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van Henten S, Kassa M, Fikre H, Melkamu R, Mekonnen T, Dessie D, Mulaw T, Bogale T, Engidaw A, Yeshanew A, Cnops L, Vogt F, Moons KGM, van Griensven J, Pareyn M. Evaluation of Less Invasive Sampling Tools for the Diagnosis of Cutaneous Leishmaniasis. Open Forum Infect Dis 2024; 11:ofae113. [PMID: 38560600 PMCID: PMC10977625 DOI: 10.1093/ofid/ofae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Background Diagnosis of cutaneous leishmaniasis (CL) usually relies on invasive samples, but it is unclear whether more patient-friendly tools are good alternatives for diverse lesions when used with polymerase chain reaction (PCR). Methods Patients with suspected CL were enrolled consecutively in a prospective diagnostic accuracy study. We compared dental broach, tape disc, and microbiopsy samples with PCR as index tests, using PCR with skin slit samples as reference test. Subsequently, we constructed a composite reference test including microscopy, the 3 index tests and skin slit PCR, and we compared these same tests with the composite reference test. We assessed diagnostic accuracy parameters with 95% confidence intervals for all comparisons. Results Among 344 included patients, 282 (82.0%) had CL diagnosed, and 62 (18.0%) CL absence, by skin slit PCR. The sensitivity and specificity by PCR were 89.0% (95% confidence interval, 84.8%-92.1%) and 58.1% (45.7%-69.5%), respectively, for dental broach, 96.1% (93.2%-97.8%) and 27.4% (17.9%-39.6%) for tape disc, and 74.8% (66.3%-81.7%) and 72.7% (51.8%-86.8%) for microbiopsy. Several reference test-negative patients were consistently positive with the index tests. Using the composite reference test, dental broach, and skin slit had similar diagnostic performance. Discussion Dental broach seems a less invasive but similarly accurate alternative to skin slit for diagnosing CL when using PCR. Tape discs lack specificity and seem unsuitable for CL diagnosis without cutoff. Reference tests for CL are problematic, since using a single reference test is likely to miss true cases, while composite reference tests are often biased and impractical as they require multiple tests.
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Affiliation(s)
- Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mekibib Kassa
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Roma Melkamu
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Tigist Mekonnen
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Dilargachew Dessie
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Tadele Mulaw
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Tadfe Bogale
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Asinakew Engidaw
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Arega Yeshanew
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia Capital Territory, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Myrthe Pareyn
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Oyeyemi OT, Ogundahunsi O, Schunk M, Fatem RG, Shollenberger LM. Neglected tropical disease (NTD) diagnostics: current development and operations to advance control. Pathog Glob Health 2024; 118:1-24. [PMID: 37872790 PMCID: PMC10769148 DOI: 10.1080/20477724.2023.2272095] [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] [Indexed: 10/25/2023] Open
Abstract
Neglected tropical diseases (NTDs) have become important public health threats that require multi-faceted control interventions. As late treatment and management of NTDs contribute significantly to the associated burdens, early diagnosis becomes an important component for surveillance and planning effective interventions. This review identifies common NTDs and highlights the progress in the development of diagnostics for these NTDs. Leveraging existing technologies to improve NTD diagnosis and improving current operational approaches for deployment of developed diagnostics are crucial to achieving the 2030 NTD elimination target. Point-of-care NTD (POC-NTD) diagnostic tools are recommended preferred diagnostic options in resource-constrained areas for mapping risk zones and monitoring treatment efficacy. However, few are currently available commercially. Technical training of remote health care workers on the use of POC-NTD diagnostics, and training of health workers on the psychosocial consequences of these diagnostics are critical in harnessing POC-NTD diagnostic potential. While the COVID-19 pandemic has challenged the possibility of achieving NTD elimination in 2030 due to the disruption of healthcare services and dwindling financial support for NTDs, the possible contribution of NTDs in exacerbating COVID-19 pandemic should motivate NTD health system strengthening.
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Affiliation(s)
- Oyetunde T. Oyeyemi
- Department of Biosciences and Biotechnology, University of Medical Sciences, Ondo, Nigeria
- Department of Biological Sciences, Old Dominion University, Virginia, USA
| | - Olumide Ogundahunsi
- The Central Office for Research and Development (CORD), University of Medical Sciences, Ondo, Nigeria
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU) institution, Munich, Germany
| | - Ramzy G. Fatem
- Schistosome Biological Supply Center, Theodor Bilharz Research Institute, Giza, Egypt
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Yadav P, Ramesh V, Avishek K, Kathuria S, Khunger N, Sharma S, Salotra P, Singh R. Application of CL Detect™ rapid test for diagnosis and liposomal amphotericin B for treatment of cutaneous leishmaniasis: A retrospective analysis from a tertiary care centre in a non-endemic area in India. Indian J Dermatol Venereol Leprol 2024; 90:78-84. [PMID: 37609737 DOI: 10.25259/ijdvl_1017_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/22/2023] [Indexed: 08/24/2023]
Abstract
Background Increasing urbanisation has led to the occurrence of cutaneous leishmaniasis (CL) in new areas, which was otherwise localised to endemic areas. Healthcare workers should be made aware of this entity to ensure clinical suspicion of CL and investigations needed to confirm CL. The article describes patients seen at a tertiary hospital in Delhi. Aims To establish the utility of the CL Detect Rapid test as a diagnostic tool and the efficacy of Liposomal Amphotericin B (LAmB) for the complete cure of CL patients. Methods Data of patients of CL (n = 16) was retrospectively analysed concerning diagnosis and treatment. Diagnosis rested on histopathology, real-time PCR, and CL Detect Rapid Test. Speciation of the parasite was based on the Internal transcribed spacer-I gene. Patients were treated with LAmB (i.v., 5 mg/kg up to three doses, five days apart). Results A positivity of 81.3% (95%CI, 54.4-96) was observed for CL Detect Rapid test in comparison with 100% (95%CI, 79.4-100.0) for real-time PCR and 43.8% (95%CI, 19.8-70.1) for microscopy/histopathological examination. L. tropica was the infective species in all cases. All the patients treated with LAmB responded to treatment, and 9/10 patients demonstrated complete regression of lesions, while one was lost to follow-up. Limitations It is a retrospective study, and the data includes only confirmed cases of CL at a single centre. Conclusion This study highlights the utility of CL Detect as a promising diagnostic tool and the efficacy of LAmB for the complete cure of CL.
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Affiliation(s)
- Priya Yadav
- Molecular Biology Laboratory, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - V Ramesh
- Department of Dermatology & STD, Safdarjang Hospital & VMMC, New Delhi, India
| | - Kumar Avishek
- Molecular Biology Laboratory, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Sushruta Kathuria
- Department of Dermatology & STD, Safdarjang Hospital & VMMC, New Delhi, India
| | - Niti Khunger
- Department of Dermatology & STD, Safdarjang Hospital & VMMC, New Delhi, India
| | - Shruti Sharma
- Department of Pathology, ICMR National Institute of Pathology, Safdardung Hospital Campus, New Delhi, India
| | - Poonam Salotra
- Molecular Biology Laboratory, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Ruchi Singh
- Molecular Biology Laboratory, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
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Gebremeskele BT, Adane G, Adem M, Tajebe F. Diagnostic performance of CL Detect rapid-immunochromatographic test for cutaneous leishmaniasis: a systematic review and meta-analysis. Syst Rev 2023; 12:240. [PMID: 38115138 PMCID: PMC10731771 DOI: 10.1186/s13643-023-02422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Sensitive, robust, and fast point-of-care tests are needed for cutaneous leishmaniasis (CL) diagnosis. The recently developed CL Detect rapid test (InBios) for detecting Leishmania peroxidoxin antigen has been evaluated in several studies. However, diagnostic performances were controversial. Therefore, this systematic review and meta-analysis aimed to determine the pooled sensitivity and specificity of CL Detect for CL diagnosis. METHODS PubMed, Scopus, EMBASE, ScienceDirect, and Google Scholar were sources of articles. We included studies reporting the diagnostic accuracy of CL Detect and CL-suspected patients in the English language. The methodological qualities of the included studies were appraised using the quality assessment of diagnostic accuracy studies-2 (QUADAS-2). Meta-analysis was conducted using Stata 14.2 and R software. RESULTS A total of 9 articles were included. The study sample size ranged from 11 to 274. The sensitivities of the individual studies ranged from 23 to 100%, and the specificities ranged from 78 to 100%. Pooled sensitivity and specificity were 68% (95% CI, 41-86%) and 94% (95% CI, 87-97%), respectively. AUC displayed 0.899. Pooled sensitivity was lower (47%, 95% CI, 34-61%) when PCR was used as a reference than microscopy (83%, 95% CI, 39-97%). Pooled sensitivity was lower (48%, 95% CI, 30-67%) for all lesion durations compared to ≤ 4 months (89%, 95% CI, 43-99%). CONCLUSIONS CL Detect has poor sensitivity and does not meet the minimal sensitivity of 95% of target product profiles designed for CL point-of-care tests. Currently, the CL Detect test looks unsuitable for CL diagnosis, despite its high specificity. Findings are limited by the low number of studies available. Further large-scale studies are recommended. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022323497.
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Affiliation(s)
- Behailu Taye Gebremeskele
- Department of Medical Laboratory Science, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia.
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Gashaw Adane
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mohammed Adem
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Fitsumbrhan Tajebe
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Leal JFDC, Barroso DH, Trindade NS, de Miranda VL, Gurgel-Gonçalves R. Automated Identification of Cutaneous Leishmaniasis Lesions Using Deep-Learning-Based Artificial Intelligence. Biomedicines 2023; 12:12. [PMID: 38275373 PMCID: PMC10813291 DOI: 10.3390/biomedicines12010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
The polymorphism of cutaneous leishmaniasis (CL) complicates diagnosis in health care services because lesions may be confused with other dermatoses such as sporotrichosis, paracocidiocomycosis, and venous insufficiency. Automated identification of skin diseases based on deep learning (DL) has been applied to assist diagnosis. In this study, we evaluated the performance of AlexNet, a DL algorithm, to identify pictures of CL lesions in patients from Midwest Brazil. We used a set of 2458 pictures (up to 10 of each lesion) obtained from patients treated between 2015 and 2022 in the Leishmaniasis Clinic at the University Hospital of Brasilia. We divided the picture database into training (80%), internal validation (10%), and testing sets (10%), and trained and tested AlexNet to identify pictures of CL lesions. We performed three simulations and trained AlexNet to differentiate CL from 26 other dermatoses (e.g., chromomycosis, ecthyma, venous insufficiency). We obtained an average accuracy of 95.04% (Confidence Interval 95%: 93.81-96.04), indicating an excellent performance of AlexNet in identifying pictures of CL lesions. We conclude that automated CL identification using AlexNet has the potential to assist clinicians in diagnosing skin lesions. These results contribute to the development of a mobile application to assist in the diagnosis of CL in health care services.
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Affiliation(s)
- José Fabrício de Carvalho Leal
- Graduate Program in Tropical Medicine, Center for Tropical Medicine, Faculty of Medicine, University of Brasília–UnB, Brasília 70904-970, Brazil;
- Laboratory of Medical Parasitology and Vector Biology, Faculty of Medicine, University of Brasília–UnB, Brasília 70904-970, Brazil; (N.S.T.); (V.L.d.M.)
| | - Daniel Holanda Barroso
- Postgraduate Program in Medical Sciences, Faculty of Medicine, University of Brasília–UnB, Brasília 70904-970, Brazil;
| | - Natália Santos Trindade
- Laboratory of Medical Parasitology and Vector Biology, Faculty of Medicine, University of Brasília–UnB, Brasília 70904-970, Brazil; (N.S.T.); (V.L.d.M.)
| | - Vinícius Lima de Miranda
- Laboratory of Medical Parasitology and Vector Biology, Faculty of Medicine, University of Brasília–UnB, Brasília 70904-970, Brazil; (N.S.T.); (V.L.d.M.)
| | - Rodrigo Gurgel-Gonçalves
- Graduate Program in Tropical Medicine, Center for Tropical Medicine, Faculty of Medicine, University of Brasília–UnB, Brasília 70904-970, Brazil;
- Laboratory of Medical Parasitology and Vector Biology, Faculty of Medicine, University of Brasília–UnB, Brasília 70904-970, Brazil; (N.S.T.); (V.L.d.M.)
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ULLAH Z, SAMAD F, BANO R, ARIF S, ZAMIR S, AZIZ N, KHAN H. Characterizing cutaneous leishmaniasis in a conflict-affected region: a study from North Waziristan, Pakistan. Turk J Med Sci 2023; 53:1767-1775. [PMID: 38813502 PMCID: PMC10760576 DOI: 10.55730/1300-0144.5746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/12/2023] [Accepted: 10/10/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Cutaneous leishmaniasis is an emerging tropical disease that remains a serious public health issue in Pakistan, particularly in North Waziristan. The current research was carried out to investigate the presence of cutaneous leishmaniasis in this region. Materials and methods This prospective observational study was conducted from October 2018 to December 2020 at District Head Quarter Hospital Miranshah in North Waziristan with the collaboration of the Pathology Department of Gomal Medical College Dera Ismail Khan, Khyber Pakhtunkhwa. Needle aspirates were used for the microscopic Giemsa-stained slides. SPSS was used for data analysis. Results Of the 5406 clinically-suspected cases, 2603(48.2%) were positive by microscopic examination. Of these 2603 patients, 1474 (57%) were male and 1129 (43%) were female. Most of the lesions were on the face, followed by upper and lower limbs. The 5-10-year age group had the highest percentage of 1167 (45%). A single lesion affected 96.6% of the patients, while 2.7% had double lesions and 0.7% had triple lesions. A high number of cutaneous leishmaniasis were seen from April to August, while the lowest number was seen November to December. Conclusion This study provides extensive information in relation to the existence of cutaneous leishmaniasis in the North Waziristan district of Pakistan, as well as the detailed demographic features of those affected by the disease.
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Affiliation(s)
- Zahid ULLAH
- Department of Pathology, Gomal Medical College, Dera Ismail Khan,
Pakistan
| | - Fazeelat SAMAD
- Department of Pathology, Gomal Medical College, Dera Ismail Khan,
Pakistan
| | - Rahila BANO
- Department of Pathology, Gomal Medical College, Dera Ismail Khan,
Pakistan
| | - Sarah ARIF
- Department of Pathology, Gomal Medical College, Dera Ismail Khan,
Pakistan
| | - Sher ZAMIR
- Department of Physiology, Gomal Medical College, Dera Ismail Khan,
Pakistan
| | - Nighat AZIZ
- Department of Pharmacology, Gomal Medical College, Dera Ismail Khan,
Pakistan
| | - Hassan KHAN
- Faculty of Pharmacy, Gomal University, Dera Ismail Khan,
Pakistan
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Menting S, Erhart A, Schallig HDFH. Laboratory Evaluation of a SARS-CoV-2 RT-LAMP Test. Trop Med Infect Dis 2023; 8:320. [PMID: 37368738 DOI: 10.3390/tropicalmed8060320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
There is a need to have more accessible molecular diagnostic tests for the diagnosis of severe acute respiratory syndrome coronavirus 2 disease in low- and middle-income countries. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) may provide an attractive option as this technology does not require a complex infrastructure. In this study, the diagnostic performance of a SARS-CoV-2 RT-LAMP was evaluated using RT-PCR-confirmed clinical specimens of COVID-19-positive (n = 55) and -negative patients (n = 55) from the Netherlands. The observed sensitivity of the RT-LAMP test was 97.2% (95% CI: 82.4-98.0%) and the specificity was 100% (95% CI: 93.5-100%). The positive predictive value of the RT-LAMP was 100%, the negative predictive value 93.2% (95% CI: 84.3-97.3%), and the diagnostic accuracy was 96.4% (95% CI: 91.0-99.0%). The agreement between the RT-LAMP and the RT-PCR was "almost perfect" (κ-value: 0.92). The evaluated RT-LAMP might provide an attractive alternative molecular diagnostic tool for SARS-CoV-2 in resource limited settings.
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Affiliation(s)
- Sandra Menting
- Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam, Laboratory for Experimental Parasitology, Department of Clinical Microbiology and Infection Prevention, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Annette Erhart
- MRC Unit The Gambia at the LSHTM, Atlantic Boulevard, Fajara, Banjul P.O. Box 273, The Gambia
| | - Henk D F H Schallig
- Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam, Laboratory for Experimental Parasitology, Department of Clinical Microbiology and Infection Prevention, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Zamanpour M, Mohebali M, Khamesipour A, Mohammadi AMA, Akhoundi B. Diagnosis of Human Cutaneous Leishmaniasis: A Comparative Study Using CL Detect ™ Dipstick, Direct Smear and Polymerase Chain Reaction Methods. Acta Parasitol 2023:10.1007/s11686-023-00662-5. [PMID: 36913075 DOI: 10.1007/s11686-023-00662-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/12/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION In most of the endemic areas, the detection of CL is based on searching for amastigotes using the direct smear method. Since expert microscopists are not usually available in every laboratory, false diagnoses are a disaster that happens. Therefore, the aim of current research is to evaluate the validity of the CL Detect™ Rapid Test (CDRT) for diagnosis CL in comparison to direct smear and polymerase chain reaction (PCR) methods. METHODS A total of 70 patients with skin lesions suspected to be CL were recruited. Skin samples from the lesions were collected and used for direct microscopic examination and the PCR method. Furthermore, the skin sample was collected in accordance with the manufacturer's instructions for the CDRT-based rapid diagnostic test. RESULTS Of 70 samples, 51 and 35 samples were positive by direct smear examination and the CDRT, respectively. The PCR showed positive results in 59 samples; 50 and 9 samples were identified as Leishmania major and Leishmania tropica, respectively. The sensitivity and specificity were calculated to be 68.6% (95% CI 54.11-80.89%) and 100% (95% CI 82.35-100%). When the results of CDRT were compared to the microscopic examinations, an agreement of 77.14% was seen between the CDRT and microscopic examination. In addition, the sensitivity and specificity were 59.32% (95% CI 45.75-71.93%) and 100% (95% CI 71.5-100%) when the CDRT was compared to PCR assay (as gold standard) and an agreement (65.71%) was found between CDRT and PCR assay. CONCLUSION As the CDRT is simple, rapid, and does not require great proficiency, it is recommended for use in the detection of CL caused by L. major or L. tropica as a diagnostic method, especially in areas with limited access to expert microscopists.
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Affiliation(s)
- Maryam Zamanpour
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .,Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Akram Mir Amin Mohammadi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Akhoundi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Evaluation of a diagnostic device, CL Detect rapid test for the diagnosis of new world cutaneous leishmaniasis in Peru. PLoS Negl Trop Dis 2023; 17:e0011054. [PMID: 36913433 PMCID: PMC10010545 DOI: 10.1371/journal.pntd.0011054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/21/2022] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a neglected disease and a public health problem in Latin America. The diagnosis of CL in poor hyperendemic regions relies to large extent on the identification of amastigotes in Giemsa-stained smears. There is an urgent need for a rapid, sensitive and low cost diagnostic method for use in field conditions for CL as current modalities are not readily available. The primary objective of this study was to determine the sensitivity and specificity of the FDA-cleared CL Detect Rapid Test in Peru, using modified test procedures rather than the instructions-for-use, by 1) increasing the extraction time and 2) increasing the volume of the sample added to the test strip. CL Detect Rapid Test results were compared against microscopy and kDNA-PCR, for the diagnosis of CL in ulcerated lesions. In addition, we compared two collection methods the dental broach used and mentioned in the CL Detect insert and the standard less invasive and easier to conduct scrapping method. METHODOLOGY Participants were patients who presented for medical consultation due to a suspected CL lesion. Four samples from the index lesion were collected using a dental broach, per package insert, and lancet scraping and tested by the modified CL Detect Rapid Test, microscopy, and PCR. PRINCIPAL FINDINGS A total of 156 subjects were eligible and evaluated. The modified CL Detect sensitivity was higher in specimens obtained by scraping (83.3%) than those from dental broach (64.2%). The specificity was lower in scrapings (77.8%) with a false positive rate of 22.2% compared with dental broach samples (91.7%) with a false positive rate of 8.3%. However, molecular analysis showed that all 8 false negative microscopy scrapings (those positive by modified CL Detect and negative by microscopy) were positive by kDNA-PCR, meaning that the modified CL Detect was more sensitive than microscopy. CONCLUSIONS These modifications to the package insert that resulted in a diagnostic sensitivity (83.3%) comparable to microscopy for species found in Peru may enable earlier anti-leishmanial drug treatment decisions based on a positive result from the CL Detect Rapid Test alone until further diagnostic tests like microscopy and PCR can be performed. TRIAL REGISTRATION NCT03762070; Clinicaltrials.gov.
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Cowan R, Varadarajan S, Wei A, Salim T, DallaPiazza M. Microbial perils of the tropics: A case of cutaneous leishmaniasis in an immigrant from South America. IDCases 2022; 31:e01669. [PMID: 36747913 PMCID: PMC9898636 DOI: 10.1016/j.idcr.2022.e01669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 01/02/2023] Open
Abstract
Cutaneous leishmaniasis is an important cause of nonhealing lesions in those recently immigrated to the United States from endemic areas. The lesions can present with various characteristics such as ulcerations, macules, or papules, and may be painful or painless. Several diagnostic modalities, including polymerase chain reaction testing, should be performed to identify the causative Leishmania species which is important in determining appropriate treatment. We describe a case of cutaneous leishmaniasis caused by Leishmania panamensis in a patient who recently traveled through South and Central America.
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Affiliation(s)
- Rachel Cowan
- Rutgers New Jersey Medical School, Newark, NJ 07101, USA
| | | | - Abraham Wei
- Rutgers New Jersey Medical School, Division of Infectious Diseases, Newark, NJ 07101, USA,Correspondence to: Department of Medicine, New Jersey Medical School, 185 South Orange Avenue, MSB I-689, Newark, NJ 07101, USA.
| | - Tanzila Salim
- Rutgers New Jersey Medical School, Division of Infectious Diseases, Newark, NJ 07101, USA
| | - Michelle DallaPiazza
- Rutgers New Jersey Medical School, Division of Infectious Diseases, Newark, NJ 07101, USA
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Gauging the skin resident Leishmania parasites through a loop mediated isothermal amplification (LAMP) assay in post-kala-azar dermal leishmaniasis. Sci Rep 2022; 12:18069. [PMID: 36302782 PMCID: PMC9614002 DOI: 10.1038/s41598-022-21497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/28/2022] [Indexed: 01/24/2023] Open
Abstract
Despite the availability of highly sensitive polymerase chain reaction (PCR)-based methods, the dearth of remotely deployable diagnostic tools circumvents the early and accurate detection of individuals with post-kala-azar dermal leishmaniasis (PKDL). Here, we evaluate a design-locked loop-mediated isothermal amplification (LAMP) assay to diagnose PKDL. A total of 76 snip-skin samples collected from individuals with probable PKDL (clinical presentation and a positive rK39 rapid diagnostic test (RDT)) were assessed by microscopy, qPCR, and LAMP. An equal number of age and sex-matched healthy controls were included to determine the specificity of the LAMP assay. The LAMP assay with a Qiagen DNA extraction (Q-LAMP) showed a promising sensitivity of 72.37% (95% CI: 60.91-82.01%) for identifying the PKDL cases. LAMP assay sensitivity declined when the DNA was extracted using a boil-spin method. Q-qPCR showed 68.42% (56.75-78.61%) sensitivity, comparable to LAMP and with an excellent agreement, whereas the microscopy exhibited a weak sensitivity of 39.47% (28.44-51.35%). When microscopy and/or qPCR were considered the gold standard, Q-LAMP exhibited an elevated sensitivity of 89.7% (95% CI: 78.83-96.11%) for detection of PKDL cases and Bayesian latent class modeling substantiated the excellent sensitivity of the assay. All healthy controls were found to be negative. Notwithstanding the optimum efficiency of the LAMP assay towards the detection of PKDL cases, further optimization of the boil-spin method is warranted to permit remote use of the assay.
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Cutaneous Leishmaniasis: A 2022 Updated Narrative Review into Diagnosis and Management Developments. Am J Clin Dermatol 2022; 23:823-840. [PMID: 36103050 PMCID: PMC9472198 DOI: 10.1007/s40257-022-00726-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/10/2023]
Abstract
This review is an update of an earlier narrative review published in 2015 on developments in the clinical management of cutaneous leishmaniasis (CL) including diagnosis, treatment, prevention and control measurements. CL is a vector-borne infection caused by the protozoan parasite Leishmania. The vector is the female sandfly. Globally, CL affects 12 million cases and annually 2 million new cases occur. CL is endemic in almost 100 countries and the total risk population is approximately 350 million people. WHO lists CL an emerging and uncontrolled disease and a neglected tropical disease. Local experience-based evidence remains the mainstay for the management of CL. Whereas intralesional therapeutic options are the first treatment option for most CL patients, those with mucocutaneous and disseminated involvement require a systemic therapeutic approach. Moreover, different Leishmania species can vary in their treatment outcomes. Therefore, species determination is critical for optimal CL clinical management. New DNA techniques allow for relatively easy Leishmania species determination, yet they are not easily implemented in resource-limited settings. There is a desperate need for novel, less toxic, and less painful treatment options, especially for children with CL. Yet, the large and well conducted studies required to provide the necessary evidence are lacking. To further control and potentially eliminate CL, we urgently need to improve vector control, and diagnostics, and we require efficient and safe vaccines. Alas, since CL primarily affects poor people, biotechnical companies dedicate little investment into the research programs that could lead to diagnostic, pharmaceutical, and vaccine innovations.
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Freire ML, Rego FD, Lopes KF, Coutinho LA, Grenfell RFQ, Avelar DM, Cota G, Pascoal-Xavier MA, Oliveira E. Anti-mitochondrial Tryparedoxin Peroxidase Monoclonal Antibody-Based Immunohistochemistry for Diagnosis of Cutaneous Leishmaniasis. Front Microbiol 2022; 12:790906. [PMID: 35295679 PMCID: PMC8918995 DOI: 10.3389/fmicb.2021.790906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Cutaneous leishmaniasis (CL) remains a globally spreading public health problem. Among Latin America countries, Brazil has the greatest number of recorded CL cases with several Leishmania species being associated with human cases. Laboratory diagnosis is one of the major challenges to disease control due to the low accuracy of parasitological techniques, the restricted use of molecular techniques, and the importance of differential diagnosis with regard to several dermatological and systemic diseases. In response, we have developed and validated an immunohistochemistry (IHC) technique for CL diagnosis using anti-mTXNPx monoclonal antibody (mAb). Recombinant Leishmania–mTXNPx was produced and used as an immunogen for mAb production through the somatic hybridization technique. The viability of mAb labeling of Leishmania amastigotes was tested by IHC performed with skin biopsies from hamsters experimentally infected with Leishmania amazonensis, Leishmania braziliensis, and Leishmania guyanensis. The enzymes horseradish peroxidase (IHC-HRP) and alkaline phosphatase (IHC-AP), both biotin-free polymer detection systems, were used in the standardization step. The IHC was further validated with skin biopsies from 49 CL patients diagnosed by clinical examination and quantitative real-time polymerase chain reaction and from 37 patients presenting other dermatological infectious diseases. Other parasitological techniques, such as direct examination and culture, were also performed for confirmed CL patients. Histopathology and IHC were performed for all included patients. Overall, the highest sensitivity was observed for IHC-AP (85.7%), followed by IHC-HRP (79.6%), direct examination (77.6%), histopathological examination (HE; 65.3%), and in vitro culture (49%). Only IHC and HE presented specificity over 90% and were able to detect CL patients regardless of parasite burden (odds ratio > 1.94; 95%CI: 0.34–11.23). A significant increase in positivity rates was observed when IHC-AP was combined with direct examination (95.9%) and HE (93.9%). The IHC techniques evaluated in here detected the main Leishmania species causing CL in Brazil and can support diagnostic strategies for controlling this neglected disease, especially if used in combination with other approaches for an integrative laboratorial diagnosis.
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Affiliation(s)
| | - Felipe Dutra Rego
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | | | | | | | | | - Gláucia Cota
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Marcelo Antônio Pascoal-Xavier
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Edward Oliveira
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- *Correspondence: Edward Oliveira,
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Erber AC, Sandler PJ, de Avelar DM, Swoboda I, Cota G, Walochnik J. Diagnosis of visceral and cutaneous leishmaniasis using loop-mediated isothermal amplification (LAMP) protocols: a systematic review and meta-analysis. Parasit Vectors 2022; 15:34. [PMID: 35073980 PMCID: PMC8785018 DOI: 10.1186/s13071-021-05133-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
Sensitive, reliable and fast diagnostic tools that are applicable in low-resource settings, at the point of care (PoC), are seen as crucial in the fight against visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL). Addressing the need for a PoC test, several diagnostic tests, including serological and molecular methods, have been developed and evaluated in the past. One promising molecular method, already implemented for diagnosis of a range of diseases, is the loop-mediated isothermal amplification (LAMP) protocol. In this systematic review and meta-analysis, using a comprehensive search strategy, we focus on studies evaluating the performance of LAMP for the diagnosis of leishmaniasis in humans and other mammals such as dogs, compared with microscopy and/or any other molecular diagnostic method. A meta-analysis, pooling sensitivity and specificity rates and calculating areas under the curve (AUCs) in summary receiver operating characteristic (SROC) plots, was conducted on datasets extracted from studies, grouped by clinical condition and sample type. We found high sensitivity and specificity for LAMP when compared with microscopy and PCR using blood samples, with pooled estimate values of > 90% for all subgroups, corresponding to calculated AUC values > 0.96, except for LAMP compared to microscopy for diagnosis of CL. However, only a limited number of studies were truly comparable. Most of the observed heterogeneity is likely based on true differences between the studies rather than sampling error only. Due to simple readout methods and low laboratory equipment requirements for sample preparation compared to other molecular methods, LAMP is a promising candidate for a molecular (near-)PoC diagnostic method for VL and CL.
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Affiliation(s)
- Astrid Christine Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1st floor, 1090, Vienna, Austria. .,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK.
| | - Peter Julian Sandler
- Department of Applied Life Sciences, FH Campus Wien University of Applied Sciences, Helmut-Qualtinger Gasse 2, 1030, Vienna, Austria
| | - Daniel Moreira de Avelar
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ines Swoboda
- Department of Applied Life Sciences, FH Campus Wien University of Applied Sciences, Helmut-Qualtinger Gasse 2, 1030, Vienna, Austria
| | - Gláucia Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Julia Walochnik
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
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van Henten S, Fikre H, Melkamu R, Dessie D, Mekonnen T, Kassa M, Bogale T, Mohammed R, Cnops L, Vogt F, Pareyn M, van Griensven J. Evaluation of the CL Detect Rapid Test in Ethiopian patients suspected for Cutaneous Leishmaniasis. PLoS Negl Trop Dis 2022; 16:e0010143. [PMID: 35041672 PMCID: PMC8797207 DOI: 10.1371/journal.pntd.0010143] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/28/2022] [Accepted: 01/04/2022] [Indexed: 01/01/2023] Open
Abstract
Background Cutaneous leishmaniasis (CL) is common in Ethiopia, mainly affecting impoverished populations in rural areas with poor access to health care. CL is routinely diagnosed using skin slit smear microscopy, which requires skilled staff and appropriately equipped laboratories. We evaluated the CL Detect Rapid Test (InBios, Washington, USA), which is supplied with a dental broach sampling device, as a diagnostic alternative which could be used in field settings. Methodology/Principal findings We evaluated the diagnostic accuracy of the CL Detect Rapid Test on skin slit and dental broach samples from suspected CL patients at the Leishmaniasis Research and Treatment Center in Gondar, Ethiopia. A combined reference test of microscopy and PCR on the skin slit sample was used, which was considered positive if one of the two tests was positive. We recruited 165 patients consecutively, of which 128 (77.6%) were confirmed as CL. All microscopy-positive results (n = 71) were also PCR-positive, and 57 patients were only positive for PCR. Sensitivity of the CL Detect Rapid Test on the skin slit was 31.3% (95% confidence interval (CI) 23.9–39.7), which was significantly higher (p = 0.010) than for the dental broach (22.7%, 95% CI 16.3–30.6). Sensitivity for both methods was significantly lower than for the routinely used microscopy, which had a sensitivity of 55.5% (IQR 46.8–63.8) compared to PCR as a reference. Conclusions/Significance The diagnostic accuracy of the CL Detect Rapid Test was low for skin slit and dental broach samples. Therefore, we do not recommend its use neither in hospital nor field settings. Trial registration This study is registered at ClinicalTrials.gov as NCT03837431. Cutaneous leishmaniasis (CL) is common in Ethiopia, and mainly affects rural areas with poor access to health care. CL is routinely diagnosed using microscopy on a skin slit sample, which requires skilled staff and appropriately equipped laboratories. We evaluated the diagnostic accuracy of the CL Detect Rapid Test as an alternative which could be used in field settings. In a population of 165 patients suspected to have CL, 78% was confirmed to have CL by PCR. We found that the CL Detect Rapid Test on the supplied dental broach had a sensitivity of only 23%; on a skin slit sample, the Rapid Test had a slightly higher sensitivity with 31%. The routine diagnostic test of microscopy on the skin slit had a significantly higher sensitivity with 56%. These findings show that the sensitivity of the CL Detect Rapid Test is low, and is much worse than that of the currently used diagnostic method. Therefore, we do not recommend it to be used for diagnosing CL in Ethiopia.
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Affiliation(s)
- Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Roma Melkamu
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Dilargachew Dessie
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Tigist Mekonnen
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Mekibib Kassa
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Tadfe Bogale
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Rezika Mohammed
- Leishmaniasis Research and Treatment Center, Gondar University Hospital, Gondar, Ethiopia
| | - Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Myrthe Pareyn
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Kariyawasam R, Valencia BM, Lau R, Shao E, Thompson CA, Stevens M, Kincaid L, Del Castillo ALQ, Cruz-Arzapalo LO, Llanos-Cuentas A, Boggild AK. Evaluation of a point-of-care molecular detection device for Leishmania spp. and intercurrent fungal and mycobacterial organisms in Peruvian patients with cutaneous ulcers. Infection 2021; 49:1203-1211. [PMID: 34368941 DOI: 10.1007/s15010-021-01673-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Overlapping clinical features of cutaneous leishmaniasis (CL) with ulcers caused by fungi and mycobacteria necessitate confirmatory diagnostic testing. We evaluated a handheld battery-operated device for detection of CL and common fungal and mycobacterial causes of ulcers. METHODS We validated Palm PCR™ for detection of common ulcerative skin pathogens using ATCC® reference and clinical strains of Leishmania, mycobacteria, and fungi in the lab and field. Amplified products were Sanger sequenced. Performance characteristics were calculated using conventional PCR as a reference standard. RESULTS Palm PCR™ detected 100% of ATCC® strains of Leishmania, fungi, and mycobacteria, with sensitivity and specificity of 90% and 91.7%, respectively. In the field, the sensitivity for detection of Leishmania in patients with suspected CL was 100%. In 61% of CL patients, co-colonization with genera such as Malassezia, Aspergillus, Candida, and Cladosporium was detected. In 50% of CL patients with an inflammatory (secondarily infected) phenotype, detected fungal species had known associations with human cutaneous disease. CONCLUSIONS Palm PCR™ performs comparably to conventional PCR for detection of Leishmania, fungi, and mycobacteria. This work has implications for the diagnostic approach to tropical ulcers, and has the potential to improve field detection of ulcerative pathogens in resource constrained areas.
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Affiliation(s)
| | - Braulio M Valencia
- Instituto de Medicina Tropical "Alexander Von Humboldt", Lima, Peru
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rachel Lau
- Public Health Ontario Laboratory, Toronto, ON, Canada
| | - Eric Shao
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Courtney A Thompson
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON, M5G 2C4, Canada
- Markham-Stouffville Hospital, Markham, ON, Canada
| | - Michael Stevens
- Division of Clinical Dermatology and Cutaneous Science, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leah Kincaid
- Alliance Dermatology Associates, Lawrenceville, NJ, USA
| | | | | | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical "Alexander Von Humboldt", Lima, Peru
- Facultad de Ciencias, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andrea K Boggild
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON, M5G 2C4, Canada.
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Fujisawa K, Silcott-Niles C, Simonson P, Lamattina D, Humeres CA, Bhattacharyya T, Mertens P, Thunissen C, O’Rourke V, Pańczuk M, Whitworth JA, Salomón OD, Miles MA. Emergent canine visceral leishmaniasis in Argentina: Comparative diagnostics and relevance to proliferation of human disease. PLoS Negl Trop Dis 2021; 15:e0009552. [PMID: 34280201 PMCID: PMC8289008 DOI: 10.1371/journal.pntd.0009552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a zoonotic protozoal vector-borne disease that is a major public health challenge. In Argentina, canine (CVL) and human visceral leishmaniasis (HVL) have recently emerged. There is a lack of standardised diagnostic tests for CVL, which hinders control of CVL and HVL. METHODOLOGY/PRINCIPAL FINDINGS Sampling was carried out in Puerto Iguazú, Argentina, comprising 190 asymptomatic, oligosymptomatic and polysymptomatic dogs. The following diagnostics were applied: microscopy of lymph node aspirate (LNA); three immunochromatographic rapid diagnostic tests (RDTs), prototype rK28-ICT, rK39-ICT (both Coris BioConcept), commercial rK39 (InBios); ELISA for IgG, IgG1 and IgG2, against rK28, rK39 or crude lysate antigen. DNA detection and analysis, with 30 dogs, was of the ITS1 region using skin samples, and loop-mediated isothermal amplification (LAMP; Eiken Loopamp) of buffy coat, skin scrape or LNA. 15.4% of dogs were positive by LNA microscopy. The rK28 RDT had higher seropositivity rate (61%) than either a prototype rK39 RDT (31.4%) or commercial rK39 RDT (18.8%), without cross-reactivity with six other pathogens. IgG anti-rK39 ELISA antibody titres, but not IgG2, were positively correlated with number of clinical signs. LAMP with LNA had a higher positivity rate than PCR; buffy coat sampling was more sensitive than skin scrape. ITS1 confirmed Leishmania (Leishmania) infantum as the agent of CVL. Leishmania (Viannia) spp. was detected in skin samples from two dogs, compatible with Leishmania (Viannia) braziliensis. CONCLUSIONS/SIGNIFICANCE Seroprevalence confirmed rapid increase in CVL in Puerto Iguazú. The rK28 RDT test potentially has great value for improved point-of-care diagnosis. Given cost reduction and accessibility, commercial LAMP may be applicable to buffy coat. RDT biomarkers of CVL clinical status are required to combat spread of CVL and HVL. The presence of Viannia, perhaps as an agent of human mucocutaneous leishmaniasis (MCL), highlights the need for vigilance and surveillance.
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Affiliation(s)
- Kyoko Fujisawa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charlotte Silcott-Niles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Poppy Simonson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniela Lamattina
- Instituto Nacional de Medicina Tropical (INMeT), ANLIS, Ministerio de Salud de la Nación, Puerto Iguazú, Misiones, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Puerto Iguazú, Misiones, Argentina
| | - Cristian A. Humeres
- Instituto Nacional de Medicina Tropical (INMeT), ANLIS, Ministerio de Salud de la Nación, Puerto Iguazú, Misiones, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Puerto Iguazú, Misiones, Argentina
| | - Tapan Bhattacharyya
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Victoria O’Rourke
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Magdalena Pańczuk
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James A. Whitworth
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oscar Daniel Salomón
- Instituto Nacional de Medicina Tropical (INMeT), ANLIS, Ministerio de Salud de la Nación, Puerto Iguazú, Misiones, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Puerto Iguazú, Misiones, Argentina
| | - Michael A. Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Potential antigenic targets used in immunological tests for diagnosis of tegumentary leishmaniasis: A systematic review. PLoS One 2021; 16:e0251956. [PMID: 34043671 PMCID: PMC8158869 DOI: 10.1371/journal.pone.0251956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/06/2021] [Indexed: 01/14/2023] Open
Abstract
Immunological tests may represent valuable tools for the diagnosis of human tegumentary leishmaniasis (TL) due to their simple execution, less invasive nature and potential use as a point-of-care test. Indeed, several antigenic targets have been used with the aim of improving the restricted scenario for TL-diagnosis. We performed a worldwide systematic review to identify antigenic targets that have been evaluated for the main clinical forms of TL, such as cutaneous (CL) and mucosal (ML) leishmaniasis. Included were original studies evaluating the sensitivity and specificity of immunological tests for human-TL, CL and/or ML diagnosis using purified or recombinant proteins, synthetic peptides or polyclonal or monoclonal antibodies to detect Leishmania-specific antibodies or antigens. The review methodology followed PRISMA guidelines and all selected studies were evaluated in accordance with QUADAS-2. Thirty-eight original studies from four databases fulfilled the selection criteria. A total of 79 antigens were evaluated for the detection of antibodies as a diagnostic for TL, CL and/or ML by ELISA. Furthermore, three antibodies were evaluated for the detection of antigen by immunochromatographic test (ICT) and immunohistochemistry (IHC) for CL-diagnosis. Several antigenic targets showed 100% of sensitivity and specificity, suggesting potential use for TL-diagnosis in its different clinical manifestations. However, a high number of proof-of-concept studies reinforce the need for further analysis aimed at verifying true diagnostic accuracy in clinical practice.
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Diagnostic performance of a Recombinant Polymerase Amplification Test-Lateral Flow (RPA-LF) for cutaneous leishmaniasis in an endemic setting of Colombia. PLoS Negl Trop Dis 2021; 15:e0009291. [PMID: 33909619 PMCID: PMC8081229 DOI: 10.1371/journal.pntd.0009291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Control of cutaneous leishmaniasis by public health systems in the Americas relies on case identification and treatment. Point-of-care diagnostics that can be performed by health workers within or near affected communities could effectively bring the health system to the resource-limited sites providing early diagnosis and treatment, reducing morbidity and the burden of disease. Methodology/principal findings A cross-sectional study was undertaken to evaluate the diagnostic test performance of Isothermal Recombinase Polymerase Amplification (RPA) targeting Leishmania kinetoplast DNA, coupled with a lateral flow (LF) immunochromatographic strip, in a field setting and a laboratory reference center. Minimally invasive swab and FTA filter paper samples were obtained by community health workers and highly trained technicians from ulcerated lesions of > 2 weeks’ evolution from 118 patients’ ≥ 2 years of age in the municipality of Tumaco, Nariño. Extracted DNA was processed by RPA-LF at a reference center or in a primary health facility in the field. Evaluation was based on a composite “gold standard” that included microscopy, culture, biopsy and real-time polymerase chain reaction detection of Leishmania 18S rDNA. Standard of care routine diagnostic tests were explored as comparators. Sensitivity and specificity of RPA-LF in the reference lab scenario were 87% (95%CI 74–94) and 86% (95%CI 74–97), respectively. In the field scenario, the sensitivity was 75% (95%CI 65–84) and specificity 89% (95%CI 78–99). Positive likelihood ratios in both scenarios were higher than 6 while negative likelihood ratios ranged to 0.2–0.3 supporting the usefulness of RPA-LF to rule-in and potentially to rule-out infection. Conclusions/significance The low complexity requirements of RPA-LF combined with non-invasive sampling support the feasibility of its utilization by community health workers with the goal of strengthening the diagnostic capacity for cutaneous leishmaniasis in Colombia. Trial registration ClinicalTrials.gov NCT04500873. Limited access to diagnosis is a critical determinant of the “neglect” that defines the so-called Neglected Tropical Diseases (NTDs) including cutaneous leishmaniasis. Diagnostic tests that can be performed close to and involve the participation of the affected communities would improve access to treatment as well as diagnosis. Using non-invasive swab and filter paper samples obtained by Community Health Workers, we evaluated the diagnostic performance of an innovative and technically simple molecular test: Isothermal Recombinase Polymerase Amplification (RPA) to detect Leishmania DNA, coupled with a lateral flow (LF) strip to read the results with the naked eye. The RPA-LF test demonstrated high sensitivity and specificity and capacity to rule in or rule out a diagnosis of cutaneous leishmaniasis in both an endemic field setting and reference laboratory. The findings encourage the further optimization of the test format for Point-of-Care diagnosis by health personnel and rural health workers in endemic settings.
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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] [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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Dixit KK, Ramesh V, Gupta R, Negi NS, Singh R, Salotra P. Real-Time Fluorimetry Loop-Mediated Isothermal Amplification for Diagnosis of Leishmaniasis and as a Tool for Assessment of Cure for Post-Kala-Azar Dermal Leishmaniasis. Am J Trop Med Hyg 2021; 104:2097-2107. [PMID: 33872204 DOI: 10.4269/ajtmh.20-1057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
Despite the dwindling number of visceral leishmaniasis (VL) cases in India, there is an urgent need for early and unequivocal diagnostics for controlling and preventing the reemergence of VL. Post-kala-azar dermal leishmaniasis (PKDL), a dermal sequela of VL, serves as a reservoir of the parasite. Diagnosis of PKDL, especially the macular variant, is challenging and poses impediment toward attainment of VL elimination. In this study, a real-time fluorimetry loop-mediated isothermal amplification (RealAmp) assay has been established for the detection of different clinical manifestations of leishmaniasis. The study included 150 leishmaniasis patients (25 VL, 25 cutaneous leishmaniasis [CL], and 100-PKDL) along with 120 controls. The assay demonstrated sensitivity of 100% (95% CI: 86.68-100) for diagnosis of VL and PKDL (95% CI: 79.61-100) and 96% (95% CI: 86.68-100) for CL with 100% specificity. Moreover, considering the cardinal role of PKDL, diagnosis using minimally invasive slit aspirate was explored, which demonstrated remarkable sensitivity of 96% (95% CI: 87.64-98.47). As a test of cure for PKDL, RealAmp successfully detected parasite in two of posttreatment cases who later reported relapse on follow-up. Also, direct sample lysis using slit aspirate was attempted in a small group that yielded sensitivity of 89% (95% CI: 67.20-96.90). RealAmp depicted excellent diagnostic accuracy in the diagnosis of leishmaniasis in concordance with the established SYBR Green I-based visual loop-mediated isothermal amplification (LAMP) and the reference comparator real-time PCR. The study endorsed the employment of LAMP either as visual-LAMP or RealAmp for an accurate and expeditious diagnosis of PKDL and as a tool for assessment of cure.
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Affiliation(s)
- Keerti Kaumudee Dixit
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India.,2Faculty of Health and Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - V Ramesh
- 3Department of Dermatology and STD, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Ratan Gupta
- 4Department of Paediatrics, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Narendra Singh Negi
- 5Department of Medicine, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Ruchi Singh
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India
| | - Poonam Salotra
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India
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22
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Ibarra-Meneses AV, Chicharro C, Sánchez C, García E, Ortega S, Ndung’u JM, Moreno J, Cruz I, Carrillo E. Loop-Mediated Isothermal Amplification Allows Rapid, Simple and Accurate Molecular Diagnosis of Human Cutaneous and Visceral Leishmaniasis Caused by Leishmania infantum When Compared to PCR. Microorganisms 2021; 9:microorganisms9030610. [PMID: 33809454 PMCID: PMC7999953 DOI: 10.3390/microorganisms9030610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Loop-mediated isothermal amplification allows the rapid, sensitive and specific amplification of DNA without complex and expensive equipment. We compared the diagnostic performance of Loopamp™ Leishmania Detection Kit (Eiken Chemical Co., Ltd., Tokyo, Japan) with conventional and real-time polymerase chain reaction (PCR) for human cutaneous and visceral leishmaniasis caused by L. infantum. A total of 230 DNA samples from cutaneous (CL) and visceral (VL) leishmaniasis cases and controls from Spain, characterized by Leishmania nested PCR (LnPCR) were tested by: (i) the Loopamp™ Leishmania Detection Kit (Loopamp), run on Genie III real-time fluorimeter (OptiGene, UK); and (ii) real-time quantitative PCR (qPCR). The Loopamp test returned 98.8% (95% confidence interval—CI: 96.0–100.00) sensitivity and specificity of 97.7% (95% CI: 92.2–100) on VL samples, and 100% (95% CI: 99.1–100) sensitivity and 100.0% (95% CI: 98.8–100.0) specificity on CL samples. The Loopamp time-to-positivity (Tp) obtained by real-time fluorimetry showed excellent concordance (C = 97.91%) and strong correlation (r = 0.799) with qPCR’s cycle threshold (Ct). The performance of Loopamp is comparable to that of LnPCR and qPCR in the diagnosis of cutaneous and visceral leishmaniasis due to L. infantum. The excellent correlation between the Tp and Ct should be further investigated to determine the accuracy of Loopamp to quantify parasite load in tissues.
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Affiliation(s)
- Ana Victoria Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Emilia García
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Sheila Ortega
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | | | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, 1202 Geneva, Switzerland;
- National School of Public Health, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
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23
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Moulik S, Sengupta S, Chatterjee M. Molecular Tracking of the Leishmania Parasite. Front Cell Infect Microbiol 2021; 11:623437. [PMID: 33692966 PMCID: PMC7937807 DOI: 10.3389/fcimb.2021.623437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
With the Visceral Leishmaniasis/Kala-azar Elimination Program in South Asia in its consolidation phase, the focus is mainly on case detection, vector control, and identifying potential sources of infection. Accordingly, emphasis is presently on curbing transmission, which is potentially achievable by identification and elimination of potential reservoirs. The strongest contenders for being the disease reservoir are cases of Post Kala-azar Dermal Leishmaniasis (PKDL) which occurs in a minor proportion of individuals apparently cured of Visceral Leishmaniasis (VL). The demonstration of parasites in tissue aspirates despite being a risky and invasive process is the gold standard for diagnosis of VL, but is now being replaced by serological tests e.g., rK39 strip test and direct agglutination test. However, these antibody based tests are limited in their ability to diagnose relapses, detect cases of PKDL, and monitor effectiveness of treatment. Accordingly, detection of antigen or nucleic acids by polymerase chain reaction has been successfully applied for monitoring of parasite kinetics. This review article provides updated information on recent developments regarding the available antibody or antigen/nucleic acid based biomarkers for longitudinal monitoring of patients with VL or PKDL and emphasizes the need for availability of studies pertaining to quantification of treatment response or relapse.
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Affiliation(s)
- Srija Moulik
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Shilpa Sengupta
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Mitali Chatterjee
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
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24
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McMahon DE, Oyesiku L, Semeere A, Kang D, Freeman EE. Novel Diagnostics for Kaposi Sarcoma and Other Skin Diseases in Resource-Limited Settings. Dermatol Clin 2020; 39:83-90. [PMID: 33228864 DOI: 10.1016/j.det.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In resource-limited settings, point-of-care diagnostic devices have the potential to reduce diagnostic delays and improve epidemiologic surveillance of dermatologic conditions. We outline novel-point-of care diagnostics that have recently been developed for dermatologic conditions that primarily affect patients living in resource-limited settings, namely, Kaposi sarcoma, cutaneous leishmaniasis, leprosy, Buruli ulcer, yaws, onchocerciasis, and lymphatic filariasis. All of the technologies described in this article are prototypes, and some have undergone field testing. These devices still require validation in real-world settings and effective pricing to have a major impact on dermatologic care in resource-limited settings.
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Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA
| | - Linda Oyesiku
- Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Esther E Freeman
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA.
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25
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Hong A, Zampieri RA, Shaw JJ, Floeter-Winter LM, Laranjeira-Silva MF. One Health Approach to Leishmaniases: Understanding the Disease Dynamics through Diagnostic Tools. Pathogens 2020; 9:pathogens9100809. [PMID: 33019713 PMCID: PMC7599840 DOI: 10.3390/pathogens9100809] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 01/19/2023] Open
Abstract
Leishmaniases are zoonotic vector-borne diseases caused by protozoan parasites of the genus Leishmania that affect millions of people around the globe. There are various clinical manifestations, ranging from self-healing cutaneous lesions to potentially fatal visceral leishmaniasis, all of which are associated with different Leishmania species. Transmission of these parasites is complex due to the varying ecological relationships between human and/or animal reservoir hosts, parasites, and sand fly vectors. Moreover, vector-borne diseases like leishmaniases are intricately linked to environmental changes and socioeconomic risk factors, advocating the importance of the One Health approach to control these diseases. The development of an accurate, fast, and cost-effective diagnostic tool for leishmaniases is a priority, and the implementation of various control measures such as animal sentinel surveillance systems is needed to better detect, prevent, and respond to the (re-)emergence of leishmaniases.
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Affiliation(s)
- Ahyun Hong
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo 05508-090, Brazil; (A.H.); (R.A.Z.); (L.M.F.-W.)
| | - Ricardo Andrade Zampieri
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo 05508-090, Brazil; (A.H.); (R.A.Z.); (L.M.F.-W.)
| | - Jeffrey Jon Shaw
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil;
| | - Lucile Maria Floeter-Winter
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo 05508-090, Brazil; (A.H.); (R.A.Z.); (L.M.F.-W.)
| | - Maria Fernanda Laranjeira-Silva
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo 05508-090, Brazil; (A.H.); (R.A.Z.); (L.M.F.-W.)
- Correspondence:
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26
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Leishmaniasis immunopathology-impact on design and use of vaccines, diagnostics and drugs. Semin Immunopathol 2020; 42:247-264. [PMID: 32152715 DOI: 10.1007/s00281-020-00788-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
Leishmaniasis is a disease complex caused by 20 species of protozoan parasites belonging to the genus Leishmania. In humans, it has two main clinical forms, visceral leishmaniasis (VL) and cutaneous or tegumentary leishmaniasis (CL), as well as several other cutaneous manifestations in a minority of cases. In the mammalian host Leishmania parasites infect different populations of macrophages where they multiply and survive in the phagolysosomal compartment. The progression of both VL and CL depends on the maintenance of a parasite-specific immunosuppressive state based around this host macrophage infection. The complexity and variation of immune responses and immunopathology in humans and the different host interactions of the different Leishmania species has an impact upon the effectiveness of vaccines, diagnostics and drugs.
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27
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Thakur S, Joshi J, Kaur S. Leishmaniasis diagnosis: an update on the use of parasitological, immunological and molecular methods. J Parasit Dis 2020; 44:253-272. [PMID: 32419743 PMCID: PMC7223249 DOI: 10.1007/s12639-020-01212-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/07/2020] [Indexed: 12/24/2022] Open
Abstract
Diagnosis of leishmaniasis has always been a major challenge as its clinical features resemble some other commonly occurring diseases such as tuberculosis, typhoid, and malaria. Reliable laboratory methods become important for differential diagnosis. Demonstration of the parasites in stained preparations of bone marrow and splenic aspirates being risky and invasive is still the gold standard for diagnosis. Serological tests utilizing rapid immunochromatographic formats or rK39 in enzyme linked immune sorbent assay, immunoblotting, direct agglutination test have complications related to high proportions of positive asymptomatic individuals and the inability to diagnose a relapse. Among the molecular techniques, polymerase chain reaction is the most commonly used technique that is successfully implied for diagnosis. This review provides updated information on the recent developments in the field of diagnosis in leishmaniasis, various methods utilized with their advantages and limitations.
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Affiliation(s)
- Shivani Thakur
- Parasitology Laboratory, Department of Zoology, Panjab University, Chandigarh, 160014 India
| | - Jyoti Joshi
- Parasitology Laboratory, Department of Zoology, Panjab University, Chandigarh, 160014 India
| | - Sukhbir Kaur
- Parasitology Laboratory, Department of Zoology, Panjab University, Chandigarh, 160014 India
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28
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Nzelu CO, Kato H, Peters NC. Loop-mediated isothermal amplification (LAMP): An advanced molecular point-of-care technique for the detection of Leishmania infection. PLoS Negl Trop Dis 2019; 13:e0007698. [PMID: 31697673 PMCID: PMC6837287 DOI: 10.1371/journal.pntd.0007698] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Leishmaniasis, caused by protozoan parasites of the Leishmania genus, represents an important health problem in many regions of the world. Lack of effective point-of-care (POC) diagnostic tests applicable in resources-limited endemic areas is a critical barrier to effective treatment and control of leishmaniasis. The development of the loop-mediated isothermal amplification (LAMP) assay has provided a new tool towards the development of a POC diagnostic test based on the amplification of pathogen DNA. LAMP does not require a thermocycler, is relatively inexpensive, and is simple to perform with high amplification sensitivity and specificity. In this review, we discuss the current technical developments, applications, diagnostic performance, challenges, and future of LAMP for molecular diagnosis and surveillance of Leishmania parasites. Studies employing the LAMP assay to diagnose human leishmaniasis have reported sensitivities of 80% to 100% and specificities of 94% to 100%. These observations suggest that LAMP offers a good molecular POC technique for the diagnosis of leishmaniasis and is also readily applicable to screening at-risk populations and vector sand flies for Leishmania infection in endemic areas.
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Affiliation(s)
- Chukwunonso O. Nzelu
- Snyder Institute for Chronic Diseases, Departments of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine and Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
- * E-mail: (CON); (NCP)
| | - Hirotomo Kato
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
| | - Nathan C. Peters
- Snyder Institute for Chronic Diseases, Departments of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine and Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
- * E-mail: (CON); (NCP)
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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] [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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30
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Collis S, El-Safi S, Atia AA, Bhattacharyya T, Hammad A, Den Boer M, Le H, Whitworth JA, Miles MA. Epidemiological and molecular investigation of resurgent cutaneous leishmaniasis in Sudan. Int J Infect Dis 2019; 88:14-20. [PMID: 31442631 PMCID: PMC6838665 DOI: 10.1016/j.ijid.2019.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Local health personnel have drawn attention to an apparent increase in incidence and severity of cutaneous leishmaniasis (CL) in Sudan. The objective of this study was to investigate CL burden and surveillance. METHODS Surveillance data were compiled from the KalaCORE programme, Leishmania coordinators in Northern Kordofan and Southern Darfur, and Khartoum Dermatology Hospital. CL lesions were sampled from 14 suspected cases from Northern Kordofan and the Hospital for Tropical Diseases in Omdurman. PCR-restriction fragment length polymorphism analysis and multilocus sequencing were used to characterize the disease agent. RESULTS All sites reported substantial increases from 2014 to 2016/7, far exceeding World Health Organization case reports for 2014, consistent with a widespread outbreak. Single seasonal peak incidence was observed, except for two peaks in Southern Darfur. In Northern Kordofan, the odds ratio for CL in the 35-44 years age group was 2.6 times higher than in the >45 years age group (p<0.0001); in Southern Darfur, the OR was 2.38 greater in males than females (p<0.0001). Lesions included severe presentations, despite chemotherapy. Leishmania major was identified as the agent. CONCLUSIONS Active surveillance is required to understand the extent of CL in Sudan, as well as training to standardize surveillance, diagnosis, reporting, and quality control. Point-of-care rapid diagnosis would be valuable. Genotyping and phenotyping are required to monitor the emergence of pathogenic strains, drug resistance, outbreaks, and changes in severity.
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Affiliation(s)
- Sarah Collis
- London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Atia A Atia
- World Health Organization, Sudan; KalaCORE Consortium, Sudan.
| | | | - Awad Hammad
- Faculty of Medicine, University of Khartoum, Sudan.
| | - Margriet Den Boer
- Médecins Sans Frontières, Amsterdam, The Netherlands; KalaCORE Consortium, London, UK.
| | - Hai Le
- London School of Hygiene and Tropical Medicine, London, UK.
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31
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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. APPLIED HEALTH ECONOMICS AND 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] [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] [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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van Henten S, Adriaensen W, Fikre H, Akuffo H, Diro E, Hailu A, Van der Auwera G, van Griensven J. Cutaneous Leishmaniasis Due to Leishmania aethiopica. EClinicalMedicine 2018; 6:69-81. [PMID: 31193672 PMCID: PMC6537575 DOI: 10.1016/j.eclinm.2018.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 01/06/2023] Open
Abstract
Leishmania aethiopica is the main causative species for cutaneous leishmaniasis (CL) in Ethiopia. Despite its considerable burden, L. aethiopica has been one of the most neglected Leishmania species. In this review, published evidence on L. aethiopica history, geography, vector, reservoir, epidemiology, parasitology, and immunology is discussed and knowledge gaps are outlined. L. aethiopica endemic regions are limited to the highland areas, although nationwide studies on CL prevalence are lacking. Phlebotomus pedifer and P. longipes are the sandfly vectors and hyraxes are considered to be the main reservoir, but the role of other sandfly species and other potential reservoirs requires further investigation. Where and how transmission occurs exactly are also still unknown. Most CL patients in Ethiopia are children and young adults. Lesions are most commonly on the face, in contrast to CL caused by other Leishmania species which may more frequently affect other body parts. CL lesions caused by L. aethiopica seem atypical and more severe in their presentation as compared to other Leishmania species. Mucocutaneous leishmaniasis and diffuse cutaneous leishmaniasis are relatively common, and healing of lesions caused by L. aethiopica seems to take longer than that of other species. A thorough documentation of the natural evolution of L. aethiopica as well as in depth studies into the immunological and parasitological characteristics that underpin the atypical and severe clinical presentation are needed. Better understanding of CL caused by this parasite species will contribute to interventions related to transmission, prevention, and treatment.
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Affiliation(s)
- Saskia van Henten
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Corresponding author.
| | - Wim Adriaensen
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Helina Fikre
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Hannah Akuffo
- Swedish International Development Agency (Sida) and Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solna, Sweden
| | - Ermias Diro
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Asrat Hailu
- Addis Ababa University School of Medicine, Ethiopia
| | - Gert Van der Auwera
- Unit of Molecular Parasitology, Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium
| | - Johan van Griensven
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Kurizky PS, Mota LMHD, Gomes CM. The paradox of tegumentary leishmaniasis diagnosis: How the need for accurate and modern techniques is being addressed in low income areas. EBioMedicine 2018; 38:19-20. [PMID: 30448226 PMCID: PMC6306384 DOI: 10.1016/j.ebiom.2018.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Patrícia Shu Kurizky
- Diagnostic Dermatology Group, Hospital Universitário de Brasília, SGAN 605, Av. L2 Norte, Brasília, DF 70.840-901, Brazil
| | - Licia Maria Henrique da Mota
- Serviço de Reumatologia, Hospital Universitário de Brasília, Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF 70.910-900, Brazil
| | - Ciro Martins Gomes
- Diagnostic Dermatology Group, Núcleo de Medicina Tropical, Pós-graduação em Ciências Médicas, Laboratório de Dermatomicologia, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF 70.910-900, Brazil.
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