysed by microscopy. Samples taken with a dental broach were tested with CL Detect, Loopamp, and PCR. All samples were transferred to the Academic Medical Center (AMC, the Netherlands) for PCR and Loopamp analyses. The diagnostic performance of the tests was evaluated against a reference combining microscopy and PCR. Findings 274 CL suspects were included in the study. In Kabul, CL Detect had a 65·4% sensitivity [95% Confidence Interval (CI): 59.2–71.2%] and a 100% specificity [95% CI: 80.5–100%], while these were 87.6% [95%CI: 82.9–91.3%] and 70.6% [95% CI: 44.0–89.7%] for Loopamp. At AMC the Loopamp's sensitivity (92.2% [95% CI: 88.2–95.2%]) and specificity (94.1% [95% CI: 71.3–99.8%]) were higher. An algorithm where CL Detect negative suspects would be tested by Loopamp yielded a 93.4% sensitivity [95% CI: 89.6–96.1%] and a 94.1% specificity [95% CI: 71.3–99.8%] when Loopamp's performance at AMC was used. Interpretation The high specificity of CL Detect and the performance of Loopamp allow their use in a diagnostic algorithm that would minimize the number of CL patients referred for confirmation. Fund Federal Ministry of Education and Research, Germany.
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Affiliation(s)
- Martijn M T Vink
- Health Works (Formerly HealthNet TPO), Lizzy Ansinghstraat 163, 1072 RG Amsterdam, The Netherlands
| | - Sami M Nahzat
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Habiburrahman Rahimi
- Health Protection and Research Organization, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Cyril Buhler
- ORDiagnostics SASU, 10Rue Irénée Blanc, 75020 Paris, France
| | - Bashir A Ahmadi
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Mohammad Nader
- Health Protection and Research Organization, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Fazal R Zazai
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | | | - Merlin van Loenen
- Amsterdam UMC, University of Amsterdam, Medical Microbiology, Parasitology Unit, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Amsterdam UMC, University of Amsterdam, Medical Microbiology, Parasitology Unit, Meibergdreef 9, Amsterdam, The Netherlands
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland.
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Picado A, Cruz I, Redard-Jacot M, Schijman AG, Torrico F, Sosa-Estani S, Katz Z, Ndung’u JM. The burden of congenital Chagas disease and implementation of molecular diagnostic tools in Latin America. BMJ Glob Health 2018; 3:e001069. [PMID: 30364393 PMCID: PMC6195131 DOI: 10.1136/bmjgh-2018-001069] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/01/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
It is estimated that between 8000 and 15 000 Trypanosoma cruzi infected babies are born every year to infected mothers in Chagas disease endemic countries. Currently, poor access to and performance of the current diagnostic algorithm, based on microscopy at birth and serology at 8–12 months after delivery, is one of the barriers to congenital Chagas disease (CCD) control. Detection of parasite DNA using molecular diagnostic tools could be an alternative or complement to current diagnostic methods, but its implementation in endemic regions remains limited. Prompt diagnosis and treatment of CCD cases would have a positive clinical and epidemiological impact. In this paper, we analysed the burden of CCD in Latin America, and the potential use of molecular tests to improve access to early diagnosis and treatment of T. cruzi infected newborns.
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Affiliation(s)
- Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Maël Redard-Jacot
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor Torres", Buenos Aires, Argentina
| | - Faustino Torrico
- Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
- Fundación CEADES, Cochabamba, Bolivia
| | - Sergio Sosa-Estani
- Centro de Investigación de Epidemiología y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
- Drugs for Neglected Diseases initiative (DNDi), Rio de Janeiro, Brazil
| | - Zachary Katz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Sunyoto T, Verdonck K, el Safi S, Potet J, Picado A, Boelaert M. Uncharted territory of the epidemiological burden of cutaneous leishmaniasis in sub-Saharan Africa-A systematic review. PLoS Negl Trop Dis 2018; 12:e0006914. [PMID: 30359376 PMCID: PMC6219817 DOI: 10.1371/journal.pntd.0006914] [Citation(s) in RCA: 17] [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: 07/11/2018] [Revised: 11/06/2018] [Accepted: 10/11/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Cutaneous leishmaniasis (CL) is the most frequent form of leishmaniasis, with 0.7 to 1.2 million cases per year globally. However, the burden of CL is poorly documented in some regions. We carried out this review to synthesize knowledge on the epidemiological burden of CL in sub-Saharan Africa. METHODS We systematically searched PubMed, CABI Global health, Africa Index Medicus databases for publications on CL and its burden. There were no restrictions on language/publication date. Case series with less than ten patients, species identification studies, reviews, non-human, and non-CL focused studies were excluded. Findings were extracted and described. The review was conducted following PRISMA guidelines; the protocol was registered in PROSPERO (42016036272). RESULTS From 289 identified records, 54 met eligibility criteria and were included in the synthesis. CL was reported from 13 of the 48 sub-Saharan African countries (3 eastern, nine western and one from southern Africa). More than half of the records (30/54; 56%) were from western Africa, notably Senegal, Burkina Faso and Mali. All studies were observational: 29 were descriptive case series (total 13,257 cases), and 24 followed a cross-sectional design. The majority (78%) of the studies were carried out before the year 2000. Forty-two studies mentioned the parasite species, but was either assumed or attributed on the historical account. Regional differences in clinical manifestations were reported. We found high variability across methodologies, leading to difficulties to compare or combine data. The prevalence in hospital settings among suspected cases ranged between 0.1 and 14.2%. At the community level, CL prevalence varied widely between studies. Outbreaks of thousands of cases occurred in Ethiopia, Ghana, and Sudan. Polymorphism of CL in HIV-infected people is a concern. Key information gaps in CL burden here include population-based CL prevalence/incidence, risk factors, and its socio-economic burden. CONCLUSION The evidence on CL epidemiology in sub-Saharan Africa is scanty. The CL frequency and severity are poorly identified. There is a need for population-based studies to define the CL burden better. Endemic countries should consider research and action to improve burden estimation and essential control measures including diagnosis and treatment capacity.
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Affiliation(s)
- Temmy Sunyoto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Policy Department, Médecins Sans Frontières - Campaign for Access to Medicines, Geneva, Switzerland
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sayda el Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Julien Potet
- Policy Department, Médecins Sans Frontières - Campaign for Access to Medicines, Geneva, Switzerland
| | - Albert Picado
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Gomez SA, Chapman LAC, Dilger E, Courtenay O, Picado A. Estimating the efficacy of community-wide use of systemic insecticides in dogs to control zoonotic visceral leishmaniasis: A modelling study in a Brazilian scenario. PLoS Negl Trop Dis 2018; 12:e0006797. [PMID: 30222756 PMCID: PMC6160230 DOI: 10.1371/journal.pntd.0006797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/27/2018] [Accepted: 08/28/2018] [Indexed: 12/31/2022] Open
Abstract
Systemic insecticides in dogs have been suggested as a public health intervention to prevent human cases of Zoonotic Visceral Leishmaniasis (ZVL). But, currently there are no systemic insecticides for dogs registered against zoo-anthropophilic pool blood feeding phlebotomine flies. We predict the impact of community-wide use of systemic insecticide in dog populations as a public health measure to control transmission of Leishmania infantum to humans using a mathematical model. We developed a Susceptible-Exposed-Infected (SEI) compartmental model to describe L. infantum transmission dynamics in dogs, with a vectorial capacity term to represent transmission between L. infantum-hosting dogs via phlebotomine flies. For Infected (I) dogs two levels of infectiousness were modelled, high infectiousness and low infectiousness. Human incidence was estimated through its relationship to infection in the dog population. We evaluated outcomes from a wide range of scenarios comprising different combinations of initial insecticide efficacy, duration of insecticide efficacy over time, and proportion of the dog population treated (60%, 70% & 80%). The same reduction in human infection incidence can be achieved via different combinations of insecticide efficacy, duration and dog coverage. For example, a systemic insecticide with an initial efficacy of 80% and 6 months above 65% efficacy would require treating at least 70% of the dogs to reduce the human infection incidence by 50%. Sensitivity analysis showed that the model outcome was most sensitive to baseline values of phlebotomine fly daily survival rate and insecticide coverage. Community-wide use of systemic insecticides applied to the “L. infantum canine reservoir” can significantly reduce human incidence of L. infantum infection. The results of this mathematical model can help defining the insecticide target product profile and how the insecticide should be applied to maximise effectiveness. Zoonotic visceral leishmaniasis (ZVL) is a potentially deadly disease in humans caused by Leishmania infantum. This leishmania species can be delivered by pool blood feeding zoo-anthropophilic phlebotomine flies to several mammals, the dog population being recognized as the main reservoir. Transmission from infected dogs to humans is through the bite of female phlebotomine sand flies. The disease is endemic in several countries and Brazil has a high prevalence of cases with over 3000 ZVL cases reported per year. The main, inefficient and highly controversial, control measure in Brazil has been culling sero-positive dogs. The community-wide use of systemic insecticides in dogs could be an alternative to control L. infantum transmission from phlebotomine flies to humans. The rationale is that phlebotomine flies which sampled their blood meals from dogs treated with systemic insecticides would die reducing the risk of L. infantum transmission. To reduce the number of ZVL cases, a large proportion of dogs in the community should be treated and the systemic insecticide used should be effective in killing phlebotomine flies acting as vectors of L. infantum parasites for a significant amount of time. We used a mathematical model mimicking L. infantum transmission to show that this novel vector control strategy could be effective. We identified the combination of different key parameters (e.g. insecticide efficacy, duration and proportion of dogs treated) that could lead to a significant reduction of the risk of L. infantum infection in humans.
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Affiliation(s)
- Sonia A. Gomez
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- * E-mail: (AP); (SAG)
| | - Lloyd A. C. Chapman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry, United Kingdom
| | - Erin Dilger
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry, United Kingdom
| | - Orin Courtenay
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry, United Kingdom
| | - Albert Picado
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- * E-mail: (AP); (SAG)
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Picado A, Ndung'u J. Elimination of sleeping sickness in Uganda could be jeopardised by conflict in South Sudan. Lancet Glob Health 2018; 5:e28-e29. [PMID: 27955775 DOI: 10.1016/s2214-109x(16)30288-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Albert Picado
- Foundation for Innovative New Diagnostics, Geneva 1202, Switzerland.
| | - Joseph Ndung'u
- Foundation for Innovative New Diagnostics, Geneva 1202, Switzerland
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Gomez SA, Curdi JL, Hernandez JAC, Peris PP, Gil AE, Velasquez RVO, Hernandez PO, Picado A. Phlebotomine mortality effect of systemic insecticides administered to dogs. Parasit Vectors 2018; 11:230. [PMID: 29622033 PMCID: PMC5887228 DOI: 10.1186/s13071-018-2820-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zoonotic visceral leishmaniasis (ZVL) caused by Leishmania (Leishmania) infantum is an important disease in humans and dogs. Different mammal species are reservoirs but dogs are considered to be the main one. Phlebotomine sand flies are the proven vector. Four systemic insecticides approved for their use in dogs were previously selected based on their potential to be used in endemic countries as part of the control programs of ZVL. These insecticides are proved to be safe and effective against the on-label insects and parasites, but there is no information about their activity against phlebotomine sand flies. METHODS The phlebotomine mortality of four systemic insecticides in dogs was evaluated using two randomized clinical trials. For the first trial, thirty dogs were randomly allocated into five groups: four treatments and one control, of equal size. The treatments evaluated were: Guardian®SR, Elanco (moxidectin); Comfortis®, Elanco (spinosad); Bravecto®, Merck Animal Health (fluralaner); and NexGard®, Merial (afoxolaner). Blood from dogs was taken at days 2, 4, 21 and 31 post-treatment (trial 1). The compound that showed the highest efficacy was selected for a second trial (trial 2) with 20 dogs sampled at days 0, 2, 4, 7, 14, 18, 32, 39, 51 and 84 post-treatment. Membrane feeding bioassays with Phlebotomus papatasi were used to evaluate the phlebotomine mortality efficacy of the different treatments. Phlebotomine mortality was observed every 24 h following the membrane feeding during 5 days. A mixed model for a negative binomial logistic regression, and a Cox proportional hazard mixed model were used to estimate phlebotomine mortality due to different treatments. RESULTS Fluralaner was the only compound that showed significant phlebotomine mortality. Fluralaner maintained the phlebotomine mortality between 60-80% for 30 days after treatment. In trial 1 we found that fluralaner increased the risk of death by 1.9 times (95% CI: 1.02-3.6) and 1.7 times (95% CI: 1.09-2.6) at days 2 and 4 after treatment. The Cox model resulted in an increase of 1.47 (95% CI: 1.1-1.96) times in hazard risk at day 2 and 1.89 (95% CI: 1.35-2.45) at day 4 after treatment. In trial 2 we found that fluralaner increased the risk of death by 1.64 times (95% CI: 1.16-2.54) and 1.97 times (95% CI: 1.23-3.17) at days 14 and 32. The hazard risk was also increased by 1.92 (95% CI: 1.4-2.64) times at day 14 after treatment. Phlebotomine survival including all experimental days was significantly lower in the fluralaner group in both trials. CONCLUSIONS A single oral treatment of fluralaner in dogs induces phlebotomine mortality. Systemic insecticides in dogs should be considered as a potential preventive measure of ZVL.
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Affiliation(s)
- Sonia Ares Gomez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Javier Lucientes Curdi
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | | | - Paz Peris Peris
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | - Adriana Esteban Gil
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | | | - Paula Ortega Hernandez
- Department of Animal Pathology, Faculty of Veterinary Medicine at the University of Zaragoza, Zaragoza, Spain
| | - Albert Picado
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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Büscher P, Bart JM, Boelaert M, Bucheton B, Cecchi G, Chitnis N, Courtin D, Figueiredo LM, Franco JR, Grébaut P, Hasker E, Ilboudo H, Jamonneau V, Koffi M, Lejon V, MacLeod A, Masumu J, Matovu E, Mattioli R, Noyes H, Picado A, Rock KS, Rotureau B, Simo G, Thévenon S, Trindade S, Truc P, Van Reet N. Do Cryptic Reservoirs Threaten Gambiense-Sleeping Sickness Elimination? Trends Parasitol 2018; 34:197-207. [PMID: 29396200 PMCID: PMC5840517 DOI: 10.1016/j.pt.2017.11.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/18/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
Trypanosoma brucei gambiense causes human African trypanosomiasis (HAT). Between 1990 and 2015, almost 440000 cases were reported. Large-scale screening of populations at risk, drug donations, and efforts by national and international stakeholders have brought the epidemic under control with <2200 cases in 2016. The World Health Organization (WHO) has set the goals of gambiense-HAT elimination as a public health problem for 2020, and of interruption of transmission to humans for 2030. Latent human infections and possible animal reservoirs may challenge these goals. It remains largely unknown whether, and to what extend, they have an impact on gambiense-HAT transmission. We argue that a better understanding of the contribution of human and putative animal reservoirs to gambiense-HAT epidemiology is mandatory to inform elimination strategies.
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Affiliation(s)
- Philippe Büscher
- Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.
| | - Jean-Mathieu Bart
- INTERTRYP, IRD, CIRAD, Univ Montpellier, Montpellier, France; Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Calle Sinesio Delgado 4, 28029 Madrid, Spain
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Bruno Bucheton
- INTERTRYP, IRD, CIRAD, Univ Montpellier, Montpellier, France
| | - Giuliano Cecchi
- Sub-regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations, CMC Road, Bole Sub City, Kebele 12/13, P O Box 5536, Addis Ababa, Ethiopia
| | - Nakul Chitnis
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, Postfach, 4002 Basel, Switzerland; University of Basel, Switzerland
| | - David Courtin
- Université Paris Descartes, Institut de Recherche pour le Développement, Unité MERIT, Mère et enfant face aux infections tropicales, 4 avenue de l'Observatoire, 75006 Paris, France
| | - Luisa M Figueiredo
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Prof Egas Moniz, 1649-028 Lisboa, Portugal
| | - José-Ramon Franco
- Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management, World Health Organization, Via Appia 20, 1202 Geneva, Switzerland
| | - Pascal Grébaut
- INTERTRYP, IRD, CIRAD, Univ Montpellier, Montpellier, France
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Hamidou Ilboudo
- Institut de Recherche sur les Bases Biologiques de la Lutte Intégrée, Centre International de Recherche-Développement sur l'Élevage en zone Subhumide, 01 BP 454 Bobo-Dioulasso 01, Burkina Faso
| | | | - Mathurin Koffi
- Université Jean Lorougnon Guédé, BP 150 Daloa, Côte d'Ivoire
| | - Veerle Lejon
- INTERTRYP, IRD, CIRAD, Univ Montpellier, Montpellier, France
| | - Annette MacLeod
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Henry Wellcome Building, 464 Bearsden Road, Glasgow, UK
| | - Justin Masumu
- Département de Parasitologie, Institut National de Recherche Biomédicale, Avenue de la Démocratie, BP 1197 Kinshasa 1, République Démocratique du Congo
| | - Enock Matovu
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P O Box 7062 Kampala, Uganda
| | - Raffaele Mattioli
- Animal Production and Health Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153 Rome, Italy
| | - Harry Noyes
- Institute of Integrative Biology, University of Liverpool, Liverpool L69 7ZB, UK
| | - Albert Picado
- Foundation for Innovative New Diagnostics, 9 Chemin des Mines, 1202 Geneva, Switzerland
| | - Kat S Rock
- Zeeman Institute for Systems Biology & Infectious Disease Research, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Brice Rotureau
- Trypanosome Transmission Group, Trypanosome Cell Biology Unit, INSERM U1201 and Department of Parasites and Insect Vectors, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France
| | - Gustave Simo
- Department of Biochemistry, Faculty of Science, University of Dschang, P O Box 67 Dschang, Cameroon
| | - Sophie Thévenon
- INTERTRYP, IRD, CIRAD, Univ Montpellier, Montpellier, France; CIRAD, INTERTRYP, Montpellier, France
| | - Sandra Trindade
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Prof Egas Moniz, 1649-028 Lisboa, Portugal
| | - Philippe Truc
- INTERTRYP, IRD, CIRAD, Univ Montpellier, Montpellier, France
| | - Nick Van Reet
- Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Sunyoto T, Adam GK, Atia AM, Hamid Y, Babiker RA, Abdelrahman N, Vander Kelen C, Ritmeijer K, Alcoba G, den Boer M, Picado A, Boelaert M. " Kala-Azar is a Dishonest Disease": Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan. Am J Trop Med Hyg 2018; 98:1091-1101. [PMID: 29488462 PMCID: PMC5928836 DOI: 10.4269/ajtmh.17-0872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: “shopping around” for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be “hiding,” requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers.
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Affiliation(s)
- Temmy Sunyoto
- Institute of Tropical Medicine, Antwerp, Belgium.,Médecins Sans Frontières Campaign for Access to Medicines, Geneva, Switzerland
| | - Gamal K Adam
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | - Atia M Atia
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | - Yassin Hamid
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | - Rabie Ali Babiker
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | - Nugdalla Abdelrahman
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | | | | | | | - Margriet den Boer
- KalaCORE Consortium, London, United Kingdom.,Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Albert Picado
- ISGlobal, Barcelona Institute of Global Health, Barcelona, Spain
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Matovu E, Kitibwa A, Picado A, Biéler S, Bessell PR, Ndung'u JM. Serological tests for gambiense human African trypanosomiasis detect antibodies in cattle. Parasit Vectors 2017; 10:546. [PMID: 29100526 PMCID: PMC5670715 DOI: 10.1186/s13071-017-2487-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background Serological tests for gambiense human African trypanosomiasis (gHAT) detect antibodies to antigens on the cell surface of bloodstream trypanosomes. As trypanosomes that cause animal African trypanosomiasis (AAT) also express related antigens, we have evaluated two rapid diagnostic tests (RDTs) on cattle in trypanosomiasis endemic and non-endemic regions, to determine whether gHAT serological tests could also be used to screen for AAT. Methods Two RDTs, 1G RDT, made with native antigens, and p2G RDT, made with recombinant antigens, were tested on 121 cattle in a trypanosomiasis-free region, and on 312 cattle from a rhodesiense HAT and AAT endemic region. A subset of samples from the endemic region were also tested with two immune trypanolysis (TL) tests. The sensitivity of the tests was estimated by evaluating the result of the RDT on samples that were positive by both microscopy and internal transcribed spacer (ITS) PCR, whilst specificity was the result of the RDT on samples that were negative by ITS PCR and microscopy, and others from the non-endemic region. Results The specificity of the p2G RDT on cattle from the non-endemic region was 97.5% (95% CI: 93.0–99.2%), compared to only 57.9% (95% CI: 48.9–66.3%) for 1G RDT. The specificities of 1G RDT, p2G RDT and TL on endemic control cattle were 14.6% (95% CI: 9.7–21.5%), 22.6% (95% CI: 16.4–30.3%) and 68.3% (95% CI: 59.6–75.9%), respectively. The sensitivities of the tests on trypanosome positive samples were 85.1% (95% CI: 79.1–89.7%), 89.1% (95% CI: 83.7–93.0%) and 59.3% (95% CI: 51.8–66.4%), respectively. Among the same samples, 51.7% were positive by both TL and the 1G RDT. Conclusions These serological tests detect cross-reacting antibodies in cattle. The p2G RDT based on recombinant antigens had a high specificity in a non-endemic region, while the 1G RDT had a lower specificity, suggesting cross-reactivity with other pathogens. Electronic supplementary material The online version of this article (10.1186/s13071-017-2487-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Enock Matovu
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, Kampala, Uganda.
| | - Annah Kitibwa
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines, Geneva, Switzerland
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines, Geneva, Switzerland
| | | | - Joseph Mathu Ndung'u
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines, Geneva, Switzerland
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Wamboga C, Matovu E, Bessell PR, Picado A, Biéler S, Ndung’u JM. Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda - Moving towards elimination. PLoS One 2017; 12:e0186429. [PMID: 29023573 PMCID: PMC5638538 DOI: 10.1371/journal.pone.0186429] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction The incidence of gambiense human African trypanosomiasis (gHAT) in Uganda has been declining, from 198 cases in 2008, to only 20 in 2012. Interruption of transmission of the disease by early diagnosis and treatment is core to the control and eventual elimination of gHAT. Until recently, the format of available screening tests had restricted screening and diagnosis to central health facilities (passive screening). We describe a novel strategy that is contributing to elimination of gHAT in Uganda through expansion of passive screening to the entire population at risk. Methodology / Principal findings In this strategy, patients who are clinically suspected of having gHAT at primary health facilities are screened using a rapid diagnostic test (RDT), followed by parasitological confirmation at strategically located microscopy centres. For patients who are positive with the RDT and negative by microscopy, blood samples undergo further testing using loop-mediated isothermal amplification (LAMP), a molecular test that detects parasite DNA. LAMP positive patients are considered strong suspects, and are re-evaluated by microscopy. Location and upgrading of facilities to perform microscopy and LAMP was informed by results of georeferencing and characterization of all public healthcare facilities in the 7 gHAT endemic districts in Uganda. Three facilities were upgraded to perform RDTs, microscopy and LAMP, 9 to perform RDTs and microscopy, and 200 to screen patients with RDTs. This reduced the distance that a sick person must travel to be screened for gHAT to a median distance of 2.5km compared to 23km previously. In this strategy, 9 gHAT cases were diagnosed in 2014, and 4 in 2015. Conclusions This enhanced passive screening strategy for gHAT has enabled full coverage of the population at risk, and is being replicated in other gHAT endemic countries. The improvement in case detection is making elimination of the disease in Uganda an imminent possibility.
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Affiliation(s)
| | - Enock Matovu
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | | | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Alonso S, Tachfouti N, Najdi A, Sicuri E, Picado A. Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco. BMJ Glob Health 2017; 2:e000315. [PMID: 29018581 PMCID: PMC5620433 DOI: 10.1136/bmjgh-2017-000315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/15/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction Visceral leishmaniasis (VL) is a neglected parasitic disease with a high fatality rate if left untreated. Endemic in Morocco, as well as in other countries in the Mediterranean basin, VL mainly affects children living in rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow (BM) aspirates is used to diagnose VL and meglumine antimoniate (SB) is the first line of treatment. Less invasive, more efficacious and safer alternatives exist. In this study we estimate the cost-effectiveness of alternative diagnostic-therapeutic algorithms for paediatric VL in Morocco. Methods A decision tree was used to estimate the cost-effectiveness of using BM or rapid diagnostic tests (RDTs) as diagnostic tools and/or SB or two liposomal amphotericin B (L-AmB) regimens: 6-day and 2-day courses to treat VL. Incremental cost-effectiveness ratios, expressed as cost per death averted, were estimated by comparing costs and effectiveness of the alternative algorithms. A threshold analysis evaluated at which price L-AmB became cost-effective compared with current practices. Results Implementing RDT and/or L-AmB treatments would be cost-effective in Morocco according to the WHO thresholds. Introducing the 6-day course L-AmB, current second-line treatment, would be highly cost-effective if L-AmB price was below US$100/phial. The 2-day L-AmB treatment, current standard treatment of paediatric VL in France, is highly cost-effective, with L-AmB at its market price (US$165/phial). Conclusions The results of this study should encourage the implementation of RDT and/or short-course L-AmB treatments for paediatric VL management in Morocco and other North African countries.
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Affiliation(s)
- Sergi Alonso
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelon, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - Nabil Tachfouti
- Laboratory of Epidemiology, clinical Research and Community Health, Sidi Mohamed Ben Abdillah University, Fez, Morocco
| | - Adil Najdi
- Laboratory of Epidemiology, clinical Research and Community Health, Sidi Mohamed Ben Abdillah University, Fez, Morocco.,School of Medicine of Tangier, Tangier, Morocco
| | - Elisa Sicuri
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelon, Barcelona, Spain.,Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Albert Picado
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelon, Barcelona, Spain.,Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Besuschio SA, Llano Murcia M, Benatar AF, Monnerat S, Cruz I, Picado A, Curto MDLÁ, Kubota Y, Wehrendt DP, Pavia P, Mori Y, Puerta C, Ndung'u JM, Schijman AG. Analytical sensitivity and specificity of a loop-mediated isothermal amplification (LAMP) kit prototype for detection of Trypanosoma cruzi DNA in human blood samples. PLoS Negl Trop Dis 2017; 11:e0005779. [PMID: 28727723 PMCID: PMC5544240 DOI: 10.1371/journal.pntd.0005779] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [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: 12/01/2016] [Revised: 08/04/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023] Open
Abstract
This study aimed to assess analytical parameters of a prototype LAMP kit that was designed for detection of Trypanosoma cruzi DNA in human blood. The prototype is based on the amplification of the highly repetitive satellite sequence of T.cruzi in microtubes containing dried reagents on the inside of the caps. The reaction is carried out at 65°C during 40 minutes. Calcein allows direct detection of amplified products with the naked eye. Inclusivity and selectivity were tested in purified DNA from Trypanosoma cruzi stocks belonging to the six discrete typing units (DTUs), in DNA from other protozoan parasites and in human DNA. Analytical sensitivity was estimated in serial dilutions of DNA samples from Sylvio X10 (Tc I) and CL Brener (Tc VI) stocks, as well as from EDTA-treated or heparinized blood samples spiked with known amounts of cultured epimastigotes (CL Brener). LAMP sensitivity was compared after DNA extraction using commercial fiberglass columns or after “Boil & Spin” rapid preparation. Moreover, the same DNA and EDTA-blood spiked samples were subjected to standardized qPCR based on the satellite DNA sequence for comparative purposes. A panel of peripheral blood specimens belonging to Chagas disease patients, including acute, congenital, chronic and reactivated cases (N = 23), as well as seronegative controls (N = 10) were evaluated by LAMP in comparison to qPCR. LAMP was able to amplify DNAs from T. cruzi stocks representative of the six DTUs, whereas it did not amplify DNAs from Leishmania sp, T. brucei sp, T. rangeli KPN+ and KPN-, P. falciparum and non-infected human DNA. Analytical sensitivity was 1x10-2 fg/μL of both CL Brener and Sylvio X10 DNAs, whereas qPCR detected up to 1x 10−1 fg/μL of CL Brener DNA and 1 fg/μl of Sylvio X10 DNA. LAMP detected 1x10-2 parasite equivalents/mL in spiked EDTA blood and 1x10-1 par.eq/mL in spiked heparinized blood using fiberglass columns for DNA extraction, whereas qPCR detected 1x10-2 par.eq./mL in EDTA blood. Boil & Spin extraction allowed detection of 1x10-2 par.eq /mL in spiked EDTA blood and 1 par.eq/ml in heparinized blood. LAMP was able to detect T.cruzi infection in peripheral blood samples collected from well-characterised seropositive patients, including acute, congenital, chronic and reactivated Chagas disease. To our knowledge, this is the first report of a prototype LAMP kit with appropriate analytical sensitivity for diagnosis of Chagas disease patients, and potentially useful for monitoring treatment response. Trypanosoma cruzi, a parasite transmitted to humans from hematophagous insects, causes Chagas Disease, a Neglected Tropical Disease with public health impact, affecting 7 million people in Latin America. Although mainly related to low income populations inhabiting rural environments, migrations have conveyed Chagas Disease to urban areas of endemic and non-endemic countries. It often presents non-specific symptoms, and direct, low cost microscopy-based diagnosis only detects acute infections, missing a high proportion of cases. Serology is the “gold standard” diagnostic technique for chronic stages and needs the concordance of at least two different assays to confirm infection. In this context, we aimed to evaluate the analytical sensitivity and specificity of a prototype kit based on a novel and rapid molecular biology reaction, named Loop mediated isothermal amplification (LAMP), using standardized Real Time PCR as a comparator. To our knowledge, this is the first LAMP prototype kit with an analytical performance appropriate for human diagnosis of Chagas disease and potentially useful for monitoring treatment response. Its simple handling using basic laboratory devices will enable point-of-care diagnosis and screening for congenital infection at birth as well as early detection of acute infections due to oral contamination.
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Affiliation(s)
- Susana A. Besuschio
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular – Consejo Nacional de Investigaciones Científicas y Tecnológicas (INGEBI-CONICET), Buenos Aires Argentina
| | - Mónica Llano Murcia
- Laboratorio de Parasitología Molecular, Facultad de Ciencias -Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Alejandro F. Benatar
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular – Consejo Nacional de Investigaciones Científicas y Tecnológicas (INGEBI-CONICET), Buenos Aires Argentina
| | | | - Israel Cruz
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - María de los Ángeles Curto
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular – Consejo Nacional de Investigaciones Científicas y Tecnológicas (INGEBI-CONICET), Buenos Aires Argentina
| | | | - Diana P. Wehrendt
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular – Consejo Nacional de Investigaciones Científicas y Tecnológicas (INGEBI-CONICET), Buenos Aires Argentina
| | - Paula Pavia
- Laboratorio de Parasitología Molecular, Facultad de Ciencias -Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Concepción Puerta
- Laboratorio de Parasitología Molecular, Facultad de Ciencias -Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Alejandro G. Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular – Consejo Nacional de Investigaciones Científicas y Tecnológicas (INGEBI-CONICET), Buenos Aires Argentina
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Loza A, Talaga A, Herbas G, Canaviri RJ, Cahuasiri T, Luck L, Guibarra A, Goncalves R, Pereira JA, Gomez SA, Picado A, Messenger LA, Bern C, Courtenay O. Systemic insecticide treatment of the canine reservoir of Trypanosoma cruzi induces high levels of lethality in Triatoma infestans, a principal vector of Chagas disease. Parasit Vectors 2017; 10:344. [PMID: 28724448 PMCID: PMC5518140 DOI: 10.1186/s13071-017-2278-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite large-scale reductions in Chagas disease prevalence across Central and South America, Trypanosoma cruzi infection remains a considerable public health problem in the Gran Chaco region where vector-borne transmission persists. In these communities, peridomestic animals are major blood-meal sources for triatomines, and household presence of infected dogs increases T. cruzi transmission risk for humans. To address the pressing need for field-friendly, complementary methods to reduce triatomine infestation and interrupt T. cruzi transmission, this study evaluated the systemic activity of three commercial, oral, single dose insecticides Fluralaner (Bravecto®), Afoxolaner (NexGard®) and Spinosad (Comfortis®) in canine feed-through assays against Triatoma infestans, the principal domestic vector species in the Southern Cone of South America. METHODS Twelve healthy, outbred dogs were recruited from the Zoonosis Surveillance and Control Program in Santa Cruz, Bolivia, and randomized to three treatment groups, each containing one control and three treated dogs. Following oral drug administration, colony-reared second and third stage T. infestans instars were offered to feed on dogs for 30 min at 2, 7, 21, 34 and 51 days post-treatment. RESULTS Eighty-five per cent (768/907) of T. infestans successfully blood-fed during bioassays, with significantly higher proportions of bugs becoming fully-engorged when exposed to Bravecto® treated dogs (P < 0.001) for reasons unknown. Exposure to Bravecto® or NexGard® induced 100% triatomine mortality in fully- or semi-engorged bugs within 5 days of feeding for the entire follow-up period. The lethality effect for Comfortis® was much lower (50-70%) and declined almost entirely after 51 days. Instead Comfortis® treatment resulted in substantial morbidity; of these, 30% fully recovered whereas 53% remained morbid after 120 h, the latter subsequently unable to feed 30 days later. CONCLUSIONS A single oral dose of Fluralaner or Afoxolaner was safe and well tolerated, producing complete triatomine mortality on treated dogs over 7.3 weeks. While both drugs were highly efficacious, more bugs exposed to Fluralaner took complete blood-meals, and experienced rapid knock-down. Coupled with its longer residual activity, Fluralaner represents an ideal insecticide for development into a complementary, operationally-feasible, community-level method of reducing triatomine infestation and potentially controlling T. cruzi transmission, in the Gran Chaco region.
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Affiliation(s)
- Ariel Loza
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Adrianna Talaga
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Gladys Herbas
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Ruben Jair Canaviri
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Thalia Cahuasiri
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Laura Luck
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Alvaro Guibarra
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Raquel Goncalves
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Juan Antonio Pereira
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Sonia A Gomez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clinic - Universitat de Barcelona, Rosello 132, 08036, Barcelona, Spain
| | - Albert Picado
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clinic - Universitat de Barcelona, Rosello 132, 08036, Barcelona, Spain
| | | | - Caryn Bern
- University of California-San Francisco, 550 16th St, 94158, San Francisco, CA, USA
| | - Orin Courtenay
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
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Abstract
Zoonotic visceral leishmaniasis (ZVL) is a public health problem endemic in some countries. Current control measures, in particular culling infected dogs, have not reduced ZVL incidence in humans. We evaluated the use of five systemic insecticides (spinosad, fluralaner, afoxolaner, sarolaner and moxidectin) currently used in dogs for other purposes (e.g. tick, flea control) in controlling ZVL transmission. The anti-phlebotomine capacity of these compounds confirmed in experimental studies makes their use in ZVL control programmes very promising. Limitations and benefits of using this new control tool are compared to current practices.
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Affiliation(s)
| | - Albert Picado
- Barcelona Institute for Global Health, Barcelona, Spain
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Pinazo MJ, Aldasoro E, Calvo-Cano A, Picado A, Muñoz J, Gascon J. Blood and Tissue Protozoa. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Picado A, Angheben A, Marchiol A, Alarcón de Noya B, Flevaud L, Pinazo MJ, Gállego M, Meymandi S, Moriana S. Development of Diagnostics for Chagas Disease: Where Should We Put Our Limited Resources? PLoS Negl Trop Dis 2017; 11:e0005148. [PMID: 28056025 PMCID: PMC5221646 DOI: 10.1371/journal.pntd.0005148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Andrea Angheben
- Centre for Tropical Diseases, Hospital Sacro Cuore, Don Calabria, Negrar, Verona, Italy
| | - Andrea Marchiol
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Belkisyolé Alarcón de Noya
- Immunology Section, Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Laurence Flevaud
- Médecins Sans Frontières Operational Centre Barcelona-Athens (MSF OCBA), Barcelona, Spain
| | - Maria Jesus Pinazo
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Gállego
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Sheba Meymandi
- Department of Cardiology, Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California, United States of America
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Abrahamian FM, Aldape MJ, Aldasoro E, Allen UD, Al-Sum H, Anadkat MJ, Anders K, Angelakis E, Angus BJ, Antoniadou A, Arena F, Arends JE, Arribas JR, Artenstein AW, Atherton JC, Aucott JN, Aw TC, Babcock HM, Bailey R, Bailey TC, Banks AZ, Barillo DJ, Barrette EP, Bauer MP, Bayston R, Beard CB, Beardsley J, Beeching NJ, Bégué RE, Beldi G, Benson CA, Berbari EF, Berenger JM, Berger C, Bernardino JI, Bille J, Billioux AC, Bitnun A, Blair I, Blanche S, Bleck TP, Bleeker-Rovers CP, Bleijenberg G, Bloch KC, Blum J, Blumberg EA, Bonomo RA, Bonten MJ, Bourayou R, Bouza E, Brandt KA, Bretelle F, Brisse S, Britton WJ, Brook I, Brouwer MC, Browne SK, Bryant AE, Bühler S, Bulger EM, Buller RML, Burke LA, Burri C, Butler MW, Calandra T, Calfee DP, Calvo-Cano A, Cameron DW, Carcillo JA, Carson G, Chambers ST, Charrel RN, Nguyen VCV, Chevaliez S, Chiller TM, Christaki E, Chung KK, Clifford DB, Clumeck N, Cohen J, Collinge J, Conlon CP, Conrad C, Cooke FJ, Cope JR, Corey GR, Cross JH, Cunha BA, Cunha CB, D'Journo B, Daikos GL, Daniels JM, Davidson RN, Day NP, De Cock KM, de Silva TI, de Vries HJ, de Wit S, Delaloye J, Denning DW, Dennis DT, Dhanireddy S, Dielubanza EJ, Diemert DJ, Doganay M, Doherty T, Dolecek C, Dondorp AM, Douglas A, Drancourt M, Dubourg G, Dudley MN, Durand G, Eckhardt BJ, Efstratiou A, Ekkelenkamp MB, Eranki A, Erdem H, Escota GV, Evans HL, Eziefula AC, Fenollar F, Fenwick A, Fierer J, Finch RG, Fleckenstein JM, Forstner C, Foschi F, Fournier PE, French MA, Gage KL, Garcia LS, Gascon J, Gastañaduy AS, Gautret P, Geisler WM, Ghanem KG, Giani T, Giannella M, Gilliam BL, Gilliet M, Glaser CA, Glupczynski Y, Gnann JW, Goldstein EJ, Gottstein B, Gouriet F, Gravitt PE, Green MD, Green ST, Groll AH, Gulick RM, Gupta A, Habib G, Harbarth S, Harris M, Hayden FG, Hetem DJ, Hill PC, Hirschel B, Hodowanec AC, Hoffart L, Hoffmann C, Holland SM, Horby PW, Horne DJ, Hraiech S, Hull MW, Huttner A, Ingram RJ, Islam J, Ison MG, James SH, Jenkins C, Jenkins SG, Jensen JS, Johnston C, Jones TB, Jordan SJ, Julian KG, Kato Y, Kauffman CA, Kaye KS, Keane MP, Keeney J, Kelly P, Kent SJ, Kern WV, Keynan Y, Kim AA, Koné-Paut I, Kosmidis C, Kroes AC, Kroon FP, Ksiazek TG, Kuhlmann FM, Kuijper EJ, Kwon JH, Kyei GB, Lacombe K, Lagacé-Wiens P, Lagier JC, Lamagni T, Landraud L, Lanternier F, LaPlante KL, Lawn SD, Lawrence SJ, Leblebicioglu H, Lee N, Leggett JE, Lehours P, Levy PY, Leyh RG, Lillis RA, Limmathurotsakul D, Lin J, Lindquist HA, Lipsky BA, Liscynesky C, Looney D, Lortholary O, Lowy FD, Luft BJ, Mackowiak PA, MacPherson PA, Maghraoui-Slim V, Mallon PW, Mangino JE, Manuel O, Marchetti O, Marks KM, Marr KA, Marrazzo J, Marschall J, Martin DH, Matonti F, Matulewicz RS, Mayer KH, McCulloh RJ, McGready R, Mdodo R, Mead S, Mégraud F, Meintjes G, Metcalf SC, Michaels MG, Migliori GB, Miles MA, Miller A, Mimiaga MJ, Mingeot-Leclercq MP, Misch EA, Mitreva M, Montaner JS, Moore CB, Muñoz P, Muñoz J, Murray CK, Musso D, Mutengo M, Mutizwa MM, Naber KG, Natarajan P, Neme S, Newton PN, Nichols RA, Nicolle LE, Nosten F, Notarangelo LD, Nutman TB, Nyirjesy P, O'Connell PR, Opal SM, Ormerod LP, Osmon DR, Pankert MB, Pantaleo G, Papazian L, Parente DM, Parola P, Parsaei S, Pascual MA, Patel R, Patrozou E, Pawlotsky JM, Peacock SJ, Pechère JC, Pelegrin I, Peters BS, Peters EJ, Petersen JM, Petersen LR, Petraitis V, Pham LL, Picado A, Pilatz A, Pilmis B, Pinazo MJ, Pletz MW, Pogue JM, Polgreen EL, Polgreen PM, Posfay-Barbe KM, Powderly WG, Presti R, Prod'hom G, Puolakkainen M, Quinn TC, Raoult D, Razonable RR, Read RC, Redfield RR, Rentenaar RJ, Reynolds SJ, Ribi C, Richardson MD, Ritter ML, Roch A, Rockstroh JK, Rojek A, Romero JR, Rooijakkers SH, Rosenbluth D, Rosenzweig SD, Rossolini GM, Rubinstein E, Ryan G, Safren SA, Sahasrabuddhe VV, Saikku PA, Sajadi MM, Salvaggio MR, Santos CA, Satlin MJ, Schaeffer AJ, Schimmer C, Schooley RT, Schumacher RF, Sha BE, Shapiro DS, Sheehan G, Shlaes DM, Shoham S, Simmons CP, Simon DW, Simon MS, Simonsen KA, Slack MP, Smith TT, Sobel JD, Souli M, Sridhar S, Steckelberg JM, Stevens DL, Strah H, Sturm AW, Sungkanuparph S, Tabrizi SJ, Tacconelli E, Tan CS, Taplitz RA, Thomas G, Thomas LD, Thuny F, Thwaites G, Tissot F, Tønjum T, Torriani FJ, Toso C, Tulkens PM, Tunkel AR, Turner CE, Ustianowski AP, van Bambeke F, van Crevel R, van de Beek D, van Delden C, van der Eerden MM, van der Meer JW, van der Poll T, van Ingen J, van Putten J, Vaudaux BP, Vermund SH, Viscidi RP, Visvanathan K, Visvesvara GS, von Seidlein L, Wagenlehner FM, Wald A, Walsh TJ, Warhurst DC, Warnock DW, Warrell DA, Warrell MJ, Warris A, Watkins RR, Weatherall DJ, Weber R, Weidner W, White JR, White PJ, Whitehorn J, Whitley RJ, Whitty CJ, Wiersinga WJ, Wilcox MH, Williams TN, Wilson CC, Wilson ME, Wisplinghoff H, Wood R, Wunderink RG, Wyles D, Yang ZT, Yoder JS, Zaidi NA, Zimmer AJ, Zuckerman JN, Zumla A. List of Contributors. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lladró S, Picado A, Ballart C, Portús M, Gállego M. Management, prevention and treatment of canine leishmaniosis in north-eastern Spain: an online questionnaire-based survey in the province of Girona with special emphasis on new preventive methods (CaniLeish vaccine and domperidone). Vet Rec 2016; 180:47. [PMID: 27895289 DOI: 10.1136/vr.103653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 11/04/2022]
Abstract
Knowledge of how canine leishmaniosis (CanL) is being managed clinically and its epidemiology is very important, since dogs are the main reservoir of human leishmaniosis. This study reports the results obtained through a questionnaire-based survey of veterinary practitioners in Girona province, a recognised, but non-documented endemic area in north-eastern Spain. The primary objective was to obtain data on the clinical management of CanL, focusing particularly on new preventive methods and therapeutic tools. The results show an extensive routine management of CanL cases and a widespread use of the CaniLeish (Virbac) vaccine and domperidone (Leisguard, Esteve). Adverse reactions were detected by a vast majority of the vaccine users (82 per cent), the most frequent being local reactions, apathy, fever and gastroenteritis. All the respondents had treated confirmed cases, and the therapeutic protocol most used was the combination of meglumine antimoniate (Glucantime, Merial) and allopurinol (Zyloric, GlaxoSmithKline).
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Affiliation(s)
- S Lladró
- Section of Parasitology, Department of Biology, Healthcare and the Environment, Faculty of Pharmacy, Universitat de Barcelona, Avda. Joan XXIII 27-31, 08028 Barcelona, Spain
| | - A Picado
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - C Ballart
- Section of Parasitology, Department of Biology, Healthcare and the Environment, Faculty of Pharmacy, Universitat de Barcelona, Avda. Joan XXIII 27-31, 08028 Barcelona, Spain
| | - M Portús
- Section of Parasitology, Department of Biology, Healthcare and the Environment, Faculty of Pharmacy, Universitat de Barcelona, Avda. Joan XXIII 27-31, 08028 Barcelona, Spain
| | - M Gállego
- Section of Parasitology, Department of Biology, Healthcare and the Environment, Faculty of Pharmacy, Universitat de Barcelona, Avda. Joan XXIII 27-31, 08028 Barcelona, Spain
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Castellarnau M, Ramón-Azcón J, Gonzalez-Quinteiro Y, López JF, Grimalt JO, Marco MP, Nieuwenhuijsen M, Picado A. Assessment of analytical methods to determine pyrethroids content of bednets. Trop Med Int Health 2016; 22:41-51. [PMID: 27717143 DOI: 10.1111/tmi.12794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present and evaluate simple, cost-effective tests to determine the amount of insecticide on treated materials. METHODS We developed and evaluated a competitive immunoassay on two different platforms: a label-free impedimetric biosensor (EIS biosensor) and a lateral flow. Both approaches were validated by gas chromatography (GC) and ELISA, gold standards for analytical methods and immunoassays, respectively. Finally, commercially available pyrethroid-treated ITN samples were analysed. Different extraction methods were evaluated. RESULTS Insecticide extraction by direct infusion of the ITN samples with dichloromethane and dioxane showed recovery efficiencies around 100% for insecticide-coated bednets, and >70% for insecticide-incorporated bednets. These results were comparable to those obtained with standard sonication methods. The competitive immunoassay characterisation with ELISA presented a dynamic range between 12 nm and 1.5 μm (coefficient of variation (CV) below 5%), with an IC50 at 138 nm, and a limit of detection (LOD) of 3.2 nm. EIS biosensor had a linear range between 1.7 nm and 61 nm (CV around 14%), with an IC50 at 10.4 nm, and a LOD of 0.6 nm. Finally, the lateral flow approach showed a dynamic range between 150 nm and 1.5 μm, an IC50 at 505 nm and a LOD of 67 nm. CONCLUSIONS ELISA can replace chromatography as an accurate laboratory technique to determine insecticide concentration in bednets. The lateral flow approach developed can be used to estimate ITN insecticide concentration in the field. This new technology, coupled to the new extraction methods, should provide reliable guidelines for ITN use and replacement in the field.
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Affiliation(s)
- Marc Castellarnau
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Javier Ramón-Azcón
- Nanobiotechnology for Diagnostics, Institute for Advanced Chemistry of Catalonia of the Spanish Council for Scientific Research, Barcelona, Spain.,CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | | | - Jordi F López
- Institute of Environmental Assessment and Water Research, Barcelona, Spain
| | - Joan O Grimalt
- Institute of Environmental Assessment and Water Research, Barcelona, Spain
| | - María-Pilar Marco
- Nanobiotechnology for Diagnostics, Institute for Advanced Chemistry of Catalonia of the Spanish Council for Scientific Research, Barcelona, Spain.,CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | - Mark Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Albert Picado
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Tachfouti N, Najdi A, Alonso S, Sicuri E, Laamrani El Idrissi A, Nejjari C, Picado A. Cost of Pediatric Visceral Leishmaniasis Care in Morocco. PLoS One 2016; 11:e0155482. [PMID: 27257808 PMCID: PMC4892465 DOI: 10.1371/journal.pone.0155482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 04/29/2016] [Indexed: 11/19/2022] Open
Abstract
Background Visceral leishmaniasis (VL) is a neglected parasitic disease that is fatal if left untreated. VL is endemic in Morocco and other countries in North Africa were it mainly affects children from rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow aspirates and serological tests are used to diagnose VL. Glucantime is the first line of treatment. The objective of this study was to report the costs associated to standard clinical management of pediatric VL from the provider perspective in Morocco. As a secondary objective we described the current clinical practices and the epidemiological characteristics of pediatric VL patients. Methods From March to June 2014 we conducted a survey in eight hospitals treating pediatric VL patients in Morocco. A pro-forma was used to collect demographic, clinical and management data from medical records. We specifically collected data on VL diagnosis and treatment. We also estimated the days of hospitalization and the time to start VL treatment. Costs were estimated by multiplying the use of resources in terms of number of days in hospital, tests performed and drugs provided by the official prices. For patients receiving part of their treatment at Primary Health Centers (PHC) we estimated the cost of administering the Glucantime as outpatient. We calculated the median cost per VL patient. We also estimated the cost of managing a VL case when different treatment strategies were applied: inpatient and outpatient. Results We obtained data from 127 VL patients. The median total cost per pediatric VL case in Morocco is 520 US$. The cost in hospitals applying an outpatient strategy is significantly lower (307 US$) than hospitals keeping the patients for the whole treatment (636 US$). However the outpatient strategy is not yet recommended as VL treatment for children in the Moroccan guidelines. VL diagnosis and treatment regimens should be standardized following the current guidelines in Morocco.
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Affiliation(s)
- Nabil Tachfouti
- Laboratory of Epidemiology, clinical Research and Community Health, Faculty of Medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Adil Najdi
- Laboratory of Epidemiology, clinical Research and Community Health, Faculty of Medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Sergi Alonso
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Elisa Sicuri
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | | | - Chakib Nejjari
- Laboratory of Epidemiology, clinical Research and Community Health, Faculty of Medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Ecole Nationale de Santé Publique (ENSP), Ministry of Health, Rabat, Morocco
| | - Albert Picado
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- * E-mail:
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47
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Ballart C, Vidal G, Picado A, Cortez MR, Torrico F, Torrico MC, Godoy RE, Lozano D, Gállego M. Intradomiciliary and peridomiciliary captures of sand flies (Diptera: Psychodidae) in the leishmaniasis endemic area of Chapare province, tropic of Cochabamba, Bolivia. Acta Trop 2016; 154:121-4. [PMID: 26608724 DOI: 10.1016/j.actatropica.2015.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/01/2015] [Revised: 11/02/2015] [Accepted: 11/13/2015] [Indexed: 11/17/2022]
Abstract
In South America, cutaneous leishmaniasis is the most frequent clinical form of leishmaniasis. Bolivia is one of the countries with higher incidence, with 33 cases per 100,000 individuals, and the disease is endemic in 70% of the territory. In the last decade, the number of cases has increased, the age range has expanded, affecting children under 5 years old, and a similar frequency between men and women is found. An entomological study with CDC light traps was conducted in three localities (Chipiriri, Santa Elena and Pedro Domingo Murillo) of the municipality of Villa Tunari, one of the main towns in the Chapare province (Department of Cochabamba, Bolivia). A total of 16 specimens belonging to 6 species of the genus Lutzomyia were captured: Lu. aragaoi, Lu. andersoni, Lu. antunesi, Lu. shawi, Lu. yuilli yuilli and Lu. auraensis. Our results showed the presence of two incriminated vectors of leishmaniasis in an urbanized area and in the intradomicile. More entomological studies are required in the Chapare province to confirm the role of vector sand flies, the intradomiciliary transmission of the disease and the presence of autochthonous cases of cutaneous leishmaniasis.
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Affiliation(s)
- C Ballart
- Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - G Vidal
- CEADES Salud y Medio Ambiente, Cochabamba, Bolivia
| | - A Picado
- Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M R Cortez
- CEADES Salud y Medio Ambiente, Cochabamba, Bolivia
| | - F Torrico
- CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Facultad de Medicina, Universidad Mayor de San Simón (U.M.S.S.), Cochabamba, Bolivia
| | - M C Torrico
- CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Facultad de Medicina, Universidad Mayor de San Simón (U.M.S.S.), Cochabamba, Bolivia
| | - R E Godoy
- Laboratório de Transmissores de Leishmanioses, Laboratório de Referência em Vigilância Entomológica: Taxonomia e Ecologia de Vetores das Leishmanioses, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - D Lozano
- CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Facultad de Medicina, Universidad Mayor de San Simón (U.M.S.S.), Cochabamba, Bolivia
| | - M Gállego
- Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
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48
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Cameron MM, Acosta-Serrano A, Bern C, Boelaert M, den Boer M, Burza S, Chapman LAC, Chaskopoulou A, Coleman M, Courtenay O, Croft S, Das P, Dilger E, Foster G, Garlapati R, Haines L, Harris A, Hemingway J, Hollingsworth TD, Jervis S, Medley G, Miles M, Paine M, Picado A, Poché R, Ready P, Rogers M, Rowland M, Sundar S, de Vlas SJ, Weetman D. Understanding the transmission dynamics of Leishmania donovani to provide robust evidence for interventions to eliminate visceral leishmaniasis in Bihar, India. Parasit Vectors 2016; 9:25. [PMID: 26812963 PMCID: PMC4729074 DOI: 10.1186/s13071-016-1309-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/15/2016] [Indexed: 12/31/2022] Open
Abstract
Visceral Leishmaniasis (VL) is a neglected vector-borne disease. In India, it is transmitted to humans by Leishmania donovani-infected Phlebotomus argentipes sand flies. In 2005, VL was targeted for elimination by the governments of India, Nepal and Bangladesh by 2015. The elimination strategy consists of rapid case detection, treatment of VL cases and vector control using indoor residual spraying (IRS). However, to achieve sustained elimination of VL, an appropriate post elimination surveillance programme should be designed, and crucial knowledge gaps in vector bionomics, human infection and transmission need to be addressed. This review examines the outstanding knowledge gaps, specifically in the context of Bihar State, India.The knowledge gaps in vector bionomics that will be of immediate benefit to current control operations include better estimates of human biting rates and natural infection rates of P. argentipes, with L. donovani, and how these vary spatially, temporally and in response to IRS. The relative importance of indoor and outdoor transmission, and how P. argentipes disperse, are also unknown. With respect to human transmission it is important to use a range of diagnostic tools to distinguish individuals in endemic communities into those who: 1) are to going to progress to clinical VL, 2) are immune/refractory to infection and 3) have had past exposure to sand flies.It is crucial to keep in mind that close to elimination, and post-elimination, VL cases will become infrequent, so it is vital to define what the surveillance programme should target and how it should be designed to prevent resurgence. Therefore, a better understanding of the transmission dynamics of VL, in particular of how rates of infection in humans and sand flies vary as functions of each other, is required to guide VL elimination efforts and ensure sustained elimination in the Indian subcontinent. By collecting contemporary entomological and human data in the same geographical locations, more precise epidemiological models can be produced. The suite of data collected can also be used to inform the national programme if supplementary vector control tools, in addition to IRS, are required to address the issues of people sleeping outside.
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Affiliation(s)
- Mary M Cameron
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | - Caryn Bern
- UCSF School of Medicine, 550 16th Street, San Francisco, 94158, CA, USA.
| | | | | | - Sakib Burza
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | - Alexandra Chaskopoulou
- European Biological Control Laboratory, USDA-ARS, Tsimiski 43 Street, Thessaloniki, 54623, Greece.
| | - Michael Coleman
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Orin Courtenay
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
| | - Simon Croft
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India.
| | - Erin Dilger
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
| | - Geraldine Foster
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Lee Haines
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Janet Hemingway
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Sarah Jervis
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
| | - Graham Medley
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Michael Miles
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Mark Paine
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Albert Picado
- FIND, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland.
| | - Richard Poché
- Genesis Laboratories, Inc., Wellington, CO, 80549, USA.
| | - Paul Ready
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Matthew Rogers
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Mark Rowland
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - David Weetman
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Picado A, Ostyn B, Rijal S, Sundar S, Singh SP, Chappuis F, Das ML, Khanal B, Gidwani K, Hasker E, Dujardin JC, Vanlerberghe V, Menten J, Coosemans M, Boelaert M. Long-lasting insecticidal nets to prevent visceral leishmaniasis in the Indian subcontinent; methodological lessons learned from a cluster randomised controlled trial. PLoS Negl Trop Dis 2015; 9:e0003597. [PMID: 25856238 PMCID: PMC4391877 DOI: 10.1371/journal.pntd.0003597] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Albert Picado
- ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Bart Ostyn
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Suman Rijal
- Department of Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shri Prakash Singh
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Murari Lal Das
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Basudha Khanal
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kamlesh Gidwani
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Veerle Vanlerberghe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joris Menten
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marc Coosemans
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
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50
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Perry MR, Prajapati VK, Menten J, Raab A, Feldmann J, Chakraborti D, Sundar S, Fairlamb AH, Boelaert M, Picado A. Arsenic exposure and outcomes of antimonial treatment in visceral leishmaniasis patients in Bihar, India: a retrospective cohort study. PLoS Negl Trop Dis 2015; 9:e0003518. [PMID: 25730310 PMCID: PMC4346263 DOI: 10.1371/journal.pntd.0003518] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/05/2015] [Indexed: 11/22/2022] Open
Abstract
Background In the late twentieth century, emergence of high rates of treatment failure with antimonial compounds (SSG) for visceral leishmaniasis (VL) caused a public health crisis in Bihar, India. We hypothesize that exposure to arsenic through drinking contaminated groundwater may be associated with SSG treatment failure due to the development of antimony-resistant parasites. Methods A retrospective cohort design was employed, as antimony treatment is no longer in routine use. The study was performed on patients treated with SSG between 2006 and 2010. Outcomes of treatment were assessed through a field questionnaire and treatment failure used as a proxy for parasite resistance. Arsenic exposure was quantified through analysis of 5 water samples from within and surrounding the patient’s home. A logistic regression model was used to evaluate the association between arsenic exposure and treatment failure. In a secondary analysis survival curves and Cox regression models were applied to assess the risk of mortality in VL patients exposed to arsenic. Results One hundred and ten VL patients treated with SSG were analysed. The failure rate with SSG was 59%. Patients with high mean local arsenic level had a non-statistically significant higher risk of treatment failure (OR = 1.78, 95% CI: 0.7–4.6, p = 0.23) than patients using wells with arsenic concentration <10 μg/L. Twenty one patients died in our cohort, 16 directly as a result of VL. Arsenic levels ≥ 10 μg/L increased the risk of all-cause (HR 3.27; 95% CI: 1.4–8.1) and VL related (HR 2.65; 95% CI: 0.96–7.65) deaths. This was time dependent: 3 months post VL symptom development, elevated risks of all-cause mortality (HR 8.56; 95% CI: 2.5–29.1) and of VL related mortality (HR 9.27; 95% CI: 1.8–49.0) were detected. Discussion/Conclusion This study indicates a trend towards increased treatment failure in arsenic exposed patients. The limitations of the retrospective study design may have masked a strong association between arsenic exposure and selection for antimonial resistance in the field. The unanticipated strong correlation between arsenic exposure and VL mortality warrants further investigation. The parasitic disease visceral leishmaniasis (VL) causes a significant burden of illness and death in India. The main drug used to treat VL, which is based on the chemical element antimony, stopped working well in about half of all patients in the late twentieth century. We hypothesised that arsenic exposure of the Indian population, through contaminated groundwater, was contributing to treatment failure with antimony based drugs. Arsenic and antimony are similar chemical elements and exposure of the parasite to arsenic within the liver of arsenic-exposed patients could allow the parasite to become resistant to treatment with antimony. Using a field-based questionnaire study we retrospectively evaluated whether arsenic exposure was linked to antimonial treatment failure in a cohort of 110 antimonial treated patients. No significant association was found, although this may be because the number of patients in the study was low as antimony use was officially discontinued in 2005 due to high rates of treatment failure. However, arsenic exposure was found to increase risk of mortality from VL particularly if death occurred more than 3 months after the symptoms of VL developed. More research into the relationship between arsenic exposure and mortality in VL is warranted.
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Affiliation(s)
- Meghan R. Perry
- Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee, Dundee, Scotland, United Kingdom
| | - Vijay K. Prajapati
- Department of Biochemistry, Central University of Rajasthan, Bandarsindri, Kishangrah, Ajmer, Rajasthan, India
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Joris Menten
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Andrea Raab
- College of Physical Sciences—Chemistry, Trace Element Speciation Laboratory, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Joerg Feldmann
- College of Physical Sciences—Chemistry, Trace Element Speciation Laboratory, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | | | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Alan H. Fairlamb
- Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee, Dundee, Scotland, United Kingdom
- * E-mail:
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Albert Picado
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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