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Corrêa-Castro G, Silva-Freitas ML, de Paula L, Soares Pereira L, Dutra MRT, Albuquerque HG, Cota G, de Azevedo Martins C, Da-Cruz AM, Gomes-Silva A, Santos-Oliveira JR. A link between circulating immune complexes and acute kidney injury in human visceral leishmaniasis. Sci Rep 2024; 14:9870. [PMID: 38684845 PMCID: PMC11059367 DOI: 10.1038/s41598-024-60209-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania infantum. Clinically, VL evolves with systemic impairment, immunosuppression and hyperactivation with hypergammaglobulinemia. Although renal involvement has been recognized, a dearth of understanding about the underlying mechanisms driving acute kidney injury (AKI) in VL remains. We aimed to evaluate the involvement of immunoglobulins (Igs) and immune complexes (CIC) in the occurrence of AKI in VL patients. Fourteen VL patients were evaluated between early treatment and 12 months post-treatment (mpt). Anti-Leishmania Igs, CIC, cystatin C, C3a and C5a were assessed and correlated with AKI markers. Interestingly, high levels of CIC were observed in VL patients up to 6 mpt. Concomitantly, twelve patients met the criteria for AKI, while high levels of cystatin C were observed up to 6 mpt. Plasmatic cystatin C was positively correlated with CIC and Igs. Moreover, C5a was correlated with cystatin C, CIC and Igs. We did not identify any correlation between amphotericin B use and kidney function markers in VL patients, although this association needs to be further explored in subsequent studies. Our data reinforce the presence of an important renal function impairment during VL, suggesting the involvement of Igs, CIC, and C5a in this clinical condition.
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Affiliation(s)
- Gabriela Corrêa-Castro
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia, IFRJ, Rio de Janeiro, Brazil
| | | | - Ludmila de Paula
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais, Minas Gerais, Brazil
| | - Leonardo Soares Pereira
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais, Minas Gerais, Brazil
| | | | | | - Glaucia Cota
- Instituto René Rachou, FIOCRUZ, Minas Gerais, Brazil
| | | | - Alda Maria Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Disciplina de Parasitologia, DMIP, Faculdade de Ciências Médicas, UERJ, Rio de Janeiro, Brazil
- Rede de Pesquisas em Saúde do Estado do Rio de Janeiro, FAPERJ, Rio de Janeiro, Brazil
- Instituto Nacional de Neuroimunomodulação, INCT-NIM-CNPq, Rio de Janeiro, Brazil
| | - Adriano Gomes-Silva
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Laboratório de Pesquisa Clínica em Micobacterioses, Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil
| | - Joanna Reis Santos-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
- Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia, IFRJ, Rio de Janeiro, Brazil.
- Instituto Nacional de Neuroimunomodulação, INCT-NIM-CNPq, Rio de Janeiro, Brazil.
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Karampas G, Koulouraki S, Daikos GL, Nanou C, Aravantinos L, Eleftheriades M, Metallinou D, Christopoulos P. Visceral Leishmaniasis in a Twin Pregnancy: A Case Report and Review of the Literature. J Clin Med 2024; 13:2400. [PMID: 38673673 PMCID: PMC11051246 DOI: 10.3390/jcm13082400] [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: 02/18/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of clinical manifestations from cutaneous ulcers to multisystem disease. Differential diagnosis is challenging as symptoms and signs are insidious, mimicking other diseases. Misdiagnosis can result in severe adverse perinatal outcomes, even maternal/neonatal death. Early treatment with liposomal amphotericin-B (LAmB) is currently the first choice with adequate effectiveness. We report a rare case of VL in a twin pregnancy with onset at the second trimester, presenting with periodic fever with rigors, right flank pain, and gradual dysregulation of all three cell lines. The positive rK39 enzyme-linked immunosorbent assay test confirmed the diagnosis. Treatment with LAmB resulted in clinical improvement within 48 h and in the delivery of two late-preterm healthy neonates with no symptoms or signs of vertical transmission. The one-year follow-up, of the mother and the neonates, was negative for recurrence. To our knowledge, this is the first reported case of VL in a twin pregnancy, and consequently treatment and perinatal outcome are of great importance.
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Affiliation(s)
- Grigorios Karampas
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Sevasti Koulouraki
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - George L. Daikos
- Mitera Hospital, 6, Erythrou Stavrou Str., 151 23 Athens, Greece;
| | - Christina Nanou
- Department of Midwifery, University of West Attica, 122 43 Athens, Greece;
| | - Leon Aravantinos
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Makarios Eleftheriades
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 122 43 Athens, Greece;
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
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3
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Gómez CA, Martínez MSA, Aguilera AL, Cosano GM, Ramos MMT. Inmunoglobulin-mediated glomerulonephritis and mixed cryoglobulinemia as a form of presentation of visceral leishmaniasis in a patient with HIV. Nefrologia 2023; 43 Suppl 2:106-108. [PMID: 38245443 DOI: 10.1016/j.nefroe.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/03/2022] [Indexed: 01/22/2024] Open
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4
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Ulasi II, Burdmann EA, Ijoma CK, Chou LF, Yang CW. Neglected and Emerging Infections of The Kidney. Semin Nephrol 2023; 43:151472. [PMID: 38216373 DOI: 10.1016/j.semnephrol.2023.151472] [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: 01/14/2024]
Abstract
Individuals, societies, and the environment are affected by neglected and emerging diseases. These diseases result in a variety of severe outcomes, including permanent disabilities, chronic diseases such as chronic kidney disease, and even mortality. Consequences include high health care expenditures, loss of means of support, social stigma, and social exclusion. The burden of these diseases is exacerbated in low- and middle-income countries owing to poverty, inadequate fundamental infrastructure, and the absence of health and social protection systems. The World Health Organization is committed to promoting the following public health strategies to prevent and control neglected tropical diseases: preventive chemotherapy; intensive case management; vector control; provision of safe drinkable water, sanitation, and hygiene; and veterinary public health. In addition, it promotes a One Health strategy, which is a collaborative, multisectoral, and interdisciplinary approach to achieving the greatest health outcomes by recognizing the interdependence of human beings, animals, plants, and their shared environment. This article provides knowledge and strategies for the prevention and treatment of neglected and emerging diseases, with a particular concentration on kidney diseases, as part of a comprehensive approach to One Health.
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Affiliation(s)
- Ifeoma I Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria-University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; Renal Unit, Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Emmanuel A Burdmann
- Laboratório de Investigação Médica (LIM 12), Faculdade de Medicina da Universidade de So Paulo, So Paulo, Brazil
| | - Chinwuba K Ijoma
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria-University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Li-Fang Chou
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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5
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Busutti M, Deni A, De Pascali AM, Ortalli M, Attard L, Granozzi B, Fabbrizio B, La Manna G, Comai G, Varani S. Updated diagnosis and graft involvement for visceral leishmaniasis in kidney transplant recipients: a case report and literature review. Infection 2022; 51:507-518. [PMID: 36329343 PMCID: PMC10042904 DOI: 10.1007/s15010-022-01943-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
Visceral leishmaniasis (VL) has become a rising concern to transplantation teams, being associated with graft dysfunction and reduced survival of renal transplant recipients. Here, we describe a case of VL occurring in a kidney transplant (KT) recipient in Italy, a country in which Leishmania infantum is endemic and we reviewed the literature on the clinical course and diagnosis of VL in KT recipients residing or travelling to southern Europe.
Results
The VL case was diagnosed 18 months after transplant and 28 days after the onset of symptoms by quantitative PCR (qPCR) on peripheral blood. A graft biopsy showed renal involvement, and PCR performed on graft tissue displayed the presence of Leishmania DNA. The retrospective confirmation of Leishmania-positive serology in a serum sample collected before transplantation, as well as the absence of anti-Leishmania IgG in the graft donor strongly suggest that reactivation of a latent parasitic infection caused VL in the current case.
Conclusion
VL is often underdiagnosed in transplant recipients, despite the presence of latent Leishmania infection being reported in endemic countries. This case report, as well as the literature review on leishmaniasis in KT recipients, underline the importance of rapid VL diagnosis to promptly undergo treatment. Serology is scarcely sensitive in immunocompromised patients, thus molecular tests in peripheral blood should be implemented and standardized for both VL identification and follow-up.
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Andrades Gómez C, Sánchez-Agesta Martínez M, Luna Aguilera A, Montilla Cosano G, Toro Ramos MM. Glomerulonefritis inmunomediada y crioglobulinemia mixta como forma de presentación de leishmaniasis visceral en paciente con VIH. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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7
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Hailu W, Mohamed R, Fikre H, Atnafu S, Tadesse A, Diro E, van Grienvsen J. Acute kidney injury in patients with Visceral Leishmaniasis in Northwest Ethiopia. PLoS One 2021; 16:e0252419. [PMID: 34101727 PMCID: PMC8186802 DOI: 10.1371/journal.pone.0252419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and associated with increased mortality. There is however limited data on acute kidney injury (AKI) in VL patients in East-Africa, particularly in areas with high rates of HIV co-infection. This study aims to determine the prevalence, characteristics and associated factors of AKI in VL patients in Northwest Ethiopia. METHODS A hospital based retrospective patient record analysis was conducted including patients treated for VL from January 2019 to December 2019 at the Leishmaniasis Research and Treatment Center (LRTC), Gondar, Ethiopia. Patients that were enrolled in ongoing clinical trials at the study site and those with significant incomplete data were excluded. Data was analyzed using SPSS version 20. P values were considered significant if < 0.05. RESULTS Among 352 VL patients treated at LRTC during the study period, 298 were included in the study. All were male patients except two; the median age was 23 years (IQR: 20-27). The overall prevalence of AKI among VL patients was 17.4% (confidence interval (CI): 13.6%-22.2%). Pre-renal azotemia (57%) and drug-induced AKI (50%) were the main etiologies of AKI at admission and post-admission respectively. Proteinuria and hematuria occurred in 85% and 42% of AKI patients respectively. Multivariate logistic regression revealed HIV co-infection (adjusted odds ratio (AOR): 6.01 95% CI: 1.99-18.27, p = 0.001) and other concomitant infections (AOR: 3.44 95% CI: 1.37-8.65, p = 0.009) to be independently associated with AKI. CONCLUSION AKI is a frequent complication in Ethiopian VL patients. Other renal manifestations included proteinuria, hematuria, and pyuria. HIV co-infection and other concomitant infections were significantly associated with AKI. Further studies are needed to quantify proteinuria and evaluate the influence of AKI on the treatment course, morbidity and mortality in VL patients.
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Affiliation(s)
- Workagegnehu Hailu
- Department of Internal Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Rezika Mohamed
- Department of Internal Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Saba Atnafu
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Azeb Tadesse
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Ermias Diro
- Department of Internal Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Johan van Grienvsen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Zou L, Chen G, Zhou Y, Ye W, Wen Y, Chen L, Li X. Continuous hypergammaglobulinemia and proteinuria after the recovery of the visceral Leishmaniasis: a case report. BMC Infect Dis 2021; 21:124. [PMID: 33509123 PMCID: PMC7844912 DOI: 10.1186/s12879-021-05819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney involvement of visceral Leishmaniasis is previously reported, but knowledge is limited. Hypergammaglobulinemia is common in visceral leishmaniasis patients. Whether hypergammaglobulinemia after leishmaniasis depletion can cause kidney injury is not well reported yet. CASE PRESENTATION We reported a patient who recovered from visceral Leishmaniasis but showed persistent hypergammaglobulinemia and elevated urinary protein. Kidney biopsy showed glomerular hypertrophy with mild segmental mesangial proliferation without tubulointerstitial involvement in light microscopy. No immune complex deposit was found in the mesangial area by neither immunofluorescent staining nor electronic microscope. Increased lysosomes were observed in proximal tubules by electronic microscope. Valsartan was administered to decrease urinary protein, and no immune-suppressive therapy was added. The urinary protein and serum IgG level gradually dropped, and serum creatinine level remained stable during three- month follow up. CONCLUSIONS Hypergammaglobulinemia is unlikely to cause renal structural or functional damage in the short term. Angiotensin blockade significantly reduced urine protein, with a minor effect on IgG elimination.
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Affiliation(s)
- Linfeng Zou
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Gang Chen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Yangzhong Zhou
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Ye
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yubin Wen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Puerta Carretero M, Ortega Díaz M, Corchete Prats E, Roldán Cortés D, Cuevas Tascón G, Martín Navarro JA, Jaldo Rodríguez MT, Medina Zahonero L, Cintra Cabrera M, Ryan Murúa P, Albalate Ramón M, de Sequera Ortiz P, Alcázar Arroyo R. Necrotizing glomerulonephritis in patients with HIV, HCV and visceral leishmaniasis. Nefrologia 2019; 40:481-484. [PMID: 31551119 DOI: 10.1016/j.nefro.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/25/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Mayra Ortega Díaz
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
| | | | - David Roldán Cortés
- Servicio de Anatomía Patológica, Hospital Universitario Infanta Leonor, Madrid, España
| | | | | | | | | | | | - Pablo Ryan Murúa
- Servicio de Anatomía Patológica, Hospital Universitario Infanta Leonor, Madrid, España
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10
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Bezerra GSN, Barbosa WL, Silva EDD, Leal NC, Medeiros ZMD. Urine as a promising sample for Leishmania DNA extraction in the diagnosis of visceral leishmaniasis - a review. Braz J Infect Dis 2019; 23:111-120. [PMID: 31054271 PMCID: PMC9425670 DOI: 10.1016/j.bjid.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 02/04/2023] Open
Abstract
Visceral leishmaniasis is a serious and debilitating infection with high fatality rate in tropical and subtropical countries. As clinical symptoms of visceral leishmaniasis are not so specific, confirmatory diagnostic methods with high sensitivity and specificity are needed. Noninvasive methods have been developed using urine as a clinical sample for visceral leishmaniasis diagnosis. In fact, there is a clear correlation between kidney impairment and Leishmania DNA in urine. However, it has been proved that Leishmania nucleic acid may also be isolated from patients without any sign of renal involvement. Even though urine has become a promissing biological sample, it is still not widely used due to several issues, such as (i) incomprehension of the whole renal pathophysiology process in visceral leishmaniasis, (ii) presence of many amplification inhibitors in urine, and (iii) lack of an efficient urinary DNA extraction method. In this article, we performed a literature review to bring a new perspective for Leishmania DNA isolation in urine.
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Affiliation(s)
- Gilberto Silva Nunes Bezerra
- Universidade de Pernambuco (UPE), Programa de Pós-Graduação em Ciências da Saúde, Recife, PE, Brazil; Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Parasitologia, Recife, PE, Brazil.
| | - Walter Lins Barbosa
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Parasitologia, Recife, PE, Brazil
| | - Elis Dionísio da Silva
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Parasitologia, Recife, PE, Brazil
| | - Nilma Cintra Leal
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Microbiologia, Recife, PE, Brazil
| | - Zulma Maria de Medeiros
- Universidade de Pernambuco (UPE), Programa de Pós-Graduação em Ciências da Saúde, Recife, PE, Brazil; Fundação Oswaldo Cruz (FIOCRUZ), Instituto Aggeu Magalhães (IAM), Departamento de Parasitologia, Recife, PE, Brazil
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11
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Alwazzeh MJ, Alhashimalsayed ZH. Visceral Leishmaniasis and Glomerulonephritis: A Case Report. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:40-43. [PMID: 30787856 PMCID: PMC6381853 DOI: 10.4103/sjmms.sjmms_166_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Visceral leishmaniasis is an endemic in the southwestern region of Saudi Arabia, with a low incidence rate. Clinical presentations of visceral leishmaniasis include recurrent fever, substantial weight loss, hepatosplenomegaly and anemia. However, the clinical features may not be easily evident owing to the involvement of multiple organs. This, in turn, can cause difficulties in establishing the correct diagnosis, and subsequently, in managing the patient. Here, the authors report a case of a 42-year-old male from Jizan, southwestern Saudi Arabia, who presented with impaired renal function. After kidney biopsy, the patient was diagnosed with glomerulonephritis of unknown etiology and treated with mycophenolate and prednisone. After 3 months, the patient developed high fever with hepatomegaly and pancytopenia. Based on the investigations, a possible diagnosis of visceral leishmaniasis was considered. Accordingly, he was treated with liposomal amphotericin B, following which his condition improved significantly. This case report discusses the relationship between glomerulonephritis and visceral leishmaniasis and focuses on the potential consequences of glomerulonephritis management without investigating the etiology of the underlying diseases, especially in patients from tropical and subtropical areas.
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Affiliation(s)
- Marwan Jabr Alwazzeh
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Zaki Hajji Alhashimalsayed
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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12
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Prasad N, Patel MR. Infection-Induced Kidney Diseases. Front Med (Lausanne) 2018; 5:327. [PMID: 30555828 PMCID: PMC6282040 DOI: 10.3389/fmed.2018.00327] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 11/07/2018] [Indexed: 12/13/2022] Open
Abstract
Infection induced kidney diseases are of concern for clinicians because timely detection and treatment of infections may cure or limit the extent of injury inflicted by microorganisms causing the infections. Infections can cause kidney injury by either direct invasion, or indirectly by immune mediated mechanisms, which manifest as post-infectious glomerulonephritis, or infection-related glomerulonephritis. Clinical manifestations may be acute or chronic depending on the microorganisms, endemic/epidemic nature and source of infection. All microbials virus, bacteria, mycobacteria, fungus, and protozoa have been implicated in kidney diseases either causing direct kidney injuries or immune-mediated injuries. Infection control practices in large parts of world is limited by poverty, social behavior, high population density, deforestation, inadequate access to safe drinking water, and poor health care facilities. Although, antimicrobials and vaccinations have successfully eradicated and cured many infectious diseases; however injudicious antimicrobial use and emergence of resistant organisms complicated the disease severity like secondary renal amyloidosis with chronic persistent infection. Re-emergence of various infections has been a recent pattern in developed world leading to uncertain diagnostic challenges, and association with kidney diseases.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manas Ranjan Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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13
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Meneses GC, De Francesco Daher E, da Silva Junior GB, Bezerra GF, da Rocha TP, de Azevedo IEP, Libório AB, Martins AMC. Visceral leishmaniasis-associated nephropathy in hospitalised Brazilian patients: new insights based on kidney injury biomarkers. Trop Med Int Health 2018; 23:1046-1057. [PMID: 29987885 DOI: 10.1111/tmi.13127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the usefulness of early acute kidney injury (AKI) biomarkers in clinical management of visceral leishmaniasis. METHODS Prospective study with 50 hospitalised VL patients. AKI biomarkers, that is, serum and urinary neutrophil gelatinase-associated lipocalin (sNGAL, uNGAL, respectively), urinary kidney injury molecule-1 (uKIM-1) and urinary monocyte chemotactic protein-1 (uMCP-1), were quantified by immunoassay (ELISA). Also, interferon-gamma (INF-y) and C-reactive protein (CRP) were evaluated as inflammatory biomarkers possibly related to VL severity. RESULTS VL patients had hyponatremia, hypoalbuminemia, hypergammaglobulinemia, haematologic and hepatic disorders. AKI was found in 46%, and one death (2%) occurred. The AKI group had significant longer hospital stay, lower levels of IFN-y and higher levels of CRP, more clinical renal abnormalities and higher levels of sNGAL, uNGAL, uKIM-1 and uMCP-1. Overall, sNGAL, uKIM-1 and uMCP-1 showed correlations with important clinical renal abnormalities, such as proteinuria, albuminuria, serum creatinine and glomerular filtration rate using adjusted correlations with CRP and IFN-y. Only sNGAL showed an early association with AKI development (OR = 2.78, 95% CI = 1.429-5.428, per each increase of 50 ng/ml), even after adjusting for clinical signals of VL severity and for immune biomarkers. Moreover, sNGAL showed a better performance in predicting AKI development (AUC-ROC = 0.81, 95% CI = 0.69-0.93; cut-off = 154 ng/ml, sensitivity = 82.6%, specificity = 74.1%, P < 0.001). CONCLUSIONS Visceral leishmaniasis-associated nephropathy showed important proximal tubular injury and glomerular inflammation. Serum NGAL showed an early association with VL-associated nephropathy and may be used to improve clinical management strategies and decrease morbimortality in VL patients.
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Affiliation(s)
- Gdayllon C Meneses
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.,Medical Sciences Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Geraldo B da Silva Junior
- Collective Health Graduate Program, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Brazil
| | - Gabriela F Bezerra
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Thaiany P da Rocha
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Isabella E P de Azevedo
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre B Libório
- Medical Sciences Post-Graduate Program, University of Fortaleza, Fortaleza, Brazil
| | - Alice M C Martins
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.,Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
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14
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Costa DL, Rocha RL, Chaves EDBF, Batista VGDV, Costa HL, Costa CHN. Predicting death from kala-azar: construction, development, and validation of a score set and accompanying software. Rev Soc Bras Med Trop 2017; 49:728-740. [PMID: 28001220 DOI: 10.1590/0037-8682-0258-2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/09/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Early identification of patients at higher risk of progressing to severe disease and death is crucial for implementing therapeutic and preventive measures; this could reduce the morbidity and mortality from kala-azar. We describe a score set composed of four scales in addition to software for quick assessment of the probability of death from kala-azar at the point of care. METHODS: Data from 883 patients diagnosed between September 2005 and August 2008 were used to derive the score set, and data from 1,031 patients diagnosed between September 2008 and November 2013 were used to validate the models. Stepwise logistic regression analyses were used to derive the optimal multivariate prediction models. Model performance was assessed by its discriminatory accuracy. A computational specialist system (Kala-Cal(r)) was developed to speed up the calculation of the probability of death based on clinical scores. RESULTS: The clinical prediction score showed high discrimination (area under the curve [AUC] 0.90) for distinguishing death from survival for children ≤2 years old. Performance improved after adding laboratory variables (AUC 0.93). The clinical score showed equivalent discrimination (AUC 0.89) for older children and adults, which also improved after including laboratory data (AUC 0.92). The score set also showed a high, although lower, discrimination when applied to the validation cohort. CONCLUSIONS: This score set and Kala-Cal(r) software may help identify individuals with the greatest probability of death. The associated software may speed up the calculation of the probability of death based on clinical scores and assist physicians in decision-making.
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Affiliation(s)
- Dorcas Lamounier Costa
- Departamento Materno-Infantil, Universidade Federal do Piauí, Teresina, Piauí, Brazil.,Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil
| | - Regina Lunardi Rocha
- Departamento de Pediatria, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Carlos Henrique Nery Costa
- Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil.,Departamento de Medicina Comunitária, Universidade Federal do Piauí, Teresina, Piauí, Brazil
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15
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Jha V, Prasad N. CKD and Infectious Diseases in Asia Pacific: Challenges and Opportunities. Am J Kidney Dis 2016; 68:148-60. [PMID: 26943982 DOI: 10.1053/j.ajkd.2016.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/15/2016] [Indexed: 02/06/2023]
Abstract
The exact number of patients with chronic kidney disease (CKD) in Asia Pacific is uncertain. In numeric terms, the region is home to the largest population of patients with untreated chronic kidney failure. The climatic, geographic, social, cultural, economic, and environmental diversity within this region is higher than in any other part of the world. Large parts of the region face a climate-related burden of infectious diseases. Infections contribute to the development and progression of CKD and complicate the course of patients with pre-existing CKD (especially those on dialysis therapy or who are immunosuppressed), increase the cost of CKD care, and contribute to mortality and morbidity. Kidney involvement is a feature of several infectious diseases prevalent in Asia Pacific. Examples include malaria, leptospirosis, scrub typhus, tuberculosis, hepatitis B and C virus, dengue hemorrhagic fever, and Hantaan virus infections. The contribution of infection-associated acute kidney injury to the overall burden of CKD has not been evaluated systematically. Research is needed to quantify the impact of infections on kidney health by undertaking prospective studies. Nephrologists need to work with infectious disease research groups and government infection surveillance and control programs.
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Affiliation(s)
- Vivekanand Jha
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Nephrology, George Institute for Global Health, New Delhi, India; Department of Nephrology, University of Oxford, Oxford, United Kingdom.
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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16
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Esch KJ, Schaut RG, Lamb IM, Clay G, Morais Lima ÁL, do Nascimento PRP, Whitley EM, Jeronimo SMB, Sutterwala FS, Haynes JS, Petersen CA. Activation of autophagy and nucleotide-binding domain leucine-rich repeat-containing-like receptor family, pyrin domain-containing 3 inflammasome during Leishmania infantum-associated glomerulonephritis. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 185:2105-17. [PMID: 26079813 DOI: 10.1016/j.ajpath.2015.04.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/14/2015] [Accepted: 04/16/2015] [Indexed: 01/21/2023]
Abstract
Chronic kidney disease is a major contributor to human and companion animal morbidity and mortality. Renal complications are sequelae of canine and human visceral leishmaniasis (VL). Despite the high incidence of infection-mediated glomerulonephritis, little is known about pathogenesis of VL-associated renal disease. Leishmania infantum-infected dogs are a naturally occurring model of VL-associated glomerulonephritis. Membranoproliferative glomerulonephritis type I [24 of 25 (96%)], with interstitial lymphoplasmacytic nephritis [23 of 25 (92%)], and glomerular and interstitial fibrosis [12 of 25 (48%)] were predominant lesions. An ultrastructural evaluation of glomeruli from animals with VL identified mesangial cell proliferation and interposition. Immunohistochemistry demonstrated significant Leishmania antigen, IgG, and C3b deposition in VL dog glomeruli. Asymptomatic and symptomatic dogs had increased glomerular nucleotide-binding domain leucine-rich repeat-containing-like receptor family, pyrin domain containing 3 and autophagosome-associated microtubule-associated protein 1 light chain 3 associated with glomerular lesion severity. Transcriptional analyses from symptomatic dogs confirmed induction of autophagy and inflammasome genes within glomeruli and tubules. On the basis of temporal VL staging, glomerulonephritis was initiated by IgG and complement deposition. This deposition preceded presence of nucleotide-binding domain leucine-rich repeat-containing-like receptor family, pyrin domain containing 3-associated inflammasomes and increased light chain 3 puncta indicative of autophagosomes in glomeruli from dogs with clinical VL and renal failure. These findings indicate potential roles for inflammasome complexes in glomerular damage during VL and autophagy in ensuing cellular responses.
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Affiliation(s)
- Kevin J Esch
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Robert G Schaut
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Ian M Lamb
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Gwendolyn Clay
- Inflammation Program, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ádila L Morais Lima
- Department of Biochemistry, Institute of Tropical Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Paulo R P do Nascimento
- Department of Biochemistry, Institute of Tropical Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Elizabeth M Whitley
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Selma M B Jeronimo
- Department of Biochemistry, Institute of Tropical Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Fayyaz S Sutterwala
- Inflammation Program, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Joseph S Haynes
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Christine A Petersen
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
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17
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Oliveira MJC, Silva GB, Sampaio AM, Montenegro BL, Alves MP, Henn GAL, Rocha HAL, Meneses GC, Martins AMC, Daher EF. Preliminary study on tubuloglomerular dysfunction and evidence of renal inflammation in patients with visceral leishmaniasis. Am J Trop Med Hyg 2014; 91:908-11. [PMID: 25114011 DOI: 10.4269/ajtmh.14-0167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Visceral leishmaniasis (VL) is a re-emerging zoonosis of worldwide distribution. Monocyte chemotactic protein-1 (MCP-1) and malondialdehyde (MDA) are inflammation biomarkers that have never been investigated in VL. The aim of this study is to investigate the association between renal abnormalities and inflammation biomarkers in VL. This study is a preliminary prospective study with 16 VL adult patients evaluated before treatment compared with a group of 13 healthy volunteers and 5 VL patients evaluated after treatment. Urinary concentration and acidification tests were performed. MCP-1 and MDA were quantified in urine. Urinary concentration deficit was found in all VL patients before (100%) and four VL patients after (80%) treatment. Urinary acidification deficit was found in nine cases before (56.2%) and two cases after (40%) treatment. Urinary MCP-1 (374 ± 359 versus 42 ± 29 pg/mg creatinine, P = 0.002) as well as urinary MDA (5.4 ± 2.6 versus 2.0 ± 0.8 μmol/mL) showed significant differences between VL patients and controls. These data show that VL patients present urinary concentration and acidification deficit, which can persist even after specific treatment. Urinary MCP-1 and MDA are elevated in patients with VL, which suggests renal inflammation and incipient renal damage.
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Affiliation(s)
- Michelle J C Oliveira
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Geraldo B Silva
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Aline M Sampaio
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Bárbara L Montenegro
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Marília P Alves
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Guilherme A L Henn
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Hermano A L Rocha
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Gdayllon C Meneses
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alice M C Martins
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Elizabeth F Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil; Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil; São José Infectious Disease Hospital, Fortaleza, Ceará, Brazil; Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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18
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Silva Junior GBD, Barros EJG, Daher EDF. Kidney involvement in leishmaniasis--a review. Braz J Infect Dis 2014; 18:434-40. [PMID: 24690431 PMCID: PMC9427481 DOI: 10.1016/j.bjid.2013.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 12/01/2022] Open
Abstract
Leishmaniasis is an infectious disease caused by protozoa of the genus Leishmania transmitted by insects of the genus Lutzomyia sp. or Phlebotomus sp. The main syndromes are cutaneous leishmaniasis, mucocutaneous leishmaniasis, visceral leishmaniasis (kala-azar) and post-kala-azar dermal leishmaniasis. This article reviews kidney involvement in cutaneous and visceral leishmaniasis, highlighting the aspects of their pathophysiology, clinical manifestations, histopathological findings, outcome and treatment.
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Affiliation(s)
- Geraldo Bezerra da Silva Junior
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; School of Medicine, Master in Collective Health, Health Sciences Center, Universidade de Fortaleza, Fortaleza, CE, Brazil.
| | - Elvino José Guardão Barros
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Elizabeth De Francesco Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil.
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19
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Silva JM, Zacarias DA, de Figueirêdo LC, Soares MRA, Ishikawa EAY, Costa DL, Costa CHN. Bone marrow parasite burden among patients with New World kala-azar is associated with disease severity. Am J Trop Med Hyg 2014; 90:621-6. [PMID: 24615127 DOI: 10.4269/ajtmh.13-0376] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Kala-azar or visceral leishmaniasis, found mostly throughout the Indian Subcontinent, East Africa, and Brazil, kills 20,000-40,000 persons annually. The agents, Leishmania donovani and Leishmania infantum, are obligatory intracellular protozoa of mononuclear phagocytes found principally in the spleen and bone marrow. Protracted fever, anemia, wasting, hepatosplenomegaly, hemorrhages, and bacterial co-infections are typical features. One hundred and twenty-two (122) in-hospital patients were studied to verify if higher bone marrow parasite load estimated by quantitative polymerase chain reaction is associated with severe disease. The estimated median parasite load was 5.0 parasites/10(6) human nucleated cells. It is much higher in deceased than among survivors (median 75.0 versus 4.2). Patients who lost more weight had a higher parasite burden, as well as patients with epistaxis, abdominal pain, edema, and jaundice. This study suggests that higher parasite load is influenced by wasting, which may lead to more severe disease.
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Affiliation(s)
- Joyce M Silva
- Laboratory of Leishmaniasis, Institute of Tropical Diseases "Natan Portella", Federal University of Piauí, Teresina, PI, Brazil; Department of Biology, Federal University of Piauí, Floriano at Floriano, PI, Brazil; Maternal and Childhood Department, Federal University of Piauí, Teresina, PI, Brazil; Laboratory of Molecular Biology, Nucleus of Tropical Medicine, Federal University of Pará, Belém, PA, Brazil; Department of Community Medicine, Federal University of Piauí, Teresina, PI, Brazil
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Phumee A, Kraivichian K, Chusri S, Noppakun N, Vibhagool A, Sanprasert V, Tampanya V, Wilde H, Siriyasatien P. Detection of Leishmania siamensis DNA in saliva by polymerase chain reaction. Am J Trop Med Hyg 2013; 89:899-905. [PMID: 24062485 DOI: 10.4269/ajtmh.12-0612] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Polymerase chain reaction was used to detect Leishmania siamensis DNA from clinical samples collected from six leishmaniasis patients during 2011-2012. The samples used in this study came from bone marrow, blood, buffy coat, saliva, urine, and tissue biopsy specimens. Saliva was a good source for L. siamensis DNA by polymerase chain reaction. L. siamensis DNA was also found in saliva of an asymptomatic case-patient. Levels of L. siamensis DNA in saliva decreased until being undetectable after treatment. These levels could be used as a marker to evaluate efficacy of the treatment. A larger study is needed to evaluate this method as a screening and survey tool to study the silent background of Leishmania infection among the at-risk population.
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Affiliation(s)
- Atchara Phumee
- Medical Sciences Program, Department of Parasitology, Division of Dermatology, and Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; Bumrungrad International Hospital, Bangkok, Thailand; Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; Excellence Center for Emerging Infectious Diseases, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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21
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Microalbuminuria and glomerular filtration rate in paediatric visceral leishmaniasis. BIOMED RESEARCH INTERNATIONAL 2013; 2013:498918. [PMID: 23865054 PMCID: PMC3705886 DOI: 10.1155/2013/498918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022]
Abstract
Visceral leishmaniasis, caused by Leishmania donovani, is a serious form of leishmaniasis and fatal if untreated. Nearly half of the VL cases are children. There are very few studies of renal function in pediatric visceral leishmaniasis. The aim of this study was to evaluate renal dysfunction by studying glomerular filtration rate (GFR), microalbuminuria, and microscopic examination of urine. Laboratory analysis was performed on blood and urine samples of 40 parasitologically confirmed pediatric VL cases. Laboratory data of urine examination showed albuminuria in 10% (4/40), white blood cells in 20% (8/40), hematuria in 10% (4/40), microalbuminuria in 37.5% (15/40), and decreased GFR in 27.5% (11/40). Renal involvement was manifested in most of the pediatric VL cases. These findings may help clinicians in decision making for safe and suitable antileishmanial treatment particularly in childhood VL.
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Pierantozzi M, Roura X, Paltrinieri S, Poggi M, Zatelli A. Variation of proteinuria in dogs with leishmaniasis treated with meglumine antimoniate and allopurinol: a retrospective study. J Am Anim Hosp Assoc 2013; 49:231-6. [PMID: 23690493 DOI: 10.5326/jaaha-ms-5840] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A retrospective study was performed using 53 client owned dogs with leishmaniasis to determine whether the degree of proteinuria, evaluated by the urine protein/creatinine ratio (UP/C), changes following treatment with meglumine antimoniate and allopurinol. Medical records of dogs with leishmaniasis in clinical stage C (according to the Canine Leishmaniasis Working Group staging system) and either proteinuric or borderline proteinuric (according to the International Renal Interest Society [IRIS] staging system) were reviewed. All dogs were treated with meglumine antimoniate and allopurinol for 4-8 wk. After treatment, UP/C, total protein, and total globulin significantly decreased and albumin and the albumin/globulin ratio (A/G) increased. After treatment, 7 of the 53 dogs (13.4%) became nonproteinuric following either a proteinuric or borderline proteinuric stage. Moreover, 12 of the 53 proteinuric dogs (22.6%) changed their stage to borderline proteinuric. The antileishmaniasis treatment with meglumine antimoniate in combination with allopurinol in dogs significantly reduced the degree of proteinuria in a short period of time. The results of the current study may be useful to the veterinary practitioner in the clinical management of canine leishmaniasis (CanL) in dogs with proteinuric chronic kidney disease.
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Abstract
BACKGROUND The aim of this study was to compare clinical manifestations, laboratory data, morbidity and mortality between adults and children with visceral leishmaniasis, with a focus on kidney function. METHODS This was a retrospective cohort study with 432 patients with visceral leishmaniasis diagnosed at 1 center in the northeast of Brazil. Patients were divided into 2 groups according to age (>21 years and ≤ 21 years old). RESULTS The time between onset of symptoms and beginning of treatment was longer in adults (89.5 versus 48.5 days, P < 0.001); signs and symptoms were similar in both groups. Failure of treatment with glucantime was more common in adults (17.6% versus 8.8%, P = 0.008). Acute kidney injury was observed in 160 patients (37.0%), and it was more severe in adults. Risk factors for acute kidney injury in adults were hypokalemia, leukopenia, chills and amphotericin B use. In children, secondary infections were found to increase the risk for acute kidney injury. Overall mortality was 8.8%, and it was significantly higher in adults (12.6% versus 4.1%, P = 0.002). CONCLUSIONS The adult population had more severe laboratory abnormalities and a worse prognosis, possibly due to delay in diagnosis. Acute kidney injury is prevalent in both groups, and it is usually more severe in adults.
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Barsoum RS. Parasitic kidney disease: milestones in the evolution of our knowledge. Am J Kidney Dis 2013; 61:501-13. [PMID: 23337800 DOI: 10.1053/j.ajkd.2012.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 09/03/2012] [Indexed: 11/11/2022]
Abstract
Of the 342 parasites that infect humans, 20 are associated with kidney disease, yet of these, only schistosomes, plasmodia, filariae, and leishmanias are held responsible for significant clinical or epidemiologic impact. Reviewing the evolution of human knowledge for these parasites discloses a lot of similarities regarding their discovery, patterns of kidney injury, and pathogenic mechanisms. From a historical perspective, our relevant information may be classified into 4 phases: (1) disease documentation in ancient and medieval scripts as far back as 2000-3000 bce; (2) discovery of the parasites, their life cycles, and clinical correlates by European clinicians working in African and Asian colonies during the second half of the 19th century; (3) discovery and characterization of the renal manifestations of monoparasitic infections during the second half of the 20th century; and (4) recognition of the confounding effects of coinfection with bacteria, viruses, or other parasites. The spectrum of respective kidney diseases extends all the way from acute kidney injury to glomerulonephritis, amyloidosis, urologic disorders, and malignancy. Discovery of the common immunopathogenetic host response to parasitic infections has provided a knowledge core that explains the similarities, diversities, and interactions with regard to kidney injury.
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Perico N, Remuzzi G. Chronic kidney disease: a research and public health priority. Nephrol Dial Transplant 2012; 27:iii19-iii26. [DOI: 10.1093/ndt/gfs284] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Oliveira RA, Lima CG, Mota RM, Martins AM, Sanches TR, Seguro AC, Andrade LC, Junior GBS, Libório AB, Daher EF. Renal function evaluation in patients with American cutaneous leishmaniasis after specific treatment with pentavalent antimonial. BMC Nephrol 2012; 13:44. [PMID: 22715954 PMCID: PMC3444398 DOI: 10.1186/1471-2369-13-44] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 06/14/2012] [Indexed: 11/25/2022] Open
Abstract
Background Renal evaluation studies are rare in American Cutaneous Leishmaniasis (ACL). The aim of this study is to investigate whether specific treatment reverts ACL-associated renal dysfunction. Methods A prospective study was conducted with 37 patients with ACL. Urinary concentrating and acidification ability was assessed before and after treatment with pentavalent antimonial. Results The patients mean age was 35.6 ± 12 years and 19 were male. Before treatment, urinary concentrating defect (U/Posm <2.8) was identified in 27 patients (77%) and urinary acidification defect in 17 patients (46%). No significant glomerular dysfunction was observed before and after specific ACL treatment. There was no reversion of urinary concentrating defects, being observed in 77% of the patients before and in 88% after treatment (p = 0.344). Urinary acidification defect was corrected in 9 patients after treatment, reducing its prevalence from 40% before to only 16% after treament, (p = 0.012). Microalbuminuria higher than 30 mg/g was found in 35% of patients before treatment and in only 8% after treatment. Regarding fractional excretion of sodium, potassium, calcium, phosphorus and magnesium, there was no significant difference between pre and post-treatment period. Conclusion As previously described, urinary concentrating and acidification defects were found in an important number of patients with ACL. Present results demonstrate that only some patients recover urinary acidification capacity, while no one returned to normal urinary concentration capacity.
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Affiliation(s)
- Rodrigo A Oliveira
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Campus Cariri, Rua Divino Salvador, Centro, Barbalha, Ceará, Brazil.
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Renal tubular dysfunction in patients with American cutaneous leishmaniasis. Kidney Int 2011; 80:1099-106. [DOI: 10.1038/ki.2011.251] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Toplu N, Aydogan A. An immunohistochemical study in cases with usual and unusual clinicopathological findings of canine visceral leishmaniosis. Parasitol Res 2011; 109:1051-7. [PMID: 21479577 DOI: 10.1007/s00436-011-2345-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
The present study describes pathologic findings and immunohistochemical diagnosis of canine visceral leishmaniasis (CVL) in 22 dogs who died naturally in the Aegean region of Turkey. At necropsy, lymphadenomegaly, hepatosplenomegaly, hepatic, and nephrosclerotic lesions were conspicuous. Histopathologically, chronic inflammatory reactions of the spleen, lymph nodes, bone marrow, liver, and skin were marked findings. Cytological and histological examinations showed macrophages loaded with Leishmania amastigotes in these organs. Immunohistochemistry revealed that immunolabeling of amastigotes and/or parasite antigen, especially in the lymph nodes, spleen, bone marrow, liver, and skin, and occasionally, in the kidneys, intestines and lungs. Our laboratory results showed that immunohistochemistry should be included, along with cytological and histological examinations, in the diagnosis of CVL.
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Affiliation(s)
- Nihat Toplu
- Department of Pathology, Faculty of Veterinary Medicine, Adnan Menderes University, 09016-Isikli, Aydin, Turkey.
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Costa CHN, Werneck GL, Costa DL, Holanda TA, Aguiar GB, Carvalho AS, Cavalcanti JC, Santos LS. Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study. Rev Soc Bras Med Trop 2011; 43:386-92. [PMID: 20802936 DOI: 10.1590/s0037-86822010000400010] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 04/16/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The objective of the study is to identify the main risk factors for death by New World visceral leishmaniasis and establish a coherent pathogenic substrate of severe disease based on clinical findings. METHODS Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. RESULTS Bacterial infection and bleeding were mutually exclusive events leading to death. Five risk factors were unique for death by bacterial infection (malnutrition, pulmonary rales, severe anemia, severe absolute neutropenia and higher neutrophil count), while another six were unique for death by bleeding (jaundice, severe relative neutropenia, severe thrombocytopenia, liver injury, kidney failure, higher bone marrow parasite load). Bacterial infection, bleeding, severe anemia, diarrhea, dyspnea, edema, jaundice and bone marrow parasite load were the main syndromes of visceral leishmaniasis among successfully treated patients. CONCLUSIONS The data support the idea that bacterial infections are due to immune paralysis. Broad organ and system involvement is plausibly due to the high production of proinflammatory cytokines, whose actions fit well with visceral leishmaniasis. The syndromes and causative mediators are typical of a slowly developing systemic inflammatory response syndrome.
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Clementi A, Battaglia G, Floris M, Castellino P, Ronco C, Cruz DN. Renal involvement in leishmaniasis: a review of the literature. NDT Plus 2011; 4:147-52. [PMID: 25984144 PMCID: PMC4421603 DOI: 10.1093/ndtplus/sfr008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 01/18/2011] [Indexed: 11/13/2022] Open
Abstract
Leishmaniasis, an infectious disease endemic in tropical, Asian and southern European countries, is caused by obligate intramacrophage protozoa and is transmitted through the bite of infected female sandflies. More than 20 leishmanial species are responsible for four main clinical syndromes: cutaneous leishmaniasis; mucocutaneous leishmaniasis; visceral leishmaniasis, also known as kala-azar, and post-kala-azar dermal leishmaniasis. Visceral leishmaniasis can present with varying clinical features and the kidney can also be involved. Both glomerular and tubular function can be altered and patients can develop proteinuria, haematuria, abnormalities in urinary concentration and acidification and acute and chronic renal insufficiency. Not only the disease itself but also the therapy administered might be responsible for the renal involvement in kala-azar. Indeed, some of the agents with efficiency against visceral leishmaniasis, such as pentavalent antimonial drugs, amphotericin B, pentamidine, miltefosine, paromomycin and simataquine, may be associated with a high risk of renal toxicity. In this article, the literature on renal involvement in visceral leishmaniasis is reviewed.
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Affiliation(s)
- Anna Clementi
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy ; International Renal Research Institute (IRRIV), Vicenza, Italy ; Department of Internal Medicine, Policlinico Universitario, Catania, Italy
| | - Giorgio Battaglia
- Department of Nephrology, Santa Marta e Santa Venera, Catania, Italy
| | - Matteo Floris
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy ; International Renal Research Institute (IRRIV), Vicenza, Italy ; Department of Nephrology San Michele Hospital, Cagliari, Italy
| | - Pietro Castellino
- Department of Internal Medicine, Policlinico Universitario, Catania, Italy
| | - Claudio Ronco
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy ; International Renal Research Institute (IRRIV), Vicenza, Italy
| | - Dinna N Cruz
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy ; International Renal Research Institute (IRRIV), Vicenza, Italy
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Nephrotic Syndrome in Leishmaniasis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2011. [DOI: 10.1097/ipc.0b013e3181f7438e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simon I, Wissing KM, Del Marmol V, Antinori S, Remmelink M, Nilufer Broeders E, Nortier JL, Corbellino M, Abramowicz D, Cascio A. Recurrent leishmaniasis in kidney transplant recipients: report of 2 cases and systematic review of the literature. Transpl Infect Dis 2011; 13:397-406. [PMID: 21281418 DOI: 10.1111/j.1399-3062.2011.00598.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
MESH Headings
- Antibodies, Protozoan/blood
- Female
- Humans
- Kidney Transplantation/adverse effects
- Leg Ulcer/parasitology
- Leg Ulcer/pathology
- Leishmania/genetics
- Leishmania/immunology
- Leishmania/isolation & purification
- Leishmania donovani/genetics
- Leishmania donovani/immunology
- Leishmania donovani/isolation & purification
- Leishmaniasis, Cutaneous/diagnosis
- Leishmaniasis, Cutaneous/parasitology
- Leishmaniasis, Cutaneous/pathology
- Leishmaniasis, Mucocutaneous/diagnosis
- Leishmaniasis, Mucocutaneous/parasitology
- Leishmaniasis, Mucocutaneous/pathology
- Leishmaniasis, Visceral/diagnosis
- Leishmaniasis, Visceral/parasitology
- Leishmaniasis, Visceral/pathology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Recurrence
- Tongue/parasitology
- Tongue/pathology
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Affiliation(s)
- I Simon
- Department of Nephrology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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BLA V, ACJ B, FJM M, MLS C, NB P, MN M, IL M, FAL C, AC V. Inflammatory response, parasite load and AgNOR expression in ear skin of symptomatic and asymptomatic Leishmania (Leishmania) chagasi infected dogs. J Venom Anim Toxins Incl Trop Dis 2011. [DOI: 10.1590/s1678-91992011000300011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Borges ACJ
- Federal University of Minas Gerais, Brazil
| | | | | | - Pereira NB
- Federal University of Minas Gerais, Brazil
| | - Melo MN
- Zoonosis Control Center, Brazil
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Oliveira JMD, Fernandes AC, Dorval MEC, Alves TP, Fernandes TD, Oshiro ET, Oliveira ALLD. [Mortality due to visceral leishmaniasis: clinical and laboratory characteristics]. Rev Soc Bras Med Trop 2010; 43:188-93. [PMID: 20464151 DOI: 10.1590/s0037-86822010000200016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 01/29/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Visceral leishmaniasis is a systemic infectious disease of broad geographical distribution, characterized by high potential for lethality. With the purpose of contributing towards reducing mortality and helping healthcare professionals in clinical management of patients with this disease, this paper aimed to investigate the clinical and laboratory characteristics of cases with a fatal outcome in hospitals in Campo Grande, Mato Grosso do Sul, between 2003 and 2008. METHODS Fifty-five medical files on patients who died due to visceral leishmaniasis were analyzed. RESULTS Among the 55 patients studied, 37 were from the municipality of Campo Grande; 41 (74.5%) were males; and age over 40 years predominated. The patients presented with fever in 89.1% of the cases. The duration of the illness from the onset of symptoms to hospitalization was 78.2 days on average. Leukopenia was seen in 85.5% of the patients. Comorbidities were present in 39 (70.9%) patients; malnutrition and alcoholism were the most frequent of these. Confirmation of the diagnosis occurred on average 6.7 days after admission. Pentavalent antimoniate was the drug most used, and 87.5% of the patients presented some type of adverse reaction. Bacterial infections occurred in 36 patients and were one of the causes of death in 27 (49%). CONCLUSIONS The data showed that early identification of these clinical and laboratory characteristics, at the time when patients are first attended, is extremely important for reducing mortality through instituting efficient therapeutic and prophylactic measures.
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Affiliation(s)
- Janaina Michelle de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS.
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Dettwiler S, McKee T, Hadaya K, Chappuis F, van Delden C, Moll S. Visceral leishmaniasis in a kidney transplant recipient: parasitic interstitial nephritis, a cause of renal dysfunction. Am J Transplant 2010; 10:1486-9. [PMID: 20486908 DOI: 10.1111/j.1600-6143.2010.03125.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Visceral leishmaniasis (VL) due to Leishmania infantum is an endemic parasitic infection in the Mediterranean area. It most commonly affects immunosuppressed individuals, especially HIV patients and less frequently organ transplant recipients. Renal involvement seems to be frequent and is mostly associated with tubulointerstitial nephritis, as described in autopsy reports. In the 61 cases of renal transplant recipients with VL reported in the literature, renal dysfunction was noted at clinical presentation and was more frequently observed as a complication of antiparasitic therapy. However, no pathological analysis of the allograft lesions was reported. We present the case of a Swiss renal transplant recipient who developed VL after vacations in Spain and Tunisia, complicated by acute parasitic nephritis in the renal allograft 3 months after a well-conducted treatment of liposomal amphotericin B.
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Affiliation(s)
- S Dettwiler
- Division of Clinical Pathology, University Hospital of Geneva, Switzerland
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Costa FAL, Prianti MG, Silva TC, Silva SMMS, Guerra JL, Goto H. T cells, adhesion molecules and modulation of apoptosis in visceral leishmaniasis glomerulonephritis. BMC Infect Dis 2010; 10:112. [PMID: 20459816 PMCID: PMC2880314 DOI: 10.1186/1471-2334-10-112] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 05/11/2010] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Immune complex deposition is the accepted mechanism of pathogenesis of VL glomerulopathy however other immune elements may participate. Further in the present study, no difference was seen between immunoglobulin and C3b deposit intensity in glomeruli between infected and non-infected dogs thus T cells, adhesion molecules and parameters of proliferation and apoptosis were analysed in dogs with naturally acquired VL from an endemic area. The dog is the most important domestic reservoir of the protozoa Leishmania (L.) chagasi that causes visceral leishmaniasis (VL). The similarity of VL manifestation in humans and dogs renders the study of canine VL nephropathy of interest with regard to human pathology. METHODS From 55 dogs with VL and 8 control non-infected dogs from an endemic area, kidney samples were analyzed by immunohistochemistry for immunoglobulin and C3b deposits, staining for CD4+ and CD8+ T cells, ICAM-1, P-selectin and quantified using morphometry. Besides proliferation marker Ki-67, apoptosis markers M30 and TUNEL staining, and related cytokines TNF-alpha, IL-1alpha were searched and quantified. RESULTS We observed similar IgG, IgM and IgA and C3b deposit intensity in dogs with VL and non-infected control dogs. However we detected the Leishmania antigen in cells in glomeruli in 54, CD4+ T cells in the glomeruli of 44, and CD8+ T cells in 17 of a total of 55 dogs with VL. Leishmania antigen was absent and T cells were absent/scarse in eight non-infected control dogs. CD 4+ T cells predominate in proliferative patterns of glomerulonephritis, however the presence of CD4+ and CD8+ T cells were not different in intensity in different patterns of glomerulonephritis. The expression of ICAM-1 and P-selectin was significantly greater in the glomeruli of infected dogs than in control dogs. In all patterns of glomerulonephritis the expression of ICAM-1 ranged from minimum to moderately severe and P-selectin from absent to severe. In the control animals the expression of these molecules ranged from absent to medium intensity. It was not observed any correlation between severity of the disease and these markers. There was a correlation between the number of Leishmania antigen positive cells and CD4+ T cells, and between the number of CD4+ T cells and CD8+ T cells. In dogs presenting different histopathological patterns of glomerulonephritis, parameters of proliferation and apoptosis were studied. Ki-67, a proliferative marker, was not detected locally, but fewer apoptotic cells and lower TNF-alpha expression were seen in infected animals than in non-infected controls. CONCLUSION Immunopathogenic mechanisms of VL glomerulonephritis are complex and data in the present study suggest no clear participation of immunoglobulin and C3b deposits in these dogs but the possible migration of CD4+ T cells into the glomeruli, participation of adhesion molecules, and diminished apoptosis of cells contributing to determine the proliferative pattern of glomerulonephritis in VL.
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Affiliation(s)
- Francisco A L Costa
- Departamento de Clinica e Cirurgia Veterinaria, Centro de Ciencias Agrarias, Universidade Federal do Piaui, Teresina, PI, Brazil
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Oliveira MJC, Silva Júnior GB, Abreu KLS, Rocha NA, Garcia AVV, Franco LFLG, Mota RMS, Libório AB, Daher EF. Risk factors for acute kidney injury in visceral leishmaniasis (Kala-Azar). Am J Trop Med Hyg 2010; 82:449-53. [PMID: 20207871 DOI: 10.4269/ajtmh.2010.09-0571] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to investigate the factors associated with acute kidney injury (AKI) in patients with visceral leishmaniasis (VL). The study patients had a diagnosis of VL and were admitted to a tertiary hospital. A multivariate analysis was performed to analyze the risk factors for AKI. A total of 224 patients were included. The mean age was 36 +/- 15 years. AKI was observed in 33.9% of cases. Risk factors associated with AKI were male gender (odds ratio [OR] = 2.2; P = 0.03), advanced age (OR = 1.05; P < 0.001), and jaundice (OR = 2.9; P = 0.002). There was an association between amphotericin B use and AKI (OR = 18.4; P < 0.0001), whereas glucantime use was associated with lower incidence of AKI compared with amphotericin B use (OR = 0.05; P < 0.0001). Mortality was 13.3%, and it was higher in AKI patients (30.2%). Therefore, factors associated with AKI were male gender, advanced age, and jaundice. Amphotericin B was an important cause of AKI in VL.
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Affiliation(s)
- Michelle J C Oliveira
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Ceará, Brazil
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Altay M, Unverdi S, Altay FA, Ceri M, Akay H, Ozer H, Kiraç H, Denizli N, Yilmaz B, Güvence N, Duranay M. Renal injury due to hepatic hydatid disease. Nephrol Dial Transplant 2010; 25:2611-5. [PMID: 20179010 DOI: 10.1093/ndt/gfq092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many studies on renal hydatid disease have been reported in the literature, and the disease process appears to be well defined. However, renal injury without direct renal invasion remains poorly understood. The present study aims to define the frequency and the property of the renal involvement in hydatid disease. METHODS Eighty patients older than 18 years and diagnosed with liver echinococcosis were included in the study. The echinococcosis was diagnosed by the haemagglutination test and abdominal ultrasonography. Twenty-four-hour protein excretion was measured for patients who had elevated serum creatinine levels or whose urinalyses were positive for haematuria or proteinuria. Subsequently, renal biopsy was performed, and the specimens were examined by light microscopy and immunofluorescence staining. RESULTS Haematuria was detected in 11 patients (13.75%), and proteinuria was detected in nine patients (11.25%). Percutaneous renal biopsy was applied to nine patients who gave signed consents to undergo the test. We detected four immunoglobulin A nephritis (together with tubulointerstitial nephritis in one patient), one membranoproliferative glomerulonephritis, one immunoglobulin M nephritis together with mesangiocapillary glomerulonephritis, one membranous glomerulonephritis, one amyloidosis and one tubulointerstitial nephritis. Renal hydatid cyst was detected only in four patients (5%). CONCLUSIONS Hydatid disease, which affects the kidney, is not rare, and we suggest that urinalysis and, if indicated, renal biopsy should be performed for hepatic hydatid disease diagnosis.
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Affiliation(s)
- Mustafa Altay
- Department of Internal Medicine, Ankara Education and Research Hospital, Ankara, Turkey.
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Suankratay C, Suwanpimolkul G, Wilde H, Siriyasatien P. Autochthonous visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected patient: the first in thailand and review of the literature. Am J Trop Med Hyg 2010; 82:4-8. [PMID: 20064986 DOI: 10.4269/ajtmh.2010.09-0434] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report a case of visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected 37-year-old Thai fisherman who presented with nephritonephrotic syndrome, fever, anemia, and thrombocytopenia. Bone marrow biopsy revealed many amastigotes within macrophages. Kidney biopsy showed membranoproliferative glomerulonephritis. Polymerase chain reaction (PCR) and nucleotide sequence analysis of the internal transcribed spacer 1 of the small subunit ribosomal RNA gene in blood and kidney biopsy specimens showed Leishmania species previously described in a Thai patient with visceral leishmaniasis. Only four autochthonous cases of leishmaniasis have been reported in Thailand since 1996. To the best of our knowledge, this is the first report of autochthonous visceral leishmaniasis in an HIV-infected Thai. With an increasing number of patients with autochthonous leishmaniasis in association with the presence of potential vector, it remains to be determined whether this vector-borne disease will become an emerging infectious disease in Thailand.
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Affiliation(s)
- Chusana Suankratay
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Goto H, Prianti MDG. Immunoactivation and immunopathogeny during active visceral leishmaniasis. Rev Inst Med Trop Sao Paulo 2009; 51:241-6. [DOI: 10.1590/s0036-46652009000500002] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 07/15/2009] [Indexed: 11/22/2022] Open
Abstract
Visceral leishmaniasis is caused by protozoan parasites of the Leishmania donovani complex. During active disease in humans, high levels of IFN-γ and TNF-α detected in blood serum, and high expression of IFN-γ mRNA in samples of the lymphoid organs suggest that the immune system is highly activated. However, studies using peripheral blood mononuclear cells have found immunosuppression specific to Leishmania antigens; this poor immune response probably results from Leishmania antigen-engaged lymphocytes being trapped in the lymphoid organs. To allow the parasites to multiply, deactivating cytokines IL-10 and TGF-β may be acting on macrophages as well as anti-Leishmania antibodies that opsonize amastigotes and induce IL-10 production in macrophages. These high activation and deactivation processes are likely to occur mainly in the spleen and liver and can be confirmed through the examination of organ samples. However, an analysis of sequential data from studies of visceral leishmaniasis in hamsters suggests that factors outside of the immune system are responsible for the early inactivation of inducible nitric oxide synthase, which occurs before the expression of deactivating cytokines. In active visceral leishmaniasis, the immune system actively participates in non-lymphoid organ lesioning. While current views only consider immunocomplex deposition, macrophages, T cells, cytokines, and immunoglobulins by diverse mechanism also play important roles in the pathogenesis.
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Affiliation(s)
- Hiro Goto
- Universidade de São Paulo, Brazil; Universidade de São Paulo, Brazil
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41
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Soares M, Moraes J, Moraes F. Renal involvement in canine leishmaniasis: a morphological and immunohistochemical study. ARQ BRAS MED VET ZOO 2009. [DOI: 10.1590/s0102-09352009000400004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IgG and IgM deposits in kidneys of dogs with visceral leishmaniasis (VL) were studied in 25 symptomatic dogs (case) and 15 asymptomatic dogs (control) by an immunohistochemical method. All tested dogs were positive for VL by polymerase chain reaction, enzyme-linked immunosorbent assay, and indirect immunofluorescence test. Kidney fragments were submitted to immunohistochemical reaction. Many morphological patterns of distribution of subendothelial granules were identified for IgG and IgM in glomerular capillaries: global, segmental, diffuse, or focal. Intensity of immunohistochemical reaction to IgG was not significantly different when comparing the symptomatic and the asymptomatic animal groups by Fisher's exact test. IgM reactions were significantly different between groups (P<0.01). Deposits of IgM on mesangial cells and in inflammatory interstitial infiltrate were rarely seen, although IgG reactions were frequent at these sites. This study concluded that immunohistochemical reactions for IgM were more intense than those observed for IgG in canine VL, and these reactions were characterized by distribution of subendothelial granules in glomerular capillaries.
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Beltrame A, Arzese A, Camporese A, Rorato G, Crapis M, Tarabini-Castellani G, Boscutti G, Pizzolitto S, Calianno G, Matteelli A, Di Muccio T, Gramiccia M, Viale P. Acute renal failure due to visceral leishmaniasis by Leishmania infantum successfully treated with a single high dose of liposomal amphotericin B. J Travel Med 2008; 15:358-60. [PMID: 19006511 DOI: 10.1111/j.1708-8305.2008.00220.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a visceral leishmaniasis case in an immunocompetent immigrant with acute renal failure. Parasites were demonstrated in bone marrow, peripheral blood, and kidney samples. A collapsing focal segmental glomerulosclerosis was documented, which was successfully treated with a single infusion of 10 mg/kg liposomal amphotericin B.
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Affiliation(s)
- Anna Beltrame
- Clinic of Infectious Diseases, Department of Clinical and Morphological Research, University of Udine, Udine, Italy.
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43
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Manna L, Reale S, Picillo E, Vitale F, Gravino AE. Urine Sampling for Real-Time Polymerase Chain Reaction-Based Diagnosis of Canine Leishmaniasis. J Vet Diagn Invest 2008; 20:64-7. [DOI: 10.1177/104063870802000112] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A real-time polymerase chain reaction (PCR) assay was used for quantifying Leishmania infantum DNA in urine samples from naturally infected dogs. Forty-one infected dogs were divided into 3 groups: 22 dogs showing only cutaneous signs (group 1), 12 dogs showing hematuria (group 2), and 7 dogs affected by severe nephropathy (group 3). Groups 2 and 3 dogs showed altered laboratory parameters related to an impairment of renal function. The real-time PCR analysis showed higher levels of Leishmania DNA in the lymph node aspirates from all groups of infected dogs versus those measured in their blood or urine. Interestingly, urine samples from dogs belonging to groups 2 and 3 contained a higher Leishmania DNA load than that detected in their blood. This finding suggests that a real-time PCR analysis of urine from infected dogs could be a useful and noninvasive tool for monitoring the severity of leishmaniasis.
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Affiliation(s)
- Laura Manna
- Dipartimento di Scienze Cliniche Veterinarie, Università di Napoli Federico II, Napoli, Italy
| | - Stefano Reale
- Dipartimento and the Istituto Zooprofilattico Sperimentale della Sicilia, Palermo, Italy
| | - Esther Picillo
- Dipartimento di Scienze Cliniche Veterinarie, Università di Napoli Federico II, Napoli, Italy
| | - Fabrizio Vitale
- Dipartimento and the Istituto Zooprofilattico Sperimentale della Sicilia, Palermo, Italy
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Izzedine H, Buhaescu I, Bodaghi B, Martinez V, Caumes E, Lehoang P, Deray G. Oculo-renal disorders in infectious diseases. Int Ophthalmol 2006; 25:299-319. [PMID: 16532294 DOI: 10.1007/s10792-005-4833-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Accepted: 11/01/2005] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this article is to review the potential ocular and renal disorders in infectious diseases to which humans are susceptible and to determine prevalence of these diseases. METHODS Published cases of oculo-renal disorders associated with various infectious diseases were collected from the international literature by searching the MEDLINE database (PUBMED 1970-2004) for original reports and review articles published in English. Citations from papers retrieved were screened and retrieved papers were evaluated. RESULTS Based on the screened data, we propose a practical, structure-oriented checklist of such lesions divided into bacterial, viral, parasital, and fugal infections. CONCLUSION The oculorenal manifestations of infectious diseases may be flagrant or subtle. Awareness of the signs and symptoms of infections allows early recognition and prompt, appropriate management. The clinical presentation and relative frequency of those manifestations are reviewed.
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Affiliation(s)
- Hassane Izzedine
- Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France.
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45
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Plevraki K, Koutinas A, Kaldrymidou H, Roumpies N, Papazoglou L, Saridomichelakis M, Savvas I, Leondides L. Effects of Allopurinol Treatment on the Progression of Chronic Nephritis in Canine Leishmaniosis (Leishmania infantum). J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02850.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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46
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Costa FAL, Goto H, Saldanha LCB, Silva SMMS, Sinhorini IL, Silva TC, Guerra JL. Histopathologic patterns of nephropathy in naturally acquired canine visceral leishmaniasis. Vet Pathol 2004; 40:677-84. [PMID: 14608021 DOI: 10.1354/vp.40-6-677] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although the nephropathy of visceral leishmaniasis (VL) is known both in humans and dogs, histopathologic alterations have not been thoroughly studied. We examined renal alterations in 55 dogs with naturally acquired VL compared with five noninfected dogs from an endemic area in northeastern Brazil. Glomerulonephritis was found in 55 dogs, interstitial alterations in 53 dogs, and tubular changes in 43 dogs with VL. The glomerular alterations found were minor glomerular abnormalities (n = 8, 14.5%), focal segmental glomerulosclerosis (n = 10, 18.2%), mesangial proliferative glomerulonephritis (n = 17, 32.7%), membranoproliferative glomerulonephritis, (n = 18, 30.9%), crescentic glomerulonephritis (n = 1, 1.8%), and chronic glomerulonephritis (n = 1, 1.8%). Morphometric and ultrastructural studies complemented the analysis. The five control animals exhibited no glomerular alterations. The glomerular lesions were related to functional alterations. Considering that the alterations of canine and human nephropathy in VL are very similar, the data obtained in this study constitute an important contribution to the understanding of canine and human VL nephropathy.
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Affiliation(s)
- F A L Costa
- Laboratório de Soroepidemiologia e Imunobiologia Celular e Molecular, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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47
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Solano-Gallego L, Rodríguez A, Iniesta L, Arboix M, Portús M, Alberola J. Detection of anti-Leishmania immunoglobulin G antibodies in urine specimens of dogs with leishmaniasis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2003; 10:849-55. [PMID: 12965915 PMCID: PMC193878 DOI: 10.1128/cdli.10.5.849-855.2003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For years, anti-Leishmania immunoglobulin G (IgG) antibodies have been detected in the sera of dogs living in areas of leishmaniasis endemicity. They have also been found in the aqueous humor and cerebrospinal fluid. In contrast, a review of the literature failed to identify the detection of anti-Leishmania antibodies in urine samples from dogs with leishmaniasis. Ninety-five dog urine samples were examined for the presence of anti-Leishmania antibodies by using a protein A enzyme-linked immunosorbent assay (ELISA). Twenty additional urine samples were collected from healthy dogs as controls. An IgG2 ELISA was performed on 26 urine samples found positive by the protein A ELISA. Twenty-three urine samples found positive to anti-Leishmania antibodies were tested for the local production of anti-Leishmania antibodies in the urinary tract by means of the urine antibody coefficient. Ten urine samples (and the corresponding serum samples) were compared by Western blot (WB) analysis. Thirty-five out of the 95 urine samples were found positive, 57 were found negative, and 3 were found inconclusive for antibody detection by the protein A ELISA. A high correlation between protein A and IgG2 levels was found in positive urine samples. Anti-Leishmania antibodies were present in the urine of dogs that had leishmaniasis, urinary protein/creatinine (U P/C) ratios of greater than one, and normal urinary sediment. A statistically significant correlation was observed between the U P/C ratios and the levels of anti-Leishmania antibodies in positive urine samples. In general, WB analysis and the urine antibody coefficient suggested that the presence of anti-Leishmania antibodies in urine was the consequence of an impairment of filtration of the glomerular barrier. However, in some dogs, WB analysis could be interpreted as suggesting that the presence of anti-Leishmania antibodies was caused, to a lesser extent, by local antibody production in the urinary tract. Antibody detection in urine could be a noninvasive method for leishmaniasis diagnosis and prognosis in dogs with glomerulonephropathies.
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Affiliation(s)
- L Solano-Gallego
- Departament de Farmacologia, Terapèutica, i Toxicologia, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
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48
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Zatelli A, Borgarelli M, Santilli R, Bonfanti U, Nigrisoli E, Zanatta R, Tarducci A, Guarraci A. Glomerular lesions in dogs infected with Leishmania organisms. Am J Vet Res 2003; 64:558-61. [PMID: 12755294 DOI: 10.2460/ajvr.2003.64.558] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To histologically identify glomerular lesions in dogs infected with Leishmania organisms. ANIMALS 41 dogs (17 sexually intact males and 14 sexually intact and 10 ovariohysterectomized females) that had positive results when tested for leishmaniosis as determined by use of serologic evaluation (indirect fluorescent antibody test, titers of 1:80 to 1:640) and direct microscopic identification of the protozoal organisms. PROCEDURE Urine samples were collected by use of cystocentesis and examined by qualitative SDS-agarose gel electrophoresis (AGE). All dogs had non-selective (glomerular) or mixed (glomerular and tubular) proteinemia. Specimens were obtained from each dog during ultrasound-assisted renal biopsy and used for histologic examination. Each specimen was stained with H&E, periodic acid-Schiff, Goldner's trichrome, methenamine silver, and Congo Red stains. Specimens were adequate for evaluation when they contained at least 5 glomeruli/section, except for specimens stained with Congo Red in which 1 glomerulus/section was adequate. RESULTS Examination of renal biopsy specimens revealed various glomerular lesions in all dogs and interstitial or tubular (or both) lesions in 23 of 41 (55%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE Glomerular lesions that develop in dogs during infection with Leishmania organisms can be classified histologically as mesangial glomerulonephritis, membranous glomerulonephritis, membranoproliferative glomerulonephritis, and focal segmental glomerulonephritis. Tubulointerstitial histopathologic conditions were not observed as the primary lesion, despite being evident in 23 of 41 (55%) dogs. Use of SDS-AGE for qualitative evaluation of proteinuria and successive collection of specimens during renal biopsies following diagnosis of nonselective glomerular proteinuria provides the possibility for early identification of renal lesions.
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Affiliation(s)
- Andrea Zatelli
- Clinica Veterinaria Pirani, Via Majakowski, 2/N 42100 Reggio Emilia, Italy
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Salgado Filho N, Ferreira TMAF, Costa JML. [Involvement of the renal function in patients with visceral leishmaniasis (kala-azar)]. Rev Soc Bras Med Trop 2003; 36:217-21. [PMID: 12806457 DOI: 10.1590/s0037-86822003000200004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Evaluation of the renal involvement of visceral leishmaniasis (kala-azar) aiming at verifying clinical and laboratorial repercussions of the renal implication on VL. Laboratory analysis was performed of blood and urine samples collected immediately after confirming diagnosis through the finding of Leishmania in bone marrow. Two (18.1%) patient presented complications associated with kala-azar. Five patients (45.4%) presented macroscopic hematuria and one case (N 9) clinical manifestations compatible with an acute nephritis syndrome. Laboratorial data of urine exam showed: proteinuria in 10 (90.9%) patients, hematuria in 7 (63.6%) and leukocyturia in 6 (54.5%) cases. Nine (81.8%) patients presented high levels of microalbuminuria, characterizing glomerular lesion. The presence of proximal tubulopathy, measured through retinol binding protein observed in 5 (45.4%) cases. CONCLUSION renal involvement was manifested in most subjects, contributing to the severity of the disease.
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50
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Abstract
OBJECTIVES To consolidate the spectrum and frequency of parasite-related rheumatic syndromes, which have largely been regarded as exceedingly rare by the general medicine, infectious disease, and rheumatology literature. METHODS A MEDLINE search was performed for articles on rheumatic syndromes related to parasitic infections published from 1966 through December 2000. Identified articles included clinical and epidemiologic studies describing cases of rheumatic syndromes associated with verified parasitic infection. RESULTS Rheumatologic syndromes, including inflammatory arthritis, inflammatory myositis, and vasculitis, have been described among multiple different parasite infections of all parasitic divisions, including Protozoa, Nematoda, and Platyhelminthes. Individual parasitic divisions are often associated with particular rheumatic syndromes, such as reactive arthritis and spondyloarthropathy, inflammatory or infectious myositis, and reactive or parainfectious vasculitis. CONCLUSIONS AND RELEVANCE Parasitic infection may underlie the clinical presentation of some rheumatic conditions. Given the continued and growing number of patients at risk for parasitosis by virtue of their country of origin, travel habits, and an immunocompromised state, potential parasitosis must be considered in patients undergoing evaluation for rheumatic complaints.
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Affiliation(s)
- Stanford L Peng
- Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA 02115, USA.
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