1
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Todeschini R, Musti MA, Pandolfi P, Troncatti M, Baldini M, Resi D, Natalini S, Bergamini F, Galletti G, Santi A, Rossi A, Rugna G, Granozzi B, Attard L, Gaspari V, Liguori G, Ortalli M, Varani S. Re-emergence of human leishmaniasis in northern Italy, 2004 to 2022: a retrospective analysis. Euro Surveill 2024; 29:2300190. [PMID: 38275016 PMCID: PMC10986649 DOI: 10.2807/1560-7917.es.2024.29.4.2300190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/07/2023] [Indexed: 01/27/2024] Open
Abstract
BackgroundHuman leishmaniasis is a protozoan disease transmitted by sand flies and endemic in the Mediterranean region. In Italy, leishmaniasis is present in the south and the western coastal regions, with an epidemic peak detected in northern Italy in the early 1970s.AimTo examine temporal trends, and demographic, clinical, geographical and environmental features of human leishmaniasis cases recorded by the local health unit (LHU) of Bologna, northern Italy.MethodsIn this retrospective observational study, we analysed human leishmaniasis cases recorded from 2004 to 2022 within the Bologna LHU. We also conducted serological investigations for canine leishmaniasis in owned dogs living near the place of infection of human cases.ResultsIn total, 173 cases of human leishmaniasis were detected, and 154 cases were considered autochthonous. An increase of human cases was observed since 2004, with incidence peaks above 2 cases/100,000 inhabitants in 2013, 2018 and 2022; epidemic peaks were preceded by dry summers. Most cases lived in the plain and hilly areas less than 400 m above sea level and many resided in isolated housing, in city outskirts, and/or near uncultivated areas, watercourses and railway sections. The incidence of canine leishmaniasis did not increase in the study period.ConclusionAn epidemic of human leishmaniasis with fluctuating annual numbers of cases, probably related to environmental and climatic factors, was identified in the Bologna LHU. Understanding the risk factors and the environmental characteristics related to places of infection is crucial to evaluate the public health implications of leishmaniasis.
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Affiliation(s)
| | | | - Paolo Pandolfi
- Department of Public Health, AUSL Bologna, Bologna, Italy
| | | | - Morena Baldini
- Department of Public Health, AUSL Bologna, Bologna, Italy
| | - Davide Resi
- Department of Public Health, AUSL Bologna, Bologna, Italy
| | | | - Federica Bergamini
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy
| | - Giorgio Galletti
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy
| | - Annalisa Santi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy
| | - Arianna Rossi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy
| | - Gianluca Rugna
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy
| | - Bianca Granozzi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luciano Attard
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valeria Gaspari
- Unit of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanna Liguori
- Department of Medical and Surgical Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Margherita Ortalli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefania Varani
- Department of Medical and Surgical Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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2
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Zaghi I, Ielasi L, Stagni B, Cascavilla A, Ferri S, Ambrosini V, Riefolo M, Varani S. A case of Leishmania infection with focal splanchnic involvement without systemic symptoms: a potential anti-inflammatory role for vitamin D. Acta Clin Belg 2022:1-4. [DOI: 10.1080/17843286.2022.2145686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- I Zaghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - L Ielasi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B Stagni
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - A Cascavilla
- Division of Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - S Ferri
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - V Ambrosini
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Riefolo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- Pathology Unit, Sant’Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - S Varani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- Unit of Clinical Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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3
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S Lima S, Cavalcante Braz D, Costa Silva V, J C Farias T, Zacarias DA, da Silva JC, Costa CHN, Costa DL. Biomarkers of the early response to treatment of visceral leishmaniasis: A prospective cohort study. Parasite Immunol 2020; 43:e12797. [PMID: 32984951 DOI: 10.1111/pim.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early biomarkers of the response to treatment are lacking and may help to reduce mortality by the vector-borne disease visceral leishmaniasis (VL). METHODS A prospective cohort study was conducted to investigate plasma cytokines and clinical laboratory data as biomarkers of the early response to specific treatment for VL in 36 patients. RESULTS The mean interleukin 6 (IL-6) concentration on the 7th day was 2.3% of the pre-treatment concentration, interleukin 10 (IL-10) was 8.0%, and interleukin 8 (IL-8) was 8.2%. On the 7th day, IL-10 was below half of the pre-treatment concentration in 100.0%, IL-8 in 95.5% and IL-6 in 90.9%. The spleen and liver sizes, haemoglobin, interleukin 1 beta (IL-1β) and tumour necrosis factor alpha (TNF-α) showed a slower recovery. Fever disappeared in 91% on the 7th day, 69.4% had a normal white cell count, and 77.8% had a normal platelet value by this time. CONCLUSIONS The plasma cytokines IL-6, IL-10 and IL-8 were demonstrated to be excellent markers of the early response to VL treatment and if tested before the 7th day, will likely prove to be better than fever measurement.
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Affiliation(s)
- Simone S Lima
- Maternal and Childhood Department, Federal University of Piauí, Teresina, Brazil
| | - Débora Cavalcante Braz
- Pharmacy Course, Federal University of Piauí, Teresina, Brazil.,Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil
| | - Vladimir Costa Silva
- Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil.,Intelligence Center for Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil
| | - Teresinha J C Farias
- Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil
| | - Danielle Alves Zacarias
- Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil
| | | | - Carlos Henrique Nery Costa
- Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil.,Intelligence Center for Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil.,Department of Community Medicine, Federal University of Piauí, Teresina, Brazil
| | - Dorcas Lamounier Costa
- Maternal and Childhood Department, Federal University of Piauí, Teresina, Brazil.,Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil.,Intelligence Center for Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil
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4
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Giorgio S, Gallo-Francisco PH, Roque GAS, Flóro E Silva M. Granulomas in parasitic diseases: the good and the bad. Parasitol Res 2020; 119:3165-3180. [PMID: 32789534 DOI: 10.1007/s00436-020-06841-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/02/2020] [Indexed: 12/12/2022]
Abstract
Parasitic diseases affect more than one billion people worldwide, and most of them are chronic conditions in which the treatment and prevention are difficult. The appearance of granulomas, defined as organized and compact structures of macrophages and other immune cells, during various parasitic diseases is frequent, since these structures will only form when individual immune cells do not control the invading agent. Th2-typering various parasitic diseases are frequent, since these structures will only form when individual immune cells do not control the invading agent. The characterization of granulomas in different parasitic diseases, as well as recent findings in this field, is discussed in this review, in order to understand the significance of the granuloma and its modulation in the host-parasite interaction and in the immune, pathological, and parasitological aspects of this interaction. The parasitic granulomatous diseases granulomatous amebic encephalitis, toxoplasmosis, leishmaniasis, neurocysticercosis, and schistosomiasis mansoni are discussed as well as the mechanistic and dynamical aspects of the infectious granulomas.
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Affiliation(s)
- Selma Giorgio
- Department of Animal Biology, Biology Institute, State University of Campinas, Campinas, 13083-865, Brazil.
| | | | | | - Marina Flóro E Silva
- Department of Animal Biology, Biology Institute, State University of Campinas, Campinas, 13083-865, Brazil
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5
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Lima IS, Solcá MS, Tafuri WL, de Freitas LAR, Dos-Santos WLC. Assessment of histological liver alterations in dogs naturally infected with Leishmania infantum. Parasit Vectors 2019; 12:487. [PMID: 31619264 PMCID: PMC6796381 DOI: 10.1186/s13071-019-3723-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/16/2019] [Indexed: 01/19/2023] Open
Abstract
Background The liver plays a central role in the development of canine visceral leishmaniasis. Studies of natural infection in animals and humans indicate a direct relationship between resolution of infection and the formation and maturation of granulomas in the liver. However, in contrast to other reports in the literature, the present study found no differences in the characteristics of hepatic granulomas that could be related to resistance or susceptibility to Leishmania. Here, we describe the hepatic alterations observed in dogs with differing clinical manifestations of visceral leishmaniasis in an endemic area in the state of Bahia, Brazil. Methods We examined 148 animals in an endemic area. The animals were clinically examined, and the infection was determined by ELISA, spleen aspirate culture and quantitative PCR. The animals were grouped into asymptomatic or symptomatic based on the number of signs of LV. The histological liver evaluation was performed in a blinded way. Results Our results indicated no association between the characteristics of granulomas and clinical presentation. We found an association between the intensity of this inflammatory response and parasite load in the animals’ spleens. It is important to note that while hepatic alterations, such as portal and perivascular inflammation and the presence of larger amounts of granulomas, were linked with higher parasite loads, we found the inverse to be true with respect to intrasinusoidal lymphocytosis, the formation of intrasinusoidal inflammatory cell aggregates and Kupffer cell hypertrophy. Conclusions Our findings suggest that the presence of mononuclear inflammatory cells inside the sinusoids is more important than that of organized granulomas in terms of the containment of parasitism by the host. We suggest that the presence of granulomas indicates the failure of a first line of defense mechanism in the control of parasite infection, which could be related to the presence of inflammatory cells and Kupffer cell hypertrophy inside the sinusoids. We further demonstrated that dogs with active Leishmania spp. infection present a higher frequency of inflammatory changes in the liver. In addition to being correlated with the severity of clinical manifestation, these hepatic alterations were also associated with changes in hematological and biochemical parameters.
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Affiliation(s)
- Isadora S Lima
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.
| | - Manuela S Solcá
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | - Wagner L Tafuri
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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6
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Evaluation of methods for detection of asymptomatic individuals infected with Leishmania infantum in the state of Piauí, Brazil. PLoS Negl Trop Dis 2019; 13:e0007493. [PMID: 31260440 PMCID: PMC6625727 DOI: 10.1371/journal.pntd.0007493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/12/2019] [Accepted: 05/24/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Visceral Leishmaniasis in humans presents with fever, anemia, and splenomegaly and can be lethal if not treated. Nevertheless, the majority of Leishmania infantum-infected individuals does not manifest symptoms and remain so provided they are not immunosuppressed. In this work, the performance of different tests was evaluated to detect asymptomatic individuals who were living in Teresina, Piauí state, Brazil, an endemic area for VL. METHODOLOGY L. infantum-specific antibodies were detected by ELISA and two different rapid immunochromatographic (IC) diagnostic tests, Kalazar Detect and OnSite, and parasitic loads were detected by real time PCR [qPCR]. Additionally, we measured levels of the biomarkers monokine induced by IFN-γ (MIG) and IFN-γ-induced protein 10 (IP-10) before and after stimulation of whole blood with soluble Leishmania antigen [SLA]. PRINCIPAL FINDINGS Kalazar Detect and OnSite detected, respectively, 76% and 64% of patients presenting with active Visceral Leishmaniasis; 50% and 57% of patients remained positive in these tests, respectively, after treatment. Of the healthy participants in the study who were living in the endemic area, only 1.7% were positive with both of the IC tests. On the other hand, reactivity in ELISA tests revealed that 13% of these individuals presented asymptomatic infections; among VL patients, 84% presenting with active disease were reactive in ELISA, and after treatment, 55.5% were seropositive. L. infantum DNA was present in the blood of 37.9% of infected individuals living in the endemic area, while IP-10 and MIG biomarkers were detected in 26.7% of them. The greatest concordance of positivity occurred between ELISA and qPCR. CONCLUSION The association of different techniques can detect asymptomatic infections, however, more research is necessary to develop ideal biomarkers that are simple to use in the clinic and in field studies in areas endemic for Visceral Leishmaniasis.
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7
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Mbati PA, Githure JI, Kagai JM, Kirigi G, Kibati F, Wasunna K, Koech DK. Evaluation of a standardized direct agglutination test (DAT) for the diagnosis of visceral leishmaniasis in Kenya. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.1999.11813475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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8
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Kaye PM, Beattie L. Lessons from other diseases: granulomatous inflammation in leishmaniasis. Semin Immunopathol 2015; 38:249-60. [PMID: 26678994 PMCID: PMC4779128 DOI: 10.1007/s00281-015-0548-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/02/2015] [Indexed: 11/16/2022]
Abstract
The Leishmania granuloma shares some, though not all, properties with that formed following mycobacterial infection. As a simplified, noncaseating granuloma composed of relatively few and largely mononuclear cell populations, it provides a tractable model system to investigate intra-granuloma cellular dynamics, immune regulation, and antimicrobial resistance. Here, the occurrence of granulomatous pathology across the spectrum of leishmaniasis, in humans and animal reservoir hosts, is first described. However, this review focuses on the process of hepatic granuloma formation as studied in rodent models of visceral leishmaniasis, starting from the initial infection of Kupffer cells to the involution of the granuloma after pathogen clearance. It describes how the application of intravital imaging and the use of computational modeling have changed some of our thoughts on granuloma function, and illustrates how host-directed therapies have been used to manipulate granuloma form and function for therapeutic benefit. Where appropriate, lessons that may be equally applicable across the spectrum of granulomatous diseases are highlighted.
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Affiliation(s)
- Paul M Kaye
- Centre for Immunology and Infection, Department of Biology and Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Lynette Beattie
- QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland, Australia, 4006
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9
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Berthier D, Brenière SF, Bras-Gonçalves R, Lemesre JL, Jamonneau V, Solano P, Lejon V, Thévenon S, Bucheton B. Tolerance to Trypanosomatids: A Threat, or a Key for Disease Elimination? Trends Parasitol 2015; 32:157-168. [PMID: 26643519 DOI: 10.1016/j.pt.2015.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/20/2015] [Accepted: 11/03/2015] [Indexed: 12/20/2022]
Abstract
So far, research on trypanosomatid infections has been driven by 'disease by disease' approaches, leading to different concepts and control strategies. It is, however, increasingly clear that they share common features such as the ability to generate long-lasting asymptomatic infections in their mammalian hosts. Trypanotolerance, long integrated in animal African trypanosomiasis control, historically refers to the ability of cattle breeds to limit Trypanosoma infection and pathology, but has only recently been recognized in humans. Whilst trypanotolerance is absent from the vocabulary on leishmaniasis and Chagas disease, asymptomatic infections also occur. We review the concept of trypanotolerance across the trypanosomatids and discuss the importance of asymptomatic carriage in the current context of elimination.
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Affiliation(s)
| | | | | | | | - Vincent Jamonneau
- CIRDES Bobo-Dioulasso 01 BP 454, Burkina Faso; IPR, 01 BP 1500 Bouaké 01, Côte d'Ivoire
| | | | - Veerle Lejon
- IRD, UMR INTERTRYP, Montpellier Cedex 5, 34398 France
| | | | - Bruno Bucheton
- IRD, UMR INTERTRYP, Montpellier Cedex 5, 34398 France; PNLTHA, Ministère de la Santé, BP 851 Conakry, République de Guinée
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10
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Abstract
The ability of Leishmania parasites to infect and persist in the antigen-presenting cell population of their mammalian hosts is dependent on their ability to gain entry to their host and host cells, to survive the mammalian cell environment, and to suppress or evade the protective immune response mechanisms of their hosts. A multitude of genes and their products have been implicated in each of these virulence-enhancing strategies to date, and we present an overview of the nature and known function of such virulence genes.
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11
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A Petri net model of granulomatous inflammation: implications for IL-10 mediated control of Leishmania donovani infection. PLoS Comput Biol 2013; 9:e1003334. [PMID: 24363630 PMCID: PMC3867212 DOI: 10.1371/journal.pcbi.1003334] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/27/2013] [Indexed: 11/30/2022] Open
Abstract
Experimental visceral leishmaniasis, caused by infection of mice with the protozoan parasite Leishmania donovani, is characterized by focal accumulation of inflammatory cells in the liver, forming discrete “granulomas” within which the parasite is eventually eliminated. To shed new light on fundamental aspects of granuloma formation and function, we have developed an in silico Petri net model that simulates hepatic granuloma development throughout the course of infection. The model was extensively validated by comparison with data derived from experimental studies in mice, and the model robustness was assessed by a sensitivity analysis. The model recapitulated the progression of disease as seen during experimental infection and also faithfully predicted many of the changes in cellular composition seen within granulomas over time. By conducting in silico experiments, we have identified a previously unappreciated level of inter-granuloma diversity in terms of the development of anti-leishmanial activity. Furthermore, by simulating the impact of IL-10 gene deficiency in a variety of lymphocyte and myeloid cell populations, our data suggest a dominant local regulatory role for IL-10 produced by infected Kupffer cells at the core of the granuloma. Granulomatous inflammation is a common feature of chronic infectious and non-infectious disease. In the parasitic disease visceral leishmaniasis, the formation of granulomas in the liver is a hallmark of effective cellular immunity and host resistance to infection. Conventional experimental models, however, have inherent limitations in their capacity to assess the dynamics of this complex inflammatory response and in their ability to discriminate the local contribution of different immune cells and mediators to the outcome of infection. To overcome these limitations and to provide a future platform for evaluating how novel drugs might be used to improve host resistance, we have developed a computational model of the Leishmania granuloma. Using this model, we show that conventional measures of parasite load potentially mask an underlying heterogeneity in the ability of individual granulomas to control parasite number. In addition, we have used our model to provide novel insights into the relative importance of IL-10 production by different immune cells found within the granuloma microenvironment. Our model thus provides a complementary tool to increase understanding of granulomatous inflammation in this and other important human diseases.
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Gramiccia M, Scalone A, Di Muccio T, Orsini S, Fiorentino E, Gradoni L. The burden of visceral leishmaniasis in Italy from 1982 to 2012: a retrospective analysis of the multi-annual epidemic that occurred from 1989 to 2009. Euro Surveill 2013. [DOI: 10.2807/1560-7917.es2013.18.29.20535] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Pedrosa CMS, Ximenes RADA, de Almeida WAP, da Rocha EMM. Validity of the polymerase chain reaction in the diagnosis of clinically suspected cases of American visceral leishmaniasis. Braz J Infect Dis 2013; 17:319-23. [PMID: 23683573 PMCID: PMC9427421 DOI: 10.1016/j.bjid.2012.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 11/23/2022] Open
Abstract
To test the validity of the polymerase chain reaction for diagnosing American visceral leishmaniasis, 88 suspected cases were studied. Diagnosis was confirmed in 47 (53.5%) and ruled out in 41 (46.5%) patients. Samples of bone marrow and peripheral blood were processed by polymerase chain reaction to evaluate the sensitivity and specificity of the test and its agreement beyond chance with microscopy examination. The polymerase chain reaction was positive in bone marrow of 100% of the patients with amastigotes seen with microscopy examination, and in 59.5% in those where no parasite were seen. Agreement beyond chance between visualization of the parasite in bone marrow aspirates and polymerase chain reaction was considered weak (Kappa = 0.41). Concordance between polymerase chain reaction of bone marrow aspirates and of peripheral blood was considered excellent (Kappa = 0.88). The test turned out positive in all bone marrow aspirates of those with the disease and whereas the positivity rate was 58.5% among those without the disease, with specificity rate of 41.5%.
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15
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Michel G, Pomares C, Ferrua B, Marty P. Importance of worldwide asymptomatic carriers of Leishmania infantum (L. chagasi) in human. Acta Trop 2011; 119:69-75. [PMID: 21679680 DOI: 10.1016/j.actatropica.2011.05.012] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/25/2011] [Accepted: 05/29/2011] [Indexed: 02/03/2023]
Abstract
Leishmaniasis due to Leishmania infantum (syn. L. chagasi) infection is a zoonotic disease present mainly in Mediterranean basin, central Asia and Brazil. Besides a limited number of human cases of clinical visceral leishmaniasis, a great number of infections remains asymptomatic. In this review, the prevalence of asymptomatic carriers of L. infantum was evaluated worldwide using parasitological methods or indirect testing such as a skin test or serology. The consequences of the presence of asymptomatic carriers on parasite transmission by blood donation or the development of clinical visceral leishmaniasis in immunocompromised individuals and its possible role as reservoir are discussed.
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16
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Detection of Leishmania parasites in the blood of patients with isolated cutaneous leishmaniasis. Int J Infect Dis 2011; 15:e491-4. [DOI: 10.1016/j.ijid.2011.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 02/03/2011] [Accepted: 03/31/2011] [Indexed: 11/21/2022] Open
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17
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Moreno EC, Gonçalves AV, Chaves AV, Melo MN, Lambertucci JR, Andrade ASR, Negrão-Corrêa D, Antunes CMDF, Carneiro M. Inaccuracy of enzyme-linked immunosorbent assay using soluble and recombinant antigens to detect asymptomatic infection by Leishmania infantum. PLoS Negl Trop Dis 2009; 3:e536. [PMID: 19841736 PMCID: PMC2759029 DOI: 10.1371/journal.pntd.0000536] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 09/24/2009] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND One of the most important drawbacks in visceral leishmaniasis (VL) population studies is the difficulty of diagnosing asymptomatic carriers. The aim of this study, conducted in an urban area in the Southeast of Brazil, was to evaluate the performance of serology to identify asymptomatic VL infection in participants selected from a cohort with a two-year follow-up period. METHODOLOGY Blood samples were collected in 2001 from 136 cohort participants (97 positive and 39 negatives, PCR/hybridization carried out in 1999). They were clinically evaluated and none had progressed to disease from their asymptomatic state. As controls, blood samples from 22 control individuals and 8 patients with kala-azar were collected. Two molecular biology techniques (reference tests) were performed: PCR with Leishmania-generic primer followed by hybridization using L. infantum probe, and PCR with specific primer to L. donovani complex. Plasma samples were tested by ELISA using three different antigens: L. infantum and L. amazonensis crude antigens, and rK39 recombinant protein. Accuracy of the serological tests was evaluated using sensitivity, specificity, likelihood ratio and ROC curve. FINDINGS The presence of Leishmania was confirmed, by molecular techniques, in all kala-azar patients and in 117 (86%) of the 136 cohort participants. Kala-azar patients showed high reactivity in ELISAs, whereas asymptomatic individuals presented low reactivity against the antigens tested. When compared to molecular techniques, the L. amazonensis and L. infantum antigens showed higher sensitivity (49.6% and 41.0%, respectively) than rK39 (26.5%); however, the specificity of rK39 was higher (73.7%) than L. amazonensis (52.6%) and L. infantum antigens (36.8%). Moreover, there was low agreement among the different antigens used (kappa<0.10). CONCLUSIONS Serological tests were inaccurate for diagnosing asymptomatic infections compared to molecular methods; this could lead to misclassification bias in population studies. Therefore, studies which have used serological assays to estimate prevalence, to evaluate intervention programs or to identify risk factors for Leishmania infection, may have had their results compromised.
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Affiliation(s)
- Elizabeth Castro Moreno
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, Minas Gerais, Brasil
- Fundação Nacional de Saúde, Belo Horizonte, Minas Gerais, Brasil
| | - Andréa Vieira Gonçalves
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, Minas Gerais, Brasil
| | - Anderson Vieira Chaves
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, Minas Gerais, Brasil
| | - Maria Norma Melo
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, Minas Gerais, Brasil
| | - José Roberto Lambertucci
- Faculdade de Medicina ,Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Belo Horizonte, Minas Gerais, Brasil
| | - Antero Silva Ribeiro Andrade
- Centro de Desenvolvimento da Tecnologia Nuclear, Comissão Nacional de Energia Nuclear, Belo Horizonte, Minas Gerais, Brasil
| | - Deborah Negrão-Corrêa
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, Minas Gerais, Brasil
| | - Carlos Mauricio de Figueiredo Antunes
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, Minas Gerais, Brasil
- Faculdade de Medicina ,Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Belo Horizonte, Minas Gerais, Brasil
| | - Mariângela Carneiro
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, Minas Gerais, Brasil
- Faculdade de Medicina ,Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Belo Horizonte, Minas Gerais, Brasil
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Moreno EC, Melo MN, Lambertucci JR, Serufo JC, Andrade ASR, Antunes CMF, Genaro O, Carneiro M. Diagnosing human asymptomatic visceral leishmaniasis in an urban area of the State of Minas Gerais, using serological and molecular biology techniques. Rev Soc Bras Med Trop 2007; 39:421-7. [PMID: 17160317 DOI: 10.1590/s0037-86822006000500001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 10/08/2006] [Indexed: 05/12/2023] Open
Abstract
A population-based cross-sectional study was set up in Sabará country, Southeastern Brazil, to identify asymptomatic human visceral leishmaniasis in an urban area of low disease prevalence. Blood was collected on filter paper (n=1,604 inhabitants) and examined by indirect immunofluorescent test, enzyme-linked immunosorbent assay and immunochromatographic strip test. The prevalence rates of infection ranged from 2.4 to 5.6% depending on the test used. One year later, venous blood was collected in a subset of 226 participants (102 seropositive and 124 seronegative). The tests performed were IFAT, ELISA, rk39-ELISA, polymerase chain reaction and hybridization with Leishmania donovani complex probe. No clinical signs or symptoms of leishmaniasis were observed. Using hybridization as a reference test, the sensitivity and specificity of serology were respectively: 24.8 and 71% (ELISA); 26.3 and 76.3% (rk-39); 30.1 and 63.4% (IFAT). Due to disagreements, different criteria were tested to define the infection and hybridization should be considered in epidemiological studies.
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Moreno EC, Melo MN, Genaro O, Lambertucci JR, Serufo JC, Andrade ASR, Antunes CMF, Carneiro M. Risk factors for Leishmania chagasi infection in an urban area of Minas Gerais State. Rev Soc Bras Med Trop 2006; 38:456-63. [PMID: 16410918 DOI: 10.1590/s0037-86822005000600002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In order to understand the determinants of human infection by Leishmania chagasi in an urban area, a cross-sectional population based study was conducted using molecular and serologic methods to identify infection. Participants were interviewed using a pre-coded questionnaire. Two criteria were tested to identify risk factors: Model 1--including all participants positive in hybridization by Leishmania donovani complex probe; Model 2--including all participants positive for hybridization and at least one serologic test. In Model 1, the variables associated with infection were: ownership of birds, time spent outside house between 6:00-10:00 PM and garbage not collected. In Model 2, the variables associated with infection were: family with knowledge of the vector, garbage not collected, garbage not removed or buried, ownership of birds and eroded areas in the neighborhood. The risk factors identified were associated with household conditions, presence of animals and the likelihood of contact with phlebotomine sandflies.
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20
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Riera C, Fisa R, Udina M, Gállego M, Portus M. Detection of Leishmania infantum cryptic infection in asymptomatic blood donors living in an endemic area (Eivissa, Balearic Islands, Spain) by different diagnostic methods. Trans R Soc Trop Med Hyg 2004; 98:102-10. [PMID: 14964810 DOI: 10.1016/s0035-9203(03)00015-4] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The extent of cryptic leishmaniasis in blood donors from a Spanish endemic area, (Eivissa Island) was studied using various immunological and parasitological methods. Sera from 656 blood donors were analysed: 16 (2.4%) were positive by ELISA and 50 (7.6%) by Western blot. Peripheral blood mononuclear cells (PBMC) and buffy coat (BC) samples, were analyzed by culture and nested-PCR. DNA of L. infantum was amplified in 27 (22.1%) of 122 PBMC. Parasites were isolated in 3 (4.5%) of 67 BC cultures and the strains were identified as L. infantum zymodeme MON-28. No parasites were isolated in PBMC culture. After 12 months, a second blood sample was obtained from 18 blood donors who were positive by nested-PCR in the first extraction; nine of them remained positive. Delayed type hypersensitivity (DTH) tests on 15/67 donors (22.3%) were positive. Comparison of results obtained by ELISA, WB and DTH; ELISA, WB and nested-PCR and nested-PCR and BC culture showed a significant association (Pearson test, P < 0.05). L. infantum zyodeme MON-28 was identified in three strains isolated from asymptomatic donors, which suggests a low virulence capacity of these strains. The detection of Leishmania DNA in a high number of asymptomatic subjects supports the need to monitor it in blood donors endemic areas.
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Affiliation(s)
- C Riera
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona E-08028, Spain.
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21
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Sipsas NV, Boletis J. Fever, hepatosplenomegaly, and pancytopenia in a renal transplant recipient. Transpl Infect Dis 2003; 5:47-52. [PMID: 12791075 DOI: 10.1034/j.1399-3062.2003.00003.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- N V Sipsas
- Infectious Diseases Unit, Pathophysiology Department, Laikon General Hospital and School of Medicine, National University of Athens, Athens, Greece.
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22
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Moral L, Rubio EM, Moya M. A leishmanin skin test survey in the human population of l'Alacantí region (Spain): implications for the epidemiology of Leishmania infantum infection in southern Europe. Trans R Soc Trop Med Hyg 2002; 96:129-32. [PMID: 12055798 DOI: 10.1016/s0035-9203(02)90278-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A study of leishmanin skin test reactors was carried out in 1997 and 1998 in an endemic region in southeast Spain, to estimate the magnitude of and the factors related to subclinical Leishmania infantum infection. In the main focus of leishmaniasis in the region, 11.5% of the children and 52.8% of the adults reacted to the skin test. Among the adults, the response was significantly greater for males and for those who had resided in the area for > or = 15 years. In the whole region, 3.7% 14-year-old students reacted to the skin test, with no gender differences. The main factors related to a positive skin test result were having a parent or sibling recovered from leishmaniasis (relative risk = 14) and living in the rural periphery of the region as opposed to the metropolitan area (relative risk = 4). These results indicate a high frequency of subclinical leishmaniasis in the region. We postulate that the decline in childhood visceral leishmaniasis in southern Europe in the second half of the 20th century is related to social changes, which gave rise to a less frequent exposure at a young age as well as a lowered susceptibility to disease through nutritional and immune improvements.
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Affiliation(s)
- L Moral
- Department of Paediatrics, Miguel Hernández University, Carretera Alicante-Valencia, s/n, E-03550 San Juan de Alicante, Spain.
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23
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Olobo JO, Gicheru MM, Anjili CO. The African Green Monkey model for cutaneous and visceral leishmaniasis. Trends Parasitol 2001; 17:588-92. [PMID: 11756043 DOI: 10.1016/s1471-4922(01)02147-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Non-human primates are valuable models for biomedical research because of their similarities to human anatomy, immunology and physiology. Leishmaniasis, a disease caused by protozoan parasites, has a worldwide distribution and results in high morbidity and mortality. Availability of a non-human primate model of leishmaniasis would facilitate the study of different aspects of this disease and would accelerate the development of vaccines and new drugs. In this article, some interesting features of the vervet monkey (African Green monkey) model of human cutaneous and visceral leishmaniasis are discussed.
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Affiliation(s)
- J O Olobo
- Dept of Medical Microbiology, Makerere University, Kampala, PO Box 7072, Kampala, Uganda.
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Abstract
In experimental visceral leishmaniasis in normal mice (BALB/c, C57BL/6) acquired resistance to Leishmania donovani, a protozoan which targets tissue macrophages, depends upon T cells, Th1 cell-type cytokine generation and activated mononuclear phagocytes. In the intact host, initial control and eventual resolution of L. donovani hepatic infection in normal mice is expressed by and accomplished within well-formed, mature tissue granulomas. In the liver, these immunologically active, inflammatory structures are assembled around a core of fused, parasitized resident macrophages (Kupffer cells) which come to be encircled by both cytokine-secreting T cells and influxing leishmanicidal blood monocytes. This pro-host defense granuloma structure-function relationship, in which histologically mature granulomas provide the microenvironment for intracellular L. donovani killing, however, is only one of seven which have been identified through experimental modifications in this model. This report reviews these structure-function relationships and illustrates the broad spectrum of additional possible responses. These responses range from structurally intact granulomas which provide no antileishmanial function (the 'ineffective' granuloma), to enlarged granulomas which show enhanced parasite killing (the 'hypertrophied' granuloma), to effective antileishmanial activity in the absence of any tissue reaction (the 'invisible' granuloma).
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Affiliation(s)
- H W Murray
- Department of Medicine, Weill College of Cornell University, New York 10021, USA.
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25
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Nuwayri-Salti N, Baydoun E, el-Tawk R, Fakhoury Makki R, Knio K. The epidemiology of leishmaniases in Lebanon. Trans R Soc Trop Med Hyg 2000; 94:164-6. [PMID: 10897356 DOI: 10.1016/s0035-9203(00)90259-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The prevalence of leishmaniasis in Lebanon was studied in 1993-97 for a Lebanese population sample of about 81,000 subjects (60% rural and 40% urban) constituting roughly 3.4% of the total population. The prevalence of cutaneous leishmaniasis was found to be 0.18% in the rural versus 0.41% in the urban areas. Visceral leishmaniasis was practically non-existent in both environments. In addition, skin tests were done and anti-Leishmania antibodies were sought in a sample of the population at risk in the rural area. Skin tests were positive in 2.5% of the tested subjects, and 1% of the normal population had elevated levels of anti-Leishmania antibodies. The difference between the prevalence of clinical disease and positive skin testing and/or antibodies may be due to the existence of past or present subclinical disease. An unexpected finding was that the prevalent dermotropic parasite in Lebanon belongs to the L. donovani complex. Further characterization of the isolates by molecular techniques and definition of the transmission cycle of this parasite may explain our epidemiological findings.
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Affiliation(s)
- N Nuwayri-Salti
- Department of Human Morphology, Faculty of Medicine, American University of Beirut, Lebanon.
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26
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Louzir H, Dellagi K. Les leishmanioses: un modèle d'étude des interactions hôte-parasite; implications pour la maladie humaine. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s0924-4204(99)80023-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Affiliation(s)
- H A Al-Shamahy
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, University of Sana'a, Republic of Yemen
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28
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Melby PC, Yang YZ, Cheng J, Zhao W. Regional differences in the cellular immune response to experimental cutaneous or visceral infection with Leishmania donovani. Infect Immun 1998; 66:18-27. [PMID: 9423834 PMCID: PMC107853 DOI: 10.1128/iai.66.1.18-27.1998] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Infection with the protozoan Leishmania donovani can cause serious visceral disease or subclinical infection in humans. To better understand the pathogenesis of this dichotomy, we have investigated the host cellular immune response to cutaneous or visceral infection in a murine model. Mice infected in the skin developed no detectable visceral parasitism, whereas intravenous inoculation resulted in hepatosplenomegaly and an increasing visceral parasite burden. Spleen cells from mice with locally controlled cutaneous infection showed strong parasite-specific proliferative and gamma interferon (IFN-gamma) responses, but spleen cells from systemically infected mice were unresponsive to parasite antigens. The in situ expression of IFN-gamma, interleukin-4 (IL-4), IL-10, IL-12, and inducible nitric oxide synthase (iNOS) mRNAs was determined in the spleen, draining lymph node (LN), and cutaneous site of inoculation. There was considerably greater expression of IFN-gamma and IL-12 p40 mRNAs in the LN draining a locally controlled cutaneous infection than in the spleen following systemic infection. Similarly, there was a high level of IFN-gamma production by LN cells following subcutaneous infection but no IFN-gamma production by spleen cells following systemic infection. Splenic IL-4 expression was transiently increased early after systemic infection, but splenic IL-10 transcripts increased throughout the course of visceral infection. IL-4 and IL-10 mRNAs were also increased in the LN following cutaneous infection. iNOS mRNA was detected earlier in the LN draining a cutaneous site of infection compared to the spleen following systemic challenge. Thus, locally controlled cutaneous infection was associated with antigen-specific spleen cell responsiveness and markedly increased levels of IFN-gamma, IL-12, and iNOS mRNA in the draining LN. Progressive splenic parasitism was associated with an early IL-4 response, markedly increased IL-10 but minimal IL-12 expression, and delayed expression of iNOS.
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Affiliation(s)
- P C Melby
- The Audie L. Murphy Veterans Administration Hospital, and Department of Medicine, The University of Texas Health Science Center, San Antonio 78284-7881, USA.
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29
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Alvar J, Cañavate C, Gutiérrez-Solar B, Jiménez M, Laguna F, López-Vélez R, Molina R, Moreno J. Leishmania and human immunodeficiency virus coinfection: the first 10 years. Clin Microbiol Rev 1997; 10:298-319. [PMID: 9105756 PMCID: PMC172921 DOI: 10.1128/cmr.10.2.298] [Citation(s) in RCA: 488] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Over 850 Leishmania-human immunodeficiency virus (HIV) coinfection cases have been recorded, the majority in Europe, where 7 to 17% of HIV-positive individuals with fever have amastigotes, suggesting that Leishmania-infected individuals without symptoms will express symptoms of leishmaniasis if they become immunosuppressed. However, there are indirect reasons and statistical data demonstrating that intravenous drug addiction plays a specific role in Leishmania infantum transmission: an anthroponotic cycle complementary to the zoonotic one has been suggested. Due to anergy in patients with coinfection, L. infantum dermotropic zymodemes are isolated from patient viscera and a higher L. infantum phenotypic variability is seen. Moreover, insect trypanosomatids that are currently considered nonpathogenic have been isolated from coinfected patients. HIV infection and Leishmania infection each induce important analogous immunological changes whose effects are multiplied if they occur concomitantly, such as a Th1-to-Th2 response switch; however, the consequences of the viral infection predominate. In fact, a large proportion of coinfected patients have no detectable anti-Leishmania antibodies. The microorganisms share target cells, and it has been demonstrated in vitro how L. infantum induces the expression of latent HIV-1. Bone marrow culture is the most useful diagnostic technique, but it is invasive. Blood smears and culture are good alternatives. PCR, xenodiagnosis, and circulating-antigen detection are available only in specialized laboratories. The relationship with low levels of CD4+ cells conditions the clinical presentation and evolution of disease. Most patients have visceral leishmaniasis, but asymptomatic, cutaneous, mucocutaneous, diffuse cutaneous, and post-kala-azar dermal leishmaniasis can be produced by L. infantum. The digestive and respiratory tracts are frequently parasitized. The course of coinfection is marked by a high relapse rate. There is a lack of randomized prospective treatment trials; therefore, coinfected patients are treated by conventional regimens. Prophylactic therapy is suggested to be helpful in preventing relapses.
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Affiliation(s)
- J Alvar
- Laboratorio de Referencia de Leishmaniasis, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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30
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Affiliation(s)
- A Di Cataldo
- Division of Pediatric Hematology and Oncology, University of Catania, Italy
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31
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Alvar J, Gutiérrez-Solar B, Pachón I, Calbacho E, Ramírez M, Vallés R, Guillén JL, Cañavate C, Amela C. AIDS and Leishmania infantum. New approaches for a new epidemiological problem. Clin Dermatol 1996; 14:541-6. [PMID: 8889333 DOI: 10.1016/0738-081x(96)00046-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J Alvar
- Reference Laboratory of Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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Nascimento MDD, Costa JM, Fiori BI, Viana GM, Filho MS, Alvim ADC, Bastos OC, Nakatani M, Reed S, Badaró R, da Silva AR, Burattini MN. [The epidemiological determinant aspects in the maintenance of visceral leishmaniasis in the state of Maranhão, Brazil]. Rev Soc Bras Med Trop 1996; 29:233-40. [PMID: 8701042 DOI: 10.1590/s0037-86821996000300003] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The authors analysed the visceral leishmaniasis (VL) aspects in the state of Maranhão, Brazil, from 1982 to 1993. The disease happens to occur predominantly in São Luís Island (MA) and during the epidemic period, town of São Luís was pointed out as the main endemic area. The greatest frequency of cases occurred in 1993, despite the use of insecticide and dogs control. There was predominance of age between 0- to 4-year-old population with 58.04% of cases. Neither the human disease nor the rainfall index had significant seasonal variation. However they were correlated moderately, with high number of cases after the period of great precipitation of rain. After this study, the data obtained will allow a better control of the disease, despite some factors such as: the urbanization, localization and dynamic of transmission in endemic areas in the Maranhão state.
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Affiliation(s)
- M do D Nascimento
- Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brasil
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Shiddo SA, Aden Mohamed A, Akuffo HO, Mohamud KA, Herzi AA, Herzi Mohamed H, Huldt G, Nilsson LA, Ouchterlony O, Thorstensson R. Visceral leishmaniasis in Somalia: prevalence of markers of infection and disease manifestations in a village in an endemic area. Trans R Soc Trop Med Hyg 1995; 89:361-5. [PMID: 7570862 DOI: 10.1016/0035-9203(95)90008-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Prevalence and disease manifestations of visceral leishmaniasis (VL) were studied in a Somali village in an area which has long been known to be endemic for VL. Demographic data were collected from 102 households, comprising 438 inhabitants. Clinical examination was performed of 306 individuals, 72% of the 426 eligible persons. Of these, 276 (90%) agreed to give blood and 246 (80%) to be skin tested with leishmanin. Leishmanin reactions were positive; in 26% anti-Leishmania antibodies were detected in 11%, and splenomegaly was recorded in 14% (23% of those who were seropositive). Malaria was hypoendemic and therefore unlikely to be responsible for more than 10% of the cases with splenomegaly. Three of the seropositive villagers with splenomegaly complained of feeling ill. The remaining 91 sero- and/or leishmanin-positive individuals had no complaint regarding their health and had not experienced any long period of illness. There was a slight over-representation of males in the group of sero- and/or leishmanin-positive villagers, possibly due to a gender-associated difference in exposure to the parasite. Among the patients with clinical VL treated at Mogadishu hospitals during 1989 and 1990, the male/female ratio was 3.3:1, which may indicate a selection of male patients for hospital care. Most patients were < or = 15 years old, suggesting that the highest risk of becoming clinically ill was among children.
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Affiliation(s)
- S A Shiddo
- Department of Morphology and Pathology, Faculty of Medicine and Surgery, Somali National University, Mogadishu, Somalia
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Gaafar A, Kharazmi A, Ismail A, Kemp M, Hey A, Christensen CB, Dafalla M, el Kadaro AY, el Hassan AM, Theander TG. Dichotomy of the T cell response to Leishmania antigens in patients suffering from cutaneous leishmaniasis; absence or scarcity of Th1 activity is associated with severe infections. Clin Exp Immunol 1995; 100:239-45. [PMID: 7743662 PMCID: PMC1534327 DOI: 10.1111/j.1365-2249.1995.tb03660.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The T cell response was studied in 25 patients suffering from cutaneous leishmaniasis caused by Leishmania major with severe (n = 10) and mild (n = 15) disease manifestations. Peripheral blood mononuclear cells (PBMC) from the patients were activated by sonicates of Leishmania promastigotes (LMP) and amastigotes (LDA), and the surface protease gp63. The proliferative responses to Leishmania antigens were lower in patients with severe disease than in patients with mild disease (P = 0.01-0.05), and such a difference was not observed in the response to purified protein derivative of tuberculin (PPD) or tetanus toxoid (TT). LMP-induced interferon-gamma (IFN-gamma) production was lower in patients with severe than in patients with mild disease (P < 0.05). When the IL-4 and IFN-gamma responses of each patient were considered, two response patterns were observed in the cultures activated by the Leishmania sonicates. One response pattern was characterized by high production of IFN-gamma without production of IL-4 (a Th1-like pattern), the other was characterized by low IFN-gamma levels which in most cases were associated with IL-4 production (not a Th1-like pattern). These patterns could not be distinguished when the cells from the same donors were stimulated by TT and PPD. The percentages of patients with a Th1-like response pattern after stimulation by LMP in patients with severe and mild disease manifestations were 30% and 80%, respectively. This difference was statistically significant (P = 0.034).
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Affiliation(s)
- A Gaafar
- Institute of Tropical Medicine, MRC, Khartoum, Sudan
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Bahrenscheer JESPER, Kemp MICHAEL, Kurtzhals JØRGENAL, Gachihi GEORGES, Kharazmi ARSALAN, Theander THORG. Interferon-γ and interleukin-4 production by human T cells recognizingLeishmania donovaniantigens separated by SDS-PAGE. APMIS 1995. [DOI: 10.1111/j.1699-0463.1995.tb01088.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kemp M, Hey AS, Kurtzhals JA, Christensen CB, Gaafar A, Mustafa MD, Kordofani AA, Ismail A, Kharazmi A, Theander TG. Dichotomy of the human T cell response to Leishmania antigens. I. Th1-like response to Leishmania major promastigote antigens in individuals recovered from cutaneous leishmaniasis. Clin Exp Immunol 1994; 96:410-5. [PMID: 8004809 PMCID: PMC1534571 DOI: 10.1111/j.1365-2249.1994.tb06043.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The T cell response to antigens from Leishmania major promastigotes was investigated in peripheral blood mononuclear cells from Sudanese individuals with a history of cutaneous leishmaniasis (CL), Sudanese individuals with positive DTH reaction in the leishmanin skin test but with no history of skin lesions, and in Danes without known exposure to Leishmania parasites. Proliferation and production of interferon-gamma (IFN-gamma) and IL-4 in antigen-stimulated cultures was measured. Lymphocytes from individuals with a history of CL proliferated vigorously and produced IFN-gamma after stimulation with either a crude preparation of L. major antigens or the major surface protease gp63. These cultures produced no or only little IL-4. Also cells from leishmanin skin test-positive donors with no history of CL produced IFN-gamma and no IL-4 in response to L. major antigens. Cells from the unexposed Danes were not activated by gp63. The cells from Danish donors produced either IFN-gamma or IL-4, but not both cytokines after incubation with the crude preparation of L. major antigens. The data show that the T cell response to Leishmania antigens in humans who have had uncomplicated CL or subclinical L. major infection is an IFN-gamma-producing Th1-like response.
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Affiliation(s)
- M Kemp
- Centre for Medical Parasitology, University of Copenhagen, Denmark
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el Hag IA, Hashim FA, el Toum IA, Homeida M, el Kalifa M, el Hassan AM. Liver morphology and function in visceral leishmaniasis (Kala-azar). J Clin Pathol 1994; 47:547-51. [PMID: 8063939 PMCID: PMC494751 DOI: 10.1136/jcp.47.6.547] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIM To study the morphology and function of the liver in visceral leishmaniasis (Kala-azar). METHODS Percutaneous liver biopsy specimens from 18 patients with confirmed visceral leishmaniasis were examined under light and electron microscopy before and after treatment with pentovalent antimony. The tissue was also examined for hepatitis B surface and core antigens using immunoperoxidase staining. Liver function was investigated in nine patients before and after treatment. RESULTS Specimens before treatment showed Kupffer cells and macrophages colonised by leishmania parasites in 40% of cases. A chronic mononuclear cell infiltrate had affected the portal tracts and lobules. Ballooning degeneration of the hepatocytes, fibrosis of the terminal hepatic venules, and pericellular fibrosis were common findings. The fibrosis was related to Ito cells transforming to fibroblast-like cells. None of the patients had hepatitis B infection. All patients had biochemical evidence of liver dysfunction before treatment. Liver function improved after treatment. CONCLUSION Visceral leishmaniasis causes morphological and functional disturbance in the liver. Focal fibrosis rather than cirrhosis occurs. The exact aetiology of hepatic damage is unclear but may have an immunological basis.
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Affiliation(s)
- I A el Hag
- Department of Pathology, Faculty of Medicine, University of Khartoum, Sudan
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Ali A, Ashford RW. Visceral leishmaniasis in Ethiopia. III. The magnitude and annual incidence of infection, as measured by serology in an endemic area. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1994; 88:43-7. [PMID: 8192514 DOI: 10.1080/00034983.1994.11812833] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A serological study of visceral leishmaniasis was carried out in a cohort of people in an endemic area of Ethiopia. The people were tested three times, at 6-monthly intervals. Seroprevalence at the start was 112 per 1000, and the annual rate of conversion from negative to positive was estimated as 106 per 1000. Both seroprevalence and incidence of seroconversion increased with age, and males showed higher rates than females, with a male:female ratio of seroconversion of 2:1. Accumulation of 6-monthly seroconversion rates was considered to give a better estimate of the annual rate itself, as the half-life of positive serology was only around 3 months.
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Affiliation(s)
- A Ali
- Institute of Pathobiology, Addis Ababa University, Ethiopia
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Kemp MICHAEL, Kurtzhals JØRGENAL, Kharazmi ARSALAN, Theander THORG. Dichotomy in the human CD4+T-cell response toLeishmaniaparasites. APMIS 1994. [DOI: 10.1111/j.1699-0463.1994.tb04850.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kemp M, Kurtzhals JA, Christensen CB, Kharazmi A, Jardim A, Bendtzen K, Gachihi GS, Olafson RW, Theander TG. Production of interferon-gamma and interleukin-4 by human T cells recognizing Leishmania lipophosphoglycan-associated protein. Immunol Lett 1993; 38:137-44. [PMID: 8294141 DOI: 10.1016/0165-2478(93)90179-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The Leishmania protein LPGAP which is co-isolated with lipophosphoglycan is a specific activator of T cells from individuals who have recovered from American leishmaniasis. We have tested the effect of LPGAP on peripheral blood mononuclear cells (PBMC) from Kenyan donors cured from L. donovani infections. LPGAP induced vigorous proliferation and production of interferon-gamma (IFN-gamma) by the cells. In addition PBMC incubated with LPGAP released interleukin-4 (IL-4) after pulsing with ionomycin and phorbol myristate acetate. Single cells were isolated from LPGAP-stimulated cell lines and expanded as T-cell clones. LPGAP-reactive T-cell clones were activated by crude preparations of both promastigotes and axenic grown amastigote-like parasites. Among 9 CD4+ T-cell clones recognizing LPGAP, cells secreting predominantly IFN-gamma as well as cells secreting predominantly IL-4 were identified. The results show that both IFN-gamma producing (Th1-like) and IL-4 producing (Th2-like) T cells recognizing LPGAP are expanded after infection with L. donovani in humans.
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Affiliation(s)
- M Kemp
- Centre for Medical Parasitology, University of Copenhagen, Denmark
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Magill AJ, Grögl M, Gasser RA, Sun W, Oster CN. Visceral infection caused by Leishmania tropica in veterans of Operation Desert Storm. N Engl J Med 1993; 328:1383-7. [PMID: 8292114 DOI: 10.1056/nejm199305133281904] [Citation(s) in RCA: 207] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Visceral leishmaniasis, usually caused by Leishmania donovani, has rarely been reported from eastern Saudi Arabia, so it was not expected to affect the soldiers of Operation Desert Storm. METHODS We evaluated eight soldiers with visceral leishmanial infection, examining their serum with an immunofluorescent-antibody assay, examining their marrow or biopsy tissue for amastigotes with an indirect immunofluorescent-monoclonal-antibody assay, and culturing the parasites. Cultured promastigotes were isolated and characterized by isoenzyme analysis. RESULTS None of the eight soldiers had classic signs or symptoms of visceral leishmaniasis (kala-azar). Seven soldiers had unexplained fever, chronic fatigue, malaise, cough, intermittent diarrhea, or abdominal pain that began up to seven months after they returned to the United States; one had no symptoms. Five had adenopathy or mild, transient hepatosplenomegaly. None had cutaneous manifestations. Diagnoses were made by bone marrow aspiration (seven patients) or lymph-node biopsy (one patient). Six isolates have been identified as L. tropica, which usually causes only cutaneous disease. Of the six patients treated with sodium stibogluconate, five improved and one remained symptomatic. CONCLUSIONS L. tropica can produce visceral infection that can cause unexplained systemic illness in persons returning from areas where this organism is endemic.
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Affiliation(s)
- A J Magill
- Infectious Disease Section, Walter Reed Army Medical Center, Washington, DC 20307-5100
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Abstract
Resistance to infection is often associated with proliferative T-cell responses corresponding to activation of the Th1 CD4+ T-cell subset, while the proliferative responses of chronically infected individuals are often limited. A mathematical model of the interaction between Th1 cells and a replicating pathogen has been used to demonstrate that antigen dose-dependent inhibition of Th1-cell proliferation may differentially predispose the host to resistance or chronic infection according to the level of exposure. Furthermore, the rapidity of pathogen turnover dramatically influences the qualitative relationship between exposure level and outcome, the temporal progression of infection, and the extent to which superimposed regulation of effector function (distinct from proliferation) will alter the predicted predisposition.
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Affiliation(s)
- A N Schweitzer
- Department of Biology, Imperial College, London, United Kingdom
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Ali A, Ashford RW. Visceral leishmaniasis in Ethiopia. II. Annual leishmanin transformation in a population. Is positive leishmanin reaction a life-long phenomenon? ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1993; 87:163-7. [PMID: 8561523 DOI: 10.1080/00034983.1993.11812750] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A one-year follow-up leishmanin skin test was undertaken in 605 subjects aged five years and above. The point prevalence of leishmanin positivity in the selected age group was 46.8%; 62.5% of the males and 32.1% of the females showed positive leishmanin reactions. The annual incidence of skin test transformation was 14.8%. In this study, positive to negative leishmanin conversion was noted in 9.3% of study subjects with initial positive leishmanin reaction.
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Affiliation(s)
- A Ali
- Institute of Pathobiology, Addis Ababa University, Ethiopia
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Ali A, Ashford RW. Visceral leishmaniasis in Ethiopia. I. Cross-sectional leishmanin skin test in an endemic locality. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1993; 87:157-61. [PMID: 8561522 DOI: 10.1080/00034983.1993.11812749] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A cross-sectional leishmanin skin test was carried out on a sample population of 730 individuals. The overall prevalence of leishmanin positivity was 36.4%; 50.9% of males and 23.2% of females showed positive skin test reaction. The skin-test profile in the study area is typical of an endemic focus of visceral leishmaniasis. The increase in leishmanin positivity with age parallels the age-specific disease profile and indicates an outdoor exposure to infection.
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Affiliation(s)
- A Ali
- Institute of Pathobiology, Addis Ababa University, Ethiopia
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Abstract
Some aspects of changing patterns of arthropodal infections and arthropod-borne diseases in Mediterranean areas are briefly discussed. Selected examples are given, with particular emphasis on the phenomenon of the synanthropic flea Ctenocephalides felis felis and on health problems caused by human infections with Argas reflexus, the common tick of urban pigeons in Europe. Finally, the risk of the emergence of Lyme borreliosis (Borrelia burgdorferi) is considered in relation to the increasing spread of environmental infestation with ticks, mainly Ixodes ricinus, an efficacious vector for the spirochaete.
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Affiliation(s)
- C Genchi
- Department of Veterinary Parasitology, University of Milan, Italy
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