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Dikhit MR, Pranav A, Kumar A, Sen A. Designing a Multi-Epitope Vaccine Candidate for Visceral Leishmaniasis Targeting Leishmania and Sand Fly Vector Antigens: An In Silico Approach. Acta Trop 2025; 264:107600. [PMID: 40154672 DOI: 10.1016/j.actatropica.2025.107600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Revised: 03/19/2025] [Accepted: 03/25/2025] [Indexed: 04/01/2025]
Abstract
Leishmania donovani, which is responsible for visceral leishmaniasis (VL), poses severe public health challenges, necessitating novel strategies to decrease its incidence. The epitopes predicted with immune informatics tools provide the opportunity for the development of a good vaccine candidate. The immunogenicity of sand fly salivary proteins SP02, SP12, SP13, SP14, SP15, SP19, and SP56 and known Leishmania MHC class I and class II epitopes was evaluated. Among the sand fly salivary proteins the most prominent ten B cell epitopes based on their immunogenicity, stability and safety were derived from these proteins. Two remarkable vaccination candidates that were considered safe, SP14 and SP15, were "LPTILAHSPAGASVNQ" (1.244) and "RLLIKDYVVTRKVVKD" (1.178), respectively. These T cell epitopes included thirteen verified MHC I and six MHC class II epitopes. All known immunodominant epitopes were used in the vaccine build together with possible linkers and an adjuvant at the N-terminus to improve immunogenicity. The proposed vaccine was extensively tested to establish its stability, non-allergic reaction, and nontoxicity, all of which were confirmed.The vaccine construct's stable interaction with TLR4 highlighted important hydrogen bonds necessary for stable receptor engagement. Indicative of a robust Th1 response, immune simulations showed an elivated IgG and IgM titers, substantial helper and cytotoxic T-cell responses, and elevated levels of IFN-γ, IL-2, and IL-12, further supporting the vaccine construct's potential as a promising candidate for leishmaniasis control. However, experimental validations will determine its potential as an effective vaccine candidate.
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Affiliation(s)
- Manas Ranjan Dikhit
- Department of Bioinformatics, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India.
| | - A Pranav
- Department of Bioinformatics, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India
| | - Ajay Kumar
- Department of Vector Biology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India
| | - Abhik Sen
- Department of Molecular Biology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India
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Mehrotra S, Tiwari R, Kumar R, Sundar S. Advances and Challenges in the Diagnosis of Leishmaniasis. Mol Diagn Ther 2025; 29:195-212. [PMID: 39843806 DOI: 10.1007/s40291-024-00762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2024] [Indexed: 01/24/2025]
Abstract
Leishmaniasis remains a significant public health challenge, particularly in endemic regions with limited resources. Traditional diagnostic methods, including microscopy, culture, and serology, though widely utilized, often suffer from limitations such as variable sensitivity, time delays, and the need for specialized infrastructure. Some of these limitations have been addressed with the emergence of molecular diagnostic techniques. Quantitative PCR (q-PCR), loop-mediated isothermal amplification (LAMP), and recombinase polymerase amplification (RPA) assays have improved the diagnostic sensitivity and specificity, enabling species identification and detection of asymptomatic infections. Further, nanodiagnostics and portable sequencing technologies such as the MinION™, along with lab-on-chip platforms, are revolutionizing the diagnostic landscape of leishmaniasis by offering point-of-care (POC) options for remote settings and field-based diagnosis. This review provides an in-depth analysis of these cutting-edge advances, discusses their application in resource-constrained settings, and evaluates their potential to reshape the future of leishmaniasis diagnosis and management.
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Affiliation(s)
- Sanjana Mehrotra
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, India
| | - Rahul Tiwari
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rajiv Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Sundar S, Alves F, Ritmeijer K, den Boer M, Forsyth C, Hughes B, Zamble C, Carter K, Angyalosi G. Patient insights research exploring disease awareness, patient life experience, and current management of visceral leishmaniasis in Bihar, India. PLoS Negl Trop Dis 2025; 19:e0012326. [PMID: 39999159 PMCID: PMC11856310 DOI: 10.1371/journal.pntd.0012326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 01/10/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a vector-borne disease caused by Leishmania parasites and transmitted by sand fly bites, targeted for elimination in India. VL primarily affects rural, low-income populations with limited health care access. In South Asia, few studies have explored patients' perspectives, diagnoses, and treatment experiences; particularly lacking an understanding about the patients' life experiences outside of clinical research settings. METHODOLOGY/PRINCIPAL FINDINGS A qualitative study was conducted in Bihar, India, using moderator-facilitated, protocol-defined discussion. Eighteen adult patients and 12 caregivers of children diagnosed with and treated for VL within the last 12 months were identified by self-report. Mean time from symptom onset to diagnosis was 13.8 days. Challenges of the early patient life experience included lack of urgency by health care professionals, delayed diagnosis, and no guarantee of treatment at the location of their VL diagnosis (63% had to switch to a different center for treatment, at times delaying treatment). Key barriers identified in previous studies that were re-confirmed in this study include out-of-pocket financial burden, absence from work/home duties, and long-distance travel to hospitals. Patients and caregivers (n = 29/30) expressed a preference for a potential oral treatment that could be taken close to home. CONCLUSIONS/SIGNIFICANCE This study reveals new insights about the patient life experience and reconfirms previous research indicating that access to care for patients with VL in the Bihar area remains a challenge. Although most patients with VL seek care early, diagnosis often requires multiple visits to a health care facility. Despite access to therapy in public hospitals, some patients reported a preference for private care. Even if diagnosis takes place in a government-funded public setting, some patients reported needing to move from the location of diagnosis to another center to receive therapy, creating an additional burden for patients. As a potential alternative to current parenteral treatment, adult patients and caregivers of pediatric patients expressed interest in a potential oral therapy because it may reduce barriers to access care.
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Affiliation(s)
- Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Fabiana Alves
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | | | | | - Colin Forsyth
- Drugs for Neglected Diseases Initiative, New York, New York, United States of America
| | - Bethan Hughes
- Novartis Pharmaceuticals U.K. Ltd, London, United Kingdom
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4
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Chu WY, Verrest L, Younis BM, Musa AM, Mbui J, Mohammed R, Olobo J, Ritmeijer K, Monnerat S, Wasunna M, Roseboom IC, Solomos A, Huitema ADR, Alves F, Dorlo TPC. Disease-Specific Differences in Pharmacokinetics of Paromomycin and Miltefosine Between Post-Kala-Azar Dermal Leishmaniasis and Visceral Leishmaniasis Patients in Eastern Africa. J Infect Dis 2024; 230:e1375-e1384. [PMID: 39166299 PMCID: PMC11646621 DOI: 10.1093/infdis/jiae413] [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: 05/09/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 08/22/2024] Open
Abstract
Treatment regimens for post-kala-azar dermal leishmaniasis (PKDL) are usually extrapolated from those for visceral leishmaniasis (VL), but drug pharmacokinetics (PK) can differ due to disease-specific variations in absorption, distribution, and elimination. This study characterized PK differences in paromomycin and miltefosine between 109 PKDL and 264 VL patients from Eastern Africa. VL patients showed 0.55-fold (95% confidence interval [CI], .41-.74) lower capacity for paromomycin saturable reabsorption in renal tubules, and required a 1.44-fold (95% CI, 1.23-1.71) adjustment when relating renal clearance to creatinine-based estimated glomerular filtration rate. Miltefosine bioavailability in VL patients was lowered by 69% (95% CI, 62%-76%) at treatment start. Comparing PKDL to VL patients on the same regimen, paromomycin plasma exposures were 0.74- to 0.87-fold, while miltefosine exposure until the end of treatment day was 1.4-fold. These pronounced PK differences between PKDL and VL patients in Eastern Africa highlight the challenges of directly extrapolating dosing regimens from one leishmaniasis presentation to another.
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Affiliation(s)
- Wan-Yu Chu
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luka Verrest
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Brima M Younis
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Ahmed M Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Jane Mbui
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rezika Mohammed
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Joseph Olobo
- Department of Immunology and Molecular Biology, Makerere University, Kampala, Uganda
| | | | | | | | - Ignace C Roseboom
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
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Tiwari R, Kumar A, Singh VK, Rajneesh, Chauhan SB, Sundar S, Nylén S, Engwerda C, Kumar R. The development and maintenance of immunity against visceral leishmaniasis. Front Immunol 2024; 15:1486407. [PMID: 39781380 PMCID: PMC11707418 DOI: 10.3389/fimmu.2024.1486407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 11/20/2024] [Indexed: 01/12/2025] Open
Abstract
Understanding the development and maintenance of immunological memory is important for efforts to eliminate parasitic diseases like leishmaniasis. Leishmaniasis encompasses a range of pathologies, resulting from infection with protozoan parasites belonging to the subgenera Leishmania and Viannia of the genus Leishmania. A striking feature of these infections is that natural or drug-mediated cure of infection generally confers life-long protection against disease. The generation of protective T cell responses are necessary to control Leishmania infections. CD4+ T helper (Th) cells orchestrate immune responses in leishmaniasis and IFNγ+ Tbet+ CD4+ T (Th1) cells are required for the activation of phagocytes to kill captured or resident parasites, while other Th cell subset, including FoxP3+ natural regulatory T cells and Th2 cells can promote disease progression by suppressing the activities of Th1 cells. Upon resolution of a primary Leishmania infection, different subsets of CD4+ T cells, including tissue-resident memory T cells, effector memory T cells, central memory T cells, and short-lived effector T cells, help to confer resistance against reinfection. To maintain long-term protective Leishmania-specific CD4+ T cells responses, it is believed that persistent parasites or re-exposure to parasites at regular intervals is required (concomitant immunity). Despite the advances in our understanding about the immune responses during leishmaniasis, the generation of long-lasting protective immunity via vaccination has yet to be achieved. In this review, we summarize our current understanding about the formation and maintenance of immunological memory and control of leishmaniasis at the individual and population level. We will focus on Indian visceral leishmaniasis and discuss T cell responses that contribute to susceptibility to leishmaniasis, parasite persistence in populations and the environment, as well as describing advances in the development of leishmaniasis vaccines aimed at inducing protective CD4+ T cell responses.
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Affiliation(s)
- Rahul Tiwari
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Awnish Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Vishal Kumar Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rajneesh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shashi Bhushan Chauhan
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Susanne Nylén
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Engwerda
- Infection and Inflammation Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rajiv Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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6
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Kushwaha AK, Shukla A, Scorza BM, Chaubey R, Maurya DK, Rai TK, Yaduvanshi S, Srivastava S, Oliva G, Le Rutte EA, Kumar R, Singh OP, Tiwary P, Singh SK, Bernhardt SA, Lawyer P, Rowton E, Petersen CA, Sundar S. Dogs as Reservoirs for Leishmania donovani, Bihar, India, 2018-2022. Emerg Infect Dis 2024; 30:2604-2613. [PMID: 39592395 PMCID: PMC11616638 DOI: 10.3201/eid3012.240649] [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] [Indexed: 11/28/2024] Open
Abstract
Visceral leishmaniasis derived from Leishmania donovani is transmitted by sand flies (Phlebotomus argentipes) throughout the Indian subcontinent. Although considered anthroponotic, L. donovani infects other mammals susceptible to sand fly bites, including dogs. Aggressive strategies to reduce sand fly populations in India have led to flies seeking nonhuman hosts, so understanding the role of dogs in L. donovani transmission has become critical. Our study investigated L. donovani infection in dogs and the potential for such infections to be transmitted back to sand flies. We performed xenodiagnosis by using P. argentipes on dogs (n = 73) with quantitative PCR-detectible parasitemia in both endemic and outbreak villages. We found that 12% (9/73) of dogs were infectious to sand flies during winter and rainy seasons. Patients with visceral leishmaniasis remain primary sources of L. donovani transmission, but our findings suggest a possible link between canine infection and human exposure.
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Affiliation(s)
| | | | - Breanna M. Scorza
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Rahul Chaubey
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Dharmendra Kumar Maurya
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Tulika Kumari Rai
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Shyamali Yaduvanshi
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Shweta Srivastava
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Gaetano Oliva
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Epke A. Le Rutte
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Rajiv Kumar
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Om Prakash Singh
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Puja Tiwary
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Shakti Kumar Singh
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Scott A. Bernhardt
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Phillip Lawyer
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
| | - Edgar Rowton
- Banaras Hindu University, Varanasi, India (A.K. Kushwaha, A. Shukla, D.K. Maurya, T.K. Rai, S. Yaduvanshi, S. Srivastava, R. Kumar, O.P. Singh, P. Tiwary); University of Iowa, Iowa City, Iowa, USA (B.M. Scorza, C.A. Petersen); Kala-Azar Medical Research Center, Muzaffarpur, India (R. Chaubey, S. Sundar); University of Naples Federico II, Naples, Italy (G. Oliva), Swiss Tropical and Public Health Institute, Basel, Switzerland (E.A. Le Rutte); National Museum of Natural History, New Delhi, India (S.K. Singh); Utah State University, Logan, Utah, USA (S.A. Bernhardt); Walter Reed Army Institute for Research, Silver Spring, Maryland, USA (P. Lawyer, E. Rowton)
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7
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Shah HK, Fathima PA, Ajithlal PM, Kumar A, Rawani A, Thakur MS, Mohanty SS, Sarma DK, Pandey K, Kumar A, Rahi M, Saini P. Nationwide cross-sectional surveillance of Leishmania donovani in phlebotomine sand flies and its impact on national kala-azar elimination in India. Sci Rep 2024; 14:28455. [PMID: 39557939 PMCID: PMC11574011 DOI: 10.1038/s41598-024-78915-0] [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: 08/12/2024] [Accepted: 11/05/2024] [Indexed: 11/20/2024] Open
Abstract
India is accelerating efforts to eliminate kala-azar by aligning its National Kala-Azar Elimination Program with the World Health Organization's (WHO) roadmap for Neglected Tropical Diseases (NTDs) 2021-2030. Elimination relies on comprehensive vector surveillance and integrated vector management. This study aimed to conduct nationwide entomological surveillance to detect Leishmania donovani in phlebotomine sand flies. A cross-sectional survey was conducted from January 2022 to December 2023 in five different biogeographical zones in India. Mechanical aspirator, light traps were used for sampling. The collected sand flies were identified to species level. Molecular xenomonitoring was conducted using kDNA qPCR, and parasite characterization targeting ITS1 gene sequencing and RFLP. Sand fly species was confirmed by DNA barcode. Molecular xenomonitoring revealed that Phlebotomus argentipes from Bihar, West Bengal, and Kerala exhibited high levels of L. donovani parasitic DNA. In Rajasthan, P. sergenti and P. papatasi and in Himachal Pradesh, P. longiductus, P. major, and P. bruneyi were positive. The high levels of L. donovani parasitic DNA detected in various Phlebotomus species, along with its presence in other sand fly species beyond the established vectors, underscore the urgent need for the National Kala-Azar Elimination Program to prioritize comprehensive and rigorous vector surveillance. Strengthening these efforts is crucial for achieving the program's goal of eliminating the disease.
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Affiliation(s)
- Harish Kumar Shah
- ICMR- Vector Control Research Centre, Field Station, Kottayam, Kerala, 686003, India
| | - P A Fathima
- ICMR- Vector Control Research Centre, Field Station, Kottayam, Kerala, 686003, India
| | - P M Ajithlal
- ICMR- Vector Control Research Centre, Field Station, Kottayam, Kerala, 686003, India
| | - Ashish Kumar
- ICMR- Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Anjali Rawani
- Department of Zoology, University of Gour Banga, Malda, West Bengal, India
| | - Mahender Singh Thakur
- Department of Bio-Science, Himachal Pradesh University, Shimla, Himachal Pradesh, India
| | - Suman Sundar Mohanty
- ICMR- National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Devojit Kumar Sarma
- ICMR- National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Krishna Pandey
- ICMR- Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Ashwani Kumar
- ICMR- Vector Control Research Centre, Puducherry, India
- Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Kanchipuram, Tamil Nadu, India
| | - Manju Rahi
- ICMR- Vector Control Research Centre, Puducherry, India
| | - Prasanta Saini
- ICMR- Vector Control Research Centre, Field Station, Kottayam, Kerala, 686003, India.
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8
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Rauf A, Rashid U, Shbeer AM, Al-Ghorbani M, Muhammad N, Khalil AA, Naz H, Sharma R, Ribaudo G. Flavonoids from Pistacia chinensis subsp. integerrima with leishmanicidal activity: computational and experimental evidence. Nat Prod Res 2024; 38:3282-3287. [PMID: 37357619 DOI: 10.1080/14786419.2023.2228459] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Pistacia chinensis subsp. integerrima is a valuable medicinal plant as its parts and extracts found application for treating diarrhea, fever, liver disorders, asthma, and inflammation. In this study, we report the leishmanicidal activity of sakuranetin, spinacetin, and patuletin extracted from P. chinensis. The tested compounds revealed a strong anti-leishmanial activity in vitro against Leishmania major showing IC50 values of 7.98 ± 0.16 µM, 9.23 ± 0.23 µM 11.09 ± 0.87 µM for sakuranetin, spinacetin, and patuletin, respectively. Moreover, to explore the potential mechanism(s) by which the compounds may act, computational docking studies were performed against dihydrofolate reductase and pteridine reductase, showing that the flavonoids could target these two key enzymes to exploit their leishmanicidal activity. In accordance with in vitro results, patuletin was highlighted as the most promising compound of the set, and binding energy values of -6.72 and -6.74 kcal/mol were computed for the two proteins, respectively.
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Affiliation(s)
- Abdur Rauf
- Department of Chemistry, University of Swabi, Swabi, Khyber Pakhtunkhwa, Pakistan
| | - Umer Rashid
- Department of Chemistry, COMSATS University Islamabad, Abbottabad Campus, Abbottabad, Pakistan
| | | | - Mohammed Al-Ghorbani
- Department of Chemistry, Faculty of Science and Arts, Ulla, Taibah University, Medina, Saudi Arabia
| | - Naveed Muhammad
- Department of Pharmacy, Abdul Wali Khan University, Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Anees Ahmed Khalil
- University Institute of Diet and Nutritional Sciences, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Humaira Naz
- Department of Biotechnology, Shaheed Benazir Bhutto Women University Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Rohit Sharma
- Department of Rasa Shastra and Bhaishajya Kalpana, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Giovanni Ribaudo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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9
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Iniguez E, Kamhawi S. Discovery of new antigens for serodiagnosis of visceral leishmaniasis in humans and dogs adds valuable tools to our arsenal. mBio 2024; 15:e0107924. [PMID: 38995021 PMCID: PMC11323473 DOI: 10.1128/mbio.01079-24] [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: 07/13/2024] Open
Abstract
Surveillance and sustained control of visceral leishmaniasis (VL) require reliable serodiagnostic tools. rK39, the gold standard antigen for VL diagnosis, is limited by its documented poor sensitivity in certain endemic regions, such as East Africa, and by the longevity of its antibodies, making it difficult to distinguish active from cured infections. In a recent publication in mBio, Roberts et al. (A. J. Roberts, H.B. Ong, S. Clare, C. Brandt, et al., mBio 15:e00859-24, 2024, https://doi.org/10.1128/mbio.00859-24) identified new immunogenic Leishmania candidates in dogs and humans. In dogs, combined antigens LdBPK_290790.1 + LdBPK_362700.1 (D4 +D46) distinguished symptomatic from asymptomatic infections. For humans, LdBPK_323600.1 (D36) antigen produced short-lived antibodies and performed well in patient cohorts from Bangladesh and Ethiopia, but not Kenya. This study adds promising new candidates to our serodiagnostic toolbox but highlights the need for more antigen discovery studies that may have to be focused on regional performance.
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Affiliation(s)
- Eva Iniguez
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Shaden Kamhawi
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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10
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Sundar S, Chakravarty J, Singh J, Verma D, Agrawal N, Dinkar A. Amphotericin B Deoxycholate Treatment of Post-Kala-Azar Dermal Leishmaniasis in India. Am J Trop Med Hyg 2024; 111:59-63. [PMID: 38834057 PMCID: PMC11229639 DOI: 10.4269/ajtmh.23-0738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/21/2024] [Indexed: 06/06/2024] Open
Abstract
Post-kala-azar dermal leishmaniasis (PKDL) is widely prevalent in the endemic regions of India, but its treatment remains unsatisfactory. The WHO recommends a 12-week treatment with oral miltefosine, but its ocular toxicities are a serious concern. The late 1980s and early 1990s saw the use of sodium stibogluconate and amphotericin B (AmB) for a brief period. Both drugs had frequent adverse events and were expensive, and the duration of treatments was unacceptably long. This retrospective study evaluated, analyzed, and reported the outcomes of PKDL patients treated with a shorter course of AmB, the most effective antileishmanial drug. The hospital records of PKDL patients treated with AmB by 30 alternate-day infusions over 60 days (instead of conventional 60-80 infusions over 100-120 days) between September 2010 and August 2016 were reviewed. Only patients with confirmed parasitological diagnosis were included. Their records were studied for treatment-related adverse events, end-of-treatment parasitological status, and 12-month follow-up results. One hundred two patients were eligible for this study between September 2010 and August 2016. After therapy, 92/102 (90.2%) patients improved; 3 (2.9%) had to cease treatment owing to severe adverse effects, and one died of severe diarrhea unrelated to AmB. Six (5.9%) patients withdrew consent before the treatment was complete. At the 12-month evaluation, 89/102 (87.3%) patients attained a final cure. A 30-infusion regimen of AmB remains highly effective in PKDL. Without a shorter, safer, and more economical regimen for the treatment of PKDL, it should be used until a better regimen is available.
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Affiliation(s)
- Shyam Sundar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Kala-Azar Medical Research Center, Muzaffarpur, India
| | - Jaya Chakravarty
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jitendra Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Deepak Verma
- Kala-Azar Medical Research Center, Muzaffarpur, India
| | - Neha Agrawal
- Department of Medicine, University of Florida, Jacksonville, Florida
| | - Anju Dinkar
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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11
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Palić S, Chu WY, Sundar S, Mondal D, Das P, Pandey K, Raja S, Rijal S, Roseboom IC, Hamadeh A, Malik PRV, Beijnen JH, Huitema ADR, Sjögren E, Alves F, Dorlo TPC. Skin pharmacokinetics of miltefosine in the treatment of post-kala-azar dermal leishmaniasis in South Asia. J Antimicrob Chemother 2024; 79:1547-1554. [PMID: 38727613 PMCID: PMC11215536 DOI: 10.1093/jac/dkae129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/04/2024] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION Post-kala-azar dermal leishmaniasis (PKDL) arises as a dermal complication following a visceral leishmaniasis (VL) infection. Current treatment options for PKDL are unsatisfactory, and there is a knowledge gap regarding the distribution of antileishmanial compounds within human skin. The present study investigated the skin distribution of miltefosine in PKDL patients, with the aim to improve the understanding of the pharmacokinetics at the skin target site in PKDL. METHODS Fifty-two PKDL patients underwent treatment with liposomal amphotericin B (20 mg/kg) plus miltefosine (allometric dosing) for 21 days. Plasma concentrations of miltefosine were measured on study days 8, 15, 22 and 30, while a punch skin biopsy was taken on day 22. A physiologically based pharmacokinetic (PBPK) model was developed to evaluate the distribution of miltefosine into the skin. RESULTS Following the allometric weight-based dosing regimen, median miltefosine concentrations on day 22 were 43.73 µg/g (IQR: 21.94-60.65 µg/g) in skin and 33.29 µg/mL (IQR: 25.9-42.58 µg/mL) in plasma. The median individual concentration ratio of skin to plasma was 1.19 (IQR: 0.79-1.9). In 87% (45/52) of patients, skin exposure was above the suggested EC90 PK target of 10.6 mg/L associated with in vitro susceptibility. Simulations indicated that the residence time of miltefosine in the skin would be more than 2-fold longer than in plasma, estimated by a mean residence time of 604 versus 266 hours, respectively. CONCLUSION This study provides the first accurate measurements of miltefosine penetration into the skin, demonstrating substantial exposure and prolonged retention of miltefosine within the skin. These findings support the use of miltefosine in cutaneous manifestations of leishmaniasis. In combination with parasitological and clinical data, these results are critical for the future optimization of combination therapies with miltefosine in the treatment of PKDL.
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Affiliation(s)
- Semra Palić
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Wan-Yu Chu
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Shyam Sundar
- Department of Medicine, Banaras Hindu University, Varanasi, India
| | - Dinesh Mondal
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Sheeraz Raja
- Drugs for Neglected Diseases initiative (DNDi) South Asia, New Delhi, India
| | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi) South Asia, New Delhi, India
| | - Ignace C Roseboom
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Abdullah Hamadeh
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul R V Malik
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Erik Sjögren
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
- Pharmetheus AB, Uppsala, Sweden
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Thomas P C Dorlo
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
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12
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Singh OP, Chaubey R, Kushwaha AK, Fay MP, Sacks D, Sundar S. Visceral Leishmaniasis-Human Immunodeficiency Virus-Coinfected Patients Are Highly Infectious to Sandflies in an Endemic Area in India. J Infect Dis 2024; 229:1909-1912. [PMID: 38713583 PMCID: PMC11175680 DOI: 10.1093/infdis/jiae156] [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: 07/20/2023] [Indexed: 05/09/2024] Open
Abstract
In an area endemic with Indian visceral leishmaniasis (VL), we performed direct xenodiagnosis to evaluate the transmission of Leishmania donovani from patients with VL-human immunodeficiency virus (HIV) coinfection to the vector sandflies, Phlebotomus argentipes. Fourteen patients with confirmed VL-HIV coinfection, with a median parasitemia of 42 205 parasite genome/mL of blood, were exposed to 732 laboratory-reared pathogen-free female P argentipes sandflies on their lower arms and legs. Microscopy revealed that 16.66% (122/732) of blood-fed flies were xenodiagnosis positive. Notably, 93% (13/14) of the VL-HIV group infected the flies, as confirmed by quantitative polymerase chain reaction and/or microscopy, and were 3 times more infectious than those who had VL without HIV.
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Affiliation(s)
| | - Rahul Chaubey
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
- Kala-Azar Medical Research Centre, Muzaffarpur, Bihar, India
| | - Anurag Kumar Kushwaha
- Department of Biochemistry, Institute of Science
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
| | | | - David Sacks
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
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13
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Langston H, Fortes Francisco A, Doidge C, Roberts CH, Khan AA, Jayawardhana S, Taylor MC, Kelly JM, Lewis MD. Dynamics of Trypanosoma cruzi infection in hamsters and novel association with progressive motor dysfunction. PLoS Negl Trop Dis 2024; 18:e0012278. [PMID: 38905323 PMCID: PMC11221660 DOI: 10.1371/journal.pntd.0012278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 07/03/2024] [Accepted: 06/07/2024] [Indexed: 06/23/2024] Open
Abstract
Chagas disease is a zoonosis caused by the protozoan parasite Trypanosoma cruzi. Clinical outcomes range from long-term asymptomatic carriage to cardiac, digestive, neurological and composite presentations that can be fatal in both acute and chronic stages of the disease. Studies of T. cruzi in animal models, principally mice, have informed our understanding of the biological basis of this variability and its relationship to infection and host response dynamics. Hamsters have higher translational value for many human infectious diseases, but they have not been well developed as models of Chagas disease. We transposed a real-time bioluminescence imaging system for T. cruzi infection from mice into female Syrian hamsters (Mesocricetus auratus). This enabled us to study chronic tissue pathology in the context of spatiotemporal infection dynamics. Acute infections were widely disseminated, whereas chronic infections were almost entirely restricted to the skin and subcutaneous adipose tissue. Neither cardiac nor digestive tract disease were reproducible features of the model. Skeletal muscle had only sporadic parasitism in the chronic phase, but nevertheless displayed significant inflammation and fibrosis, features also seen in mouse models. Whereas mice had normal locomotion, all chronically infected hamsters developed hindlimb muscle hypertonia and a gait dysfunction resembling spastic diplegia. With further development, this model may therefore prove valuable in studies of peripheral nervous system involvement in Chagas disease.
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Affiliation(s)
- Harry Langston
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amanda Fortes Francisco
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ciaran Doidge
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chrissy H. Roberts
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Archie A. Khan
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shiromani Jayawardhana
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin C. Taylor
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John M. Kelly
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael D. Lewis
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Kumar A, Singh VK, Madhukar P, Tiwari R, Roy R, Rajneesh, Mehrotra S, Sundar S, Kumar R. Evaluation of blood based quantitative PCR as a molecular diagnostic tool for post kala-azar dermal leishmaniasis (PKDL). Mol Biol Rep 2024; 51:716. [PMID: 38824237 DOI: 10.1007/s11033-024-09640-0] [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: 02/05/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Post kala-azar dermal leishmaniasis (PKDL) is a consequential dermal manifestation of visceral leishmaniasis (VL), serving as a parasite reservoir. The traditional diagnostic approach, which requires an invasive skin biopsy is associated with inherent risks and necessitates skilled healthcare practitioners in sterile settings. There is a critical need for a rapid, less invasive method for Leishmania detection. The main objective of this study was to evaluate and compare the diagnostic efficacy of PCR and qPCR in detecting PKDL, utilizing both skin and blood samples and to assess the utility of blood samples for molecular diagnosis. METHODS AND RESULTS 73 individuals exhibiting clinical symptoms of PKDL and who had tested positive for rK39 rapid diagnostic test (RDT) were enrolled in this study. For the diagnosis of PKDL, both PCR and real-time quantitative PCR (qPCR), employing SYBR Green and TaqMan assays, were performed on blood and skin matched samples. qPCR results using both TaqMan and SYBR Green assay, indicated higher parasite loads in the skin compared to blood, as evident by the Ct values. Importantly, when blood samples were used for PKDL diagnosis by qPCR, an encouraging sensitivity of 69.35% (TaqMan assay) and 79.36% (SYBR Green) were obtained, compared to 8.2% with conventional PCR. CONCLUSION The findings of the study suggest the potential utility of blood for molecular diagnosis by qPCR, offering a less invasive alternative to skin biopsies in field setting for the early detection of parasitaemia in PKDL patients and effective management and control of the disease.
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Affiliation(s)
- Awnish Kumar
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Vishal K Singh
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Prasoon Madhukar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rahul Tiwari
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Ritirupa Roy
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rajneesh
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Sanjana Mehrotra
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rajiv Kumar
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
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15
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Sundar S, Pandey K, Mondal D, Madhukar M, Kamal Topno R, Kumar A, Kumar V, Kumar Verma D, Chakravarty J, Chaubey R, Kumari P, Rashid MU, Maruf S, Ghosh P, Raja S, Rode J, den Boer M, Das P, Alvar J, Rijal S, Alves F. A phase II, non-comparative randomised trial of two treatments involving liposomal amphotericin B and miltefosine for post-kala-azar dermal leishmaniasis in India and Bangladesh. PLoS Negl Trop Dis 2024; 18:e0012242. [PMID: 38900786 PMCID: PMC11189210 DOI: 10.1371/journal.pntd.0012242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND In Southeast Asia, treatment is recommended for all patients with post-kala-azar dermal leishmaniasis (PKDL). Adherence to the first-line regimen, twelve weeks of miltefosine (MF), is low and ocular toxicity has been observed with this exposure period. We assessed the safety and efficacy of two shorter-course treatments: liposomal amphotericin B (LAmB) alone and combined with MF. METHODOLOGY/PRINCIPAL FINDINGS An open-label, phase II, randomized, parallel-arm, non-comparative trial was conducted in patients with parasitologically confirmed PKDL, 6 to ≤60 years. Patients were assigned to 20 mg/kg LAmB (total dose, in five injections over 15 days) alone or combined with allometric MF (3 weeks). The primary endpoint was definitive cure at 12 months, defined as complete resolution of papular and nodular lesions and >80% re-pigmentation of macular lesions. Definitive cure at 24 months was a secondary efficacy endpoint. 118/126 patients completed the trial. Definitive cure at 12 months was observed in 29% (18/63) patients receiving LAmB and 30% (19/63) receiving LAmB/MF (mITT), increasing to 58% and 66%, respectively, at 24 months. Most lesions had resolved/improved at 12 and 24 months for patients receiving LAmB (90%, 83%) and LAmB/MF (85%, 88%) by qualitative assessment. One death, unrelated to study drugs, was reported; no study drug-related serious adverse events were observed. The most frequent adverse drug reactions were MF-related vomiting and nausea, and LAmB-related hypokalaemia and infusion reactions. Most adverse events were mild; no ocular adverse events occurred. CONCLUSIONS/SIGNIFICANCE Both regimens are suitably safe and efficacious alternatives to long-course MF for PKDL in South Asia. TRIAL REGISTRATION CTRI/2017/04/008421.
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Affiliation(s)
- Shyam Sundar
- Kala-azar Medical Research Center (KARMC), Muzaffarpur, India
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Krishna Pandey
- ICMR-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, (icddrb,b), Dhaka, Bangladesh
| | - Major Madhukar
- ICMR-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Roshan Kamal Topno
- ICMR-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Ashish Kumar
- ICMR-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Vinod Kumar
- ICMR-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | | | - Jaya Chakravarty
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rahul Chaubey
- Kala-azar Medical Research Center (KARMC), Muzaffarpur, India
| | - Poonam Kumari
- Kala-azar Medical Research Center (KARMC), Muzaffarpur, India
| | - Md. Utba Rashid
- International Centre for Diarrhoeal Disease Research, (icddrb,b), Dhaka, Bangladesh
| | - Shomik Maruf
- International Centre for Diarrhoeal Disease Research, (icddrb,b), Dhaka, Bangladesh
| | - Prakash Ghosh
- International Centre for Diarrhoeal Disease Research, (icddrb,b), Dhaka, Bangladesh
| | - Sheeraz Raja
- Drugs for Neglected Diseases initiative, New Delhi, India
| | - Joelle Rode
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | | | - Pradeep Das
- ICMR-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Suman Rijal
- Drugs for Neglected Diseases initiative, New Delhi, India
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
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Rock KS, Chapman LAC, Dobson AP, Adams ER, Hollingsworth TD. The Hidden Hand of Asymptomatic Infection Hinders Control of Neglected Tropical Diseases: A Modeling Analysis. Clin Infect Dis 2024; 78:S175-S182. [PMID: 38662705 PMCID: PMC11045017 DOI: 10.1093/cid/ciae096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Neglected tropical diseases are responsible for considerable morbidity and mortality in low-income populations. International efforts have reduced their global burden, but transmission is persistent and case-finding-based interventions rarely target asymptomatic individuals. METHODS We develop a generic mathematical modeling framework for analyzing the dynamics of visceral leishmaniasis in the Indian sub-continent (VL), gambiense sleeping sickness (gHAT), and Chagas disease and use it to assess the possible contribution of asymptomatics who later develop disease (pre-symptomatics) and those who do not (non-symptomatics) to the maintenance of infection. Plausible interventions, including active screening, vector control, and reduced time to detection, are simulated for the three diseases. RESULTS We found that the high asymptomatic contribution to transmission for Chagas and gHAT and the apparently high basic reproductive number of VL may undermine long-term control. However, the ability to treat some asymptomatics for Chagas and gHAT should make them more controllable, albeit over relatively long time periods due to the slow dynamics of these diseases. For VL, the toxicity of available therapeutics means the asymptomatic population cannot currently be treated, but combining treatment of symptomatics and vector control could yield a quick reduction in transmission. CONCLUSIONS Despite the uncertainty in natural history, it appears there is already a relatively good toolbox of interventions to eliminate gHAT, and it is likely that Chagas will need improvements to diagnostics and their use to better target pre-symptomatics. The situation for VL is less clear, and model predictions could be improved by additional empirical data. However, interventions may have to improve to successfully eliminate this disease.
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Affiliation(s)
- Kat S Rock
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, United Kingdom
- Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Lloyd A C Chapman
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew P Dobson
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
- Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Emily R Adams
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - T Déirdre Hollingsworth
- Nuffield Department of Medicine, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
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Singh-Phulgenda S, Kumar R, Dahal P, Munir A, Rashan S, Chhajed R, Naylor C, Maguire BJ, Siddiqui NA, Harriss E, Rahi M, Alves F, Sundar S, Stepniewska K, Musa A, Guerin PJ, Pandey K. Post-kala-azar dermal leishmaniasis (PKDL) drug efficacy study landscape: A systematic scoping review of clinical trials and observational studies to assess the feasibility of establishing an individual participant-level data (IPD) platform. PLoS Negl Trop Dis 2024; 18:e0011635. [PMID: 38626228 PMCID: PMC11051605 DOI: 10.1371/journal.pntd.0011635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/26/2024] [Accepted: 03/27/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis which can occur after successful treatment of visceral leishmaniasis (VL) and is a public health problem in VL endemic areas. We conducted a systematic scoping review to assess the characteristics of published PKDL clinical studies, understand the scope of research and explore the feasibility and value of developing a PKDL individual patient data (IPD) platform. METHODS A systematic review of published literature was conducted to identify PKDL clinical studies by searching the following databases: PubMed, Scopus, Ovid Embase, Web of Science Core Collection, WHO Global Index Medicus, PASCAL, Clinicaltrials.gov, Ovid Global Health, Cochrane Database and CENTRAL, and the WHO International Clinical Trials Registry Platform. Only prospective studies in humans with PKDL diagnosis, treatment, and follow-up measurements between January 1973 and March 2023 were included. Extracted data includes variables on patient characteristics, treatment regimens, diagnostic methods, geographical locations, efficacy endpoints, adverse events and statistical methodology. RESULTS A total of 3,418 records were screened, of which 56 unique studies (n = 2,486 patients) were included in this review. Out of the 56 studies, 36 (64.3%) were from India (1983-2022), 12 (21.4%) from Sudan (1992-2021), 6 (10.7%) were from Bangladesh (1991-2019), and 2 (3.6%) from Nepal (2001-2007). Five (8.9%) studies were published between 1981-1990 (n = 193 patients), 10 (17.9%) between 1991-2000 (n = 230 patients), 10 (17.9%) between 2001-2010 (n = 198 patients), and 31 (55.4%) from 2011 onwards (n = 1,865 patients). Eight (14.3%) were randomised clinical trials, and 48 (85.7%) were non-randomised studies. The median post-treatment follow-up duration was 365 days (range: 90-540 days) in 8 RCTs and 360 days (range: 28-2,373 days) in 48 non-randomised studies. Disease diagnosis was based on clinical criterion in 3 (5.4%) studies, a mixture of clinical and parasitological methods in 47 (83.9%) and was unclear in 6 (10.7%) studies. Major drugs used for treatment were miltefosine (n = 636 patients), liposomal amphotericin B (L-AmB) (n = 508 patients), and antinomy regimens (n = 454 patients). Ten other drug regimens were tested in 270 patients with less than 60 patients per regimen. CONCLUSIONS Our review identified studies with very limited sample size for the three major drugs (miltefosine, L-AmB, and pentavalent antimony), while the number of patients combined across studies suggest that the IPD platform would be valuable. With the support of relevant stakeholders, the global PKDL community and sufficient financing, a PKDL IPD platform can be realised. This will allow for exploration of different aspects of treatment safety and efficacy, which can potentially guide future healthcare decisions and clinical practices.
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Affiliation(s)
- Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rishikesh Kumar
- ICMR—Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India
| | - Prabin Dahal
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Abdalla Munir
- Department of Clinical Pathology and Immunology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Sumayyah Rashan
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rutuja Chhajed
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Caitlin Naylor
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Brittany J. Maguire
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Niyamat Ali Siddiqui
- ICMR—Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India
| | - Eli Harriss
- The Knowledge Centre, Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Manju Rahi
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Kasia Stepniewska
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ahmed Musa
- Department of Clinical Pathology and Immunology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Philippe J. Guerin
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Krishna Pandey
- ICMR—Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India
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Guha SK, Sardar AA, Saha P, Chatterjee M, Jana K, Samanta A, Maji D, Biswas P, Bhattacharya R, Maji AK. Challenges for maintaining post elimination phase of visceral leishmaniasis control programme in India: A field-based study. PLoS Negl Trop Dis 2024; 18:e0012028. [PMID: 38452055 PMCID: PMC10950250 DOI: 10.1371/journal.pntd.0012028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/19/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND India is going through the maintenance phase of VL elimination programme which may be threatened by the persistence of hidden parasite pools among asymptomatic leishmanial infection (ALI) and PKDL. The present work was designed to determine the burden of VL, PKDL, and ALI and to assess the role of treatment of ALI in maintaining post-elimination phase. METHODS AND FINDING The study was undertaken in Malda district, West Bengal, India during October 2016 to September 2021. Study areas were divided into 'Study' and 'Control' arms. VL and PKDL cases of both the arms were diagnosed by three active mass surveys with an interval of one year and treated as per National guideline. ALI of 'Study' arm was treated like VL. ALI of 'Control' arm was followed up to determine their fate. Fed sand-fly pools were analysed for parasitic DNA. No significant difference was noted between the incidence of VL and PKDL in both the arms. Incidence of ALI declined sharply in 'Study' arm but an increasing trend was observed in 'Control' arm. Significantly higher rate of sero-conversion was noted in 'Control' arm and was found to be associated with untreated ALI burden. Parasitic DNA was detected in 22.8% ALI cases and 2.2% sand-fly pools. CONCLUSION Persistence of a significant number of PKDL and ALI and ongoing transmission, as evidenced by new infection and detection of leishmanial DNA in vector sand-flies, may threaten the maintenance of post-elimination phase. Emphasis should be given for elimination of pathogen to prevent resurgence of VL epidemics.
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Affiliation(s)
| | - Ashif Ali Sardar
- Department of Microbiology, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Pabitra Saha
- Department of Microbiology, School of Tropical Medicine, Kolkata, West Bengal, India
- Department of Zoology, P. R. Thakur Govt. College, Thakurnagar, West Bengal, India
| | - Moytrey Chatterjee
- Department of Microbiology, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Kingsuk Jana
- Department of Microbiology, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Anwesha Samanta
- Department of Microbiology, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Dipankar Maji
- Department of Health and Family Welfare, Government of West Bengal, Swasthya Bhavan, Kolkata, West Bengal, India
| | - Prasanta Biswas
- Department of Health and Family Welfare, Government of West Bengal, Swasthya Bhavan, Kolkata, West Bengal, India
| | - Rahul Bhattacharya
- Department of Statistics, University of Calcutta, Kolkata, West Bengal, India
| | - Ardhendu Kumar Maji
- Department of Microbiology, School of Tropical Medicine, Kolkata, West Bengal, India
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19
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Subramanian S, Maheswari RU, Prabavathy G, Khan MA, Brindha B, Srividya A, Kumar A, Rahi M, Nightingale ES, Medley GF, Cameron MM, Roy N, Jambulingam P. Modelling spatiotemporal patterns of visceral leishmaniasis incidence in two endemic states in India using environment, bioclimatic and demographic data, 2013-2022. PLoS Negl Trop Dis 2024; 18:e0011946. [PMID: 38315725 PMCID: PMC10868833 DOI: 10.1371/journal.pntd.0011946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 02/15/2024] [Accepted: 01/26/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND As of 2021, the National Kala-azar Elimination Programme (NKAEP) in India has achieved visceral leishmaniasis (VL) elimination (<1 case / 10,000 population/year per block) in 625 of the 633 endemic blocks (subdistricts) in four states. The programme needs to sustain this achievement and target interventions in the remaining blocks to achieve the WHO 2030 target of VL elimination as a public health problem. An effective tool to analyse programme data and predict/ forecast the spatial and temporal trends of VL incidence, elimination threshold, and risk of resurgence will be of use to the programme management at this juncture. METHODOLOGY/PRINCIPAL FINDINGS We employed spatiotemporal models incorporating environment, climatic and demographic factors as covariates to describe monthly VL cases for 8-years (2013-2020) in 491 and 27 endemic and non-endemic blocks of Bihar and Jharkhand states. We fitted 37 models of spatial, temporal, and spatiotemporal interaction random effects with covariates to monthly VL cases for 6-years (2013-2018, training data) using Bayesian inference via Integrated Nested Laplace Approximation (INLA) approach. The best-fitting model was selected based on deviance information criterion (DIC) and Watanabe-Akaike Information Criterion (WAIC) and was validated with monthly cases for 2019-2020 (test data). The model could describe observed spatial and temporal patterns of VL incidence in the two states having widely differing incidence trajectories, with >93% and 99% coverage probability (proportion of observations falling inside 95% Bayesian credible interval for the predicted number of VL cases per month) during the training and testing periods. PIT (probability integral transform) histograms confirmed consistency between prediction and observation for the test period. Forecasting for 2021-2023 showed that the annual VL incidence is likely to exceed elimination threshold in 16-18 blocks in 4 districts of Jharkhand and 33-38 blocks in 10 districts of Bihar. The risk of VL in non-endemic neighbouring blocks of both Bihar and Jharkhand are less than 0.5 during the training and test periods, and for 2021-2023, the probability that the risk greater than 1 is negligible (P<0.1). Fitted model showed that VL occurrence was positively associated with mean temperature, minimum temperature, enhanced vegetation index, precipitation, and isothermality, and negatively with maximum temperature, land surface temperature, soil moisture and population density. CONCLUSIONS/SIGNIFICANCE The spatiotemporal model incorporating environmental, bioclimatic, and demographic factors demonstrated that the KAMIS database of the national programmme can be used for block level predictions of long-term spatial and temporal trends in VL incidence and risk of outbreak / resurgence in endemic and non-endemic settings. The database integrated with the modelling framework and a dashboard facility can facilitate such analysis and predictions. This could aid the programme to monitor progress of VL elimination at least one-year ahead, assess risk of resurgence or outbreak in post-elimination settings, and implement timely and targeted interventions or preventive measures so that the NKAEP meet the target of achieving elimination by 2030.
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Affiliation(s)
| | | | | | | | - Balan Brindha
- ICMR-Vector Control Research Centre, Indira Nagar, Puducherry, India
| | | | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Indira Nagar, Puducherry, India
| | - Manju Rahi
- ICMR-Vector Control Research Centre, Indira Nagar, Puducherry, India
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Emily S Nightingale
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mary M Cameron
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nupur Roy
- National Centre for Vector-Borne Diseases Control, Ministry of Health and Family Welfare, Government of India, New Delhi
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20
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Shaw JJ, Marinho-Júnior JF, Courtenay O, Brandão-Filho SP. Assessing reservoir host status in leishmaniasis with special reference to the infectiousness of Leishmania (Viannia) braziliensis infections in wild rodents. Rev Soc Bras Med Trop 2023; 56:0503. [PMID: 38126376 PMCID: PMC10726968 DOI: 10.1590/0037-8682-0503-2023] [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: 10/26/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Molecular methods have been responsible for a notable increase in the detection of Leishmaniinae infections in wild animals. Determining their infectiousness is of paramount importance in evaluating their epidemiological significance. One of the most efficient ways of determining infectiousness for vector borne diseases is xenodiagnosis with the appropriate vector. However, this is logistically very difficult to accomplish in the field, and an ideal solution is to find a molecular surrogate for xenodiagnosis. In this review we discuss different approaches to the problem by focusing on the infectiousness of Leishmania (Viannia) braziliensis in rodents under laboratory and field conditions. Comparisons with similar studies for other Leishmania species emphasizes that there are pivotal differences in the infectiousness and the importance of asymptomatic infections in different hosts. Potentially the most promising surrogate is the real time quantitative PCR (qPCR). However, its success depends on choosing a tissue that relates to the vector's feeding location and the parasite's tissue tropism. This requires detailed knowledge of the infection of each species in its wild hosts. We conclude that for L. (V.) braziliensis infections in wild rodents the tissue of choice for a molecular xenodiagnostic test, based on the qPCR is blood, providing that a significant number of samples must be examined.
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Affiliation(s)
- Jeffrey J. Shaw
- Universidade de São Paulo, Instituto de Ciências Biomédicas, Departamento de Parasitologia, São Paulo, SP, Brasil. Universidade de São PauloInstituto de Ciências BiomédicasDepartamento de ParasitologiaSão PauloSPBrasil
| | - José F. Marinho-Júnior
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Recife, PE, Brasil. Fundação Oswaldo CruzInstituto Aggeu MagalhãesRecifePEBrasil
| | - Orin Courtenay
- University of Warwick, School of Life Sciences and the Zeeman Institute, Coventry, United Kingdom.University of WarwickSchool of Life Sciences and the Zeeman InstituteCoventryUnited Kingdom
| | - Sinval P. Brandão-Filho
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Recife, PE, Brasil. Fundação Oswaldo CruzInstituto Aggeu MagalhãesRecifePEBrasil
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21
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Ghosh D, Rashid MU, Sagar SK, Uddin MR, Maruf S, Ghosh P, Chowdhury R, Rahat MA, Islam MN, Aktaruzzaman MM, Sohel ANM, Banjara MR, Kroeger A, Aseffa A, Mondal D. Epidemiological, serological, and entomological aspects of visceral leishmaniasis (VL) in suspected new VL foci in Bangladesh. Acta Trop 2023; 248:107021. [PMID: 37716668 DOI: 10.1016/j.actatropica.2023.107021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 09/13/2023] [Indexed: 09/18/2023]
Abstract
The study aimed to explore epidemiological, serological, and entomological aspects of visceral leishmaniasis (VL) in suspected new VL foci and assess the knowledge, attitude, and practices of the community living in the alleged new VL foci. The study investigated new visceral leishmaniasis (VL) cases reported between 2019 and 2020 in four sub-districts (Dharmapasha, Hakimpur, Islampur and Savar) where we tested 560 members using the rK39 rapid test and conducted vector collections in six neighbouring houses of the index cases to assess sandfly density and distribution, examined sandflies' infection, and determined the spatial relationship with VL infection. Furthermore, we highlighted the importance of early detection, and community awareness in controlling the spread of the disease. The study screened 1078 people from 231 households in the four sub-districts for fever, history of visceral leishmaniasis (VL), and PKDL-like skin lesions. Among sub-districts, positivity rate for rK39 rapid test was highest (3.5 %) in Savar. Sandflies were present across all areas except in Dharmapasha, but all 21 collected female P. argentipes sandflies were negative for Leishmania parasite DNA. We found one person from Islampur with a history of VL, and one from Islampur and another one from Savar had PKDL. After the awareness intervention, more people became familiar with VL infection (91.2 %), and their knowledge concerning sandflies being the vector of the disease and the risk of having VL increased significantly (30.1 %). The study found no active case in the suspected new foci, but some asymptomatic individuals were present. As sandfly vectors exist in these areas, the National Kala-azar Elimination Programme (NKEP) should consider these areas as kala-azar endemic and initiate control activities as per national guidelines.
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Affiliation(s)
- Debashis Ghosh
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Md Utba Rashid
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Soumik Kha Sagar
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Md Rasel Uddin
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Shomik Maruf
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Prakash Ghosh
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Rajashree Chowdhury
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Md Abu Rahat
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Md Nazmul Islam
- Communicable Disease Control (CDC), Directorate General of Health Services (DGHS), Mohakhali, Dhaka 1212, Bangladesh
| | - M M Aktaruzzaman
- Communicable Disease Control (CDC), Directorate General of Health Services (DGHS), Mohakhali, Dhaka 1212, Bangladesh
| | - Abu Nayeem Mohammad Sohel
- Communicable Disease Control (CDC), Directorate General of Health Services (DGHS), Mohakhali, Dhaka 1212, Bangladesh
| | - Megha Raj Banjara
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland; Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Axel Kroeger
- University of Freiburg, Centre for Medicine and Society, Freiburg, Germany
| | - Abraham Aseffa
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Dinesh Mondal
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh.
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22
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Jyotisha, Qureshi R, Qureshi IA. Development of a multi-epitope vaccine candidate for leishmanial parasites applying immunoinformatics and in vitro approaches. Front Immunol 2023; 14:1269774. [PMID: 38035118 PMCID: PMC10684680 DOI: 10.3389/fimmu.2023.1269774] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Leishmaniasis is a neglected tropical disease, and its severity necessitates the development of a potent and efficient vaccine for the disease; however, no human vaccine has yet been approved for clinical use. This study aims to design and evaluate a multi-epitope vaccine against the leishmanial parasite by utilizing helper T-lymphocyte (HTL), cytotoxic T-lymphocyte (CTL), and linear B-lymphocyte (LBL) epitopes from membrane-bound acid phosphatase of Leishmania donovani (LdMAcP). The designed multi-epitope vaccine (LdMAPV) was highly antigenic, non-allergenic, and non-toxic, with suitable physicochemical properties. The three-dimensional structure of LdMAPV was modeled and validated, succeeded by molecular docking and molecular dynamics simulation (MDS) studies that confirmed the high binding affinity and stable interactions between human toll-like receptors and LdMAPV. In silico disulfide engineering provided improved stability to LdMAPV, whereas immune simulation displayed the induction of both immune responses, i.e., antibody and cell-mediated immune responses, with a rise in cytokines. Furthermore, LdMAPV sequence was codon optimized and cloned into the pET-28a vector, followed by its expression in a bacterial host. The recombinant protein was purified using affinity chromatography and subjected to determine its effect on cytotoxicity, cytokines, and nitric oxide generation by mammalian macrophages. Altogether, this report provides a multi-epitope vaccine candidate from a leishmanial protein participating in parasitic virulence that has shown its potency to be a promising vaccine candidate against leishmanial parasites.
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Affiliation(s)
- Jyotisha
- Department of Biotechnology & Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, India
| | - Rahila Qureshi
- Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Insaf Ahmed Qureshi
- Department of Biotechnology & Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, India
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23
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Kaye PM, Matlashewski G, Mohan S, Le Rutte E, Mondal D, Khamesipour A, Malvolti S. Vaccine value profile for leishmaniasis. Vaccine 2023; 41 Suppl 2:S153-S175. [PMID: 37951693 DOI: 10.1016/j.vaccine.2023.01.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/22/2022] [Accepted: 01/24/2023] [Indexed: 11/14/2023]
Abstract
Leishmania infections are global, occurring in 98 countries and all World Health Organization (WHO) regions with 600 million to 1 billion people at risk of infection. Visceral leishmaniasis is associated with almost 20,000 reported deaths annually, with children under 5 years of age being at the greatest risk of mortality. Amongst WHO-recognised Neglected Tropical Diseases (NTDs), leishmaniasis is one of the most important in terms of mortality and morbidity. With an increasing global burden of disease and a growing threat from climate change, urbanisation and drug resistance, there remains an imperative to develop leishmaniasis vaccines. New tools to understand correlates of protection and to assess vaccine efficacy are being developed to ease the transition into larger scale efficacy trials or provide alternate routes to licensure. Early indications suggest a diverse portfolio of manufacturers exists in endemic countries with an appetite to develop leishmaniasis vaccines. This Vaccine Value Profile (VVP) provides a high-level, comprehensive assessment of the currently available data to inform the potential public health, economic, and societal value of leishmaniasis vaccines. The leishmaniasis VVP was developed by a working group of subject matter experts from academia, public health groups, policy organizations, and non-profit organizations. All contributors have extensive expertise on various elements of the leishmaniasis VVP and have collectively described the state of knowledge and identified the current gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Paul M Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, York, UK.
| | - Greg Matlashewski
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada.
| | - Sakshi Mohan
- Center for Health Economics (CHE), University of York, York, UK.
| | - Epke Le Rutte
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Dinesh Mondal
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
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Younis BM, Mudawi Musa A, Monnerat S, Abdelrahim Saeed M, Awad Gasim Khalil E, Elbashir Ahmed A, Ahmed Ali M, Noureldin A, Muthoni Ouattara G, Nyakaya GM, Teshome S, Omollo T, Ochieng M, Egondi T, Mmbone M, Chu WY, Dorlo TPC, Zijlstra EE, Wasunna M, Alvar J, Alves F. Safety and efficacy of paromomycin/miltefosine/liposomal amphotericin B combinations for the treatment of post-kala-azar dermal leishmaniasis in Sudan: A phase II, open label, randomized, parallel arm study. PLoS Negl Trop Dis 2023; 17:e0011780. [PMID: 37988402 PMCID: PMC10721181 DOI: 10.1371/journal.pntd.0011780] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/14/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Treatment for post-kala-azar dermal leishmaniasis (PKDL) in Sudan is currently recommended only for patients with persistent or severe disease, mainly because of the limitations of current therapies, namely toxicity and long hospitalization. We assessed the safety and efficacy of miltefosine combined with paromomycin and liposomal amphotericin B (LAmB) for the treatment of PKDL in Sudan. METHODOLOGY/PRINCIPAL FINDINGS An open-label, phase II, randomized, parallel-arm, non-comparative trial was conducted in patients with persistent (stable or progressive disease for ≥ 6 months) or grade 3 PKDL, aged 6 to ≤ 60 years in Sudan. The median age was 9.0 years (IQR 7.0-10.0y) and 87% of patients were ≤12 years old. Patients were randomly assigned to either daily intra-muscular paromomycin (20mg/kg, 14 days) plus oral miltefosine (allometric dose, 42 days)-PM/MF-or LAmB (total dose of 20mg/kg, administered in four injections in week one) and oral miltefosine (allometric dose, 28 days)-LAmB/MF. The primary endpoint was a definitive cure at 12 months after treatment onset, defined as clinical cure (100% lesion resolution) and no additional PKDL treatment between end of therapy and 12-month follow-up assessment. 104/110 patients completed the trial. Definitive cure at 12 months was achieved in 54/55 (98.2%, 95% CI 90.3-100) and 44/55 (80.0%, 95% CI 70.2-91.9) of patients in the PM/MF and AmB/MF arms, respectively, in the mITT set (all randomized patients receiving at least one dose of treatment; in case of error of treatment allocation, the actual treatment received was used in the analysis). No SAEs or deaths were reported, and most AEs were mild or moderate. At least one adverse drug reaction (ADR) was reported in 13/55 (23.6%) patients in PM/MF arm and 28/55 (50.9%) in LAmB/MF arm, the most frequent being miltefosine-related vomiting and nausea, and LAmB-related hypokalaemia; no ocular or auditory ADRs were reported. CONCLUSIONS/SIGNIFICANCE The PM/MF regimen requires shorter hospitalization than the currently recommended 60-90-day treatment, and is safe and highly efficacious, even for patients with moderate and severe PKDL. It can be administered at primary health care facilities, with LAmB/MF as a good alternative. For future VL elimination, we need new, safe oral therapies for all patients with PKDL. TRIAL REGISTRATION ClinicalTrials.gov NCT03399955, https://clinicaltrials.gov/study/NCT03399955 ClinicalTrials.gov ClinicalTrials.gov.
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Affiliation(s)
- Brima Musa Younis
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Ahmed Mudawi Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | | | | | | | - Mujahid Ahmed Ali
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Ali Noureldin
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | | | | | | | | | | | | | - Wan-Yu Chu
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | - Jorge Alvar
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
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Singh AK, de Gooyer T, Singh OP, Pandey S, Neyaz A, Cloots K, Kansal S, Malaviya P, Rai M, Nylén S, Chakravarty J, Hasker E, Sundar S. Wuchereria bancrofti infection is associated with progression to clinical visceral leishmaniasis in VL- endemic areas in Muzaffarpur, Bihar, India. PLoS Negl Trop Dis 2023; 17:e0011729. [PMID: 37903175 PMCID: PMC10635566 DOI: 10.1371/journal.pntd.0011729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 11/09/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Co-endemicity of neglected tropical diseases (NTDs) necessitates that these diseases should be considered concomitantly to understand the relationship between pathology and to support disease management and control programs. The aims of the study were to assess the prevalence of filarial infection in asymptomatic Leishmania donovani infected individuals and the correlation of Wuchereria bancrofti infection with progression to clinical visceral leishmaniasis (VL) in Bihar, India. METHODOLOGY/PRINCIPAL FINDINGS Within the Muzaffarpur-TMRC Health and Demographic Surveillance System (HDSS) area, a cohort of Leishmania seropositive (n = 476) or seronegative individuals (n = 1130) were sampled annually for three years for filarial infection and followed for progression to clinical VL. To corroborate the results from the cohort study, we also used a retrospective case-control study of 36 VL cases and 71 controls selected from a subset of the HDSS population to investigate the relationship between progression to clinical VL and the prevalence of filarial infection at baseline. Our findings suggest a higher probability of progression to clinical VL in individuals with a history of filarial infection: in both the cohort and case-control studies, progression to clinical VL was higher among filaria infected individuals (RR = 2.57, p = 0.056, and OR = 2.52, p = 0.046 respectively). CONCLUSION This study describes that progression to clinical VL disease is associated with serological evidence of prior infection with W. bancrofti. The integration of disease programs for Leishmania and lymphatic filariasis extend beyond the relationship of sequential or co-infection with disease burden. To ensure elimination targets can be reached and sustained, we suggest areas of co-endemicity would benefit from overlapping vector control activities, health system networks and surveillance infrastructure.
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Affiliation(s)
- Abhishek Kumar Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Tanyth de Gooyer
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Om Prakash Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Department of Biochemistry, Institute of Sciences, Banaras Hindu University, Varanasi, India
| | - Sundaram Pandey
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Aziza Neyaz
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Kristien Cloots
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sangeeta Kansal
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Paritosh Malaviya
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Madhukar Rai
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Susanne Nylén
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solna, Sweden
| | - Jaya Chakravarty
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Pierneef L, Malaviya P, van Hooij A, Sundar S, Singh AK, Kumar R, de Jong D, Meuldijk M, Kumar A, Zhou Z, Cloots K, Corstjens P, Hasker E, Geluk A. Field-friendly anti-PGL-I serosurvey in children to monitor Mycobacterium leprae transmission in Bihar, India. Front Med (Lausanne) 2023; 10:1260375. [PMID: 37828950 PMCID: PMC10565223 DOI: 10.3389/fmed.2023.1260375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
Background It has been amply described that levels of IgM antibodies against Mycobacterium leprae (M. leprae) phenolic glycolipid I (PGL-I) correlate strongly with the bacterial load in an infected individual. These findings have generated the concept of using seropositivity for antibodies against M. leprae PGL-I as an indicator of the proportion of the population that has been infected. Although anti-PGL-I IgM levels provide information on whether an individual has ever been infected, their presence cannot discriminate between recent and past infections. Since infection in (young) children by definition indicates recent transmission, we piloted the feasibility of assessment of anti-PGL-I IgM seroprevalence among children in a leprosy endemic area in India as a proxy for recent M. leprae transmission. Material and methods A serosurvey for anti-PGL-I IgM antibodies among children in highly leprosy endemic villages in Bihar, India, was performed, applying the quantitative anti-PGL-I UCP-LFA cassette combined with low-invasive, small-volume fingerstick blood (FSB). Results Local staff obtained FSB of 1,857 children (age 3-11 years) living in 12 leprosy endemic villages in Bihar; of these, 215 children (11.58%) were seropositive for anti-PGL-I IgM. Conclusion The anti-PGL-I seroprevalence level of 11.58% among children corresponds with the seroprevalence levels described in studies in other leprosy endemic areas over the past decades where no prophylactic interventions have taken place. The anti-PGL-I UCP-LFA was found to be a low-complexity tool that could be practically combined with serosurveys and was well-accepted by both healthcare staff and the population. On route to leprosy elimination, quantitative anti-PGL-I serology in young children holds promise as a strategy to monitor recent M. leprae transmission in an area.
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Affiliation(s)
- Louise Pierneef
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Paritosh Malaviya
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anouk van Hooij
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Abhishek Kumar Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rajiv Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Danielle de Jong
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Maaike Meuldijk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Awnish Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Zijie Zhou
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Kristien Cloots
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Paul Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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Kumar A, Singh VK, Tiwari R, Madhukar P, Rajneesh, Kumar S, Gautam V, Engwerda C, Sundar S, Kumar R. Post kala-azar dermal leishmaniasis in the Indian sub-continent: challenges and strategies for elimination. Front Immunol 2023; 14:1236952. [PMID: 37638047 PMCID: PMC10451093 DOI: 10.3389/fimmu.2023.1236952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Visceral leishmaniasis (VL) is a severe and often fatal form of leishmaniasis caused by Leishmania donovani in the Indian sub-continent. Post Kala-azar Dermal Leishmaniasis (PKDL) is a late cutaneous manifestation of VL, typically occurring after apparent cure of VL, but sometimes even without a prior history of VL in India. PKDL serves as a significant yet neglected reservoir of infection and plays a crucial role in the transmission of the disease, posing a serious threat to the VL elimination program in the Indian sub-continent. Therefore, the eradication of PKDL should be a priority within the current VL elimination program aimed at achieving a goal of less than 1 case per 10,000 in the population at the district or sub-district levels of VL endemic areas. To accomplish this, a comprehensive understanding of the pathogenesis of PKDL is essential, as well as developing strategies for disease management. This review provides an overview of the current status of diagnosis and treatment options for PKDL, highlighting our current knowledge of the immune responses underlying disease development and progression. Additionally, the review discusses the impact of PKDL on elimination programs and propose strategies to overcome this challenge and achieve the goal of elimination. By addressing the diagnostic and therapeutic gaps, optimizing surveillance and control measures, and implementing effective intervention strategies, it is possible to mitigate the burden of PKDL and facilitate the successful elimination of VL in the Indian sub-continent.
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Affiliation(s)
- Awnish Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Vishal Kumar Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rahul Tiwari
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Prasoon Madhukar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rajneesh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shashi Kumar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Vibhav Gautam
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Christian Engwerda
- Immunology and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rajiv Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Sundar S, Singh J, Dinkar A, Agrawal N. Safety and Effectiveness of Miltefosine in Post-Kala-Azar Dermal Leishmaniasis: An Observational Study. Open Forum Infect Dis 2023; 10:ofad231. [PMID: 37234513 PMCID: PMC10205550 DOI: 10.1093/ofid/ofad231] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Background Post-kala-azar dermal leishmaniasis (PKDL) is a dermal complication of visceral leishmaniasis. Oral miltefosine (MF) is the first-line treatment for PKDL patients in South Asia. This study assessed the safety and effectiveness of MF therapy after 12 months of follow-up to explore more precise data. Methods In this observational study, 300 confirmed PKDL patients were enrolled. MF with the usual dose was administered to all patients for 12 weeks and followed up for 1 year. Clinical evolution was recorded systematically by photographs at screening and at 12 weeks, 6 months, and 12 months after treatment onset. Definitive cure consisted of disappearance of skin lesions with a negative PCR at 12 weeks or with >70% of lesions, disappearing or fading at 12-month follow-up. Patients with reappearing clinical features and any positive diagnostics of PKDL during the follow-up were considered as nonresponsive. Results Among 300 patients, 286 (95.3%) completed 12 weeks of treatment. The per-protocol cure rate at 12 months was 97%, but 7 patients relapsed and 51 (17%) were lost to 12-month follow-up, resulting in a final cure rate of only 76%. Eye-related adverse events were noted in 11 (3.7%) patients and resolved in most (72.7%) within 12 months. Unfortunately, 3 patients had persistent partial vision loss. Mild to moderate gastrointestinal side effects were seen in 28% patients. Conclusions Moderate effectiveness of MF was observed in the present study. A significant number of patients developed ocular complications, and thus MF for treatment for PKDL should be suspended and replaced with a safer alternative regimen.
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Affiliation(s)
- Shyam Sundar
- Correspondence: Shyam Sundar, MD, Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India (); Jitendra Singh, MD, Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India ()
| | - Jitendra Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anju Dinkar
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Takele Y, Mulaw T, Adem E, Womersley R, Kaforou M, Franssen SU, Levin M, Taylor GP, Müller I, Cotton JA, Kropf P. Recurrent visceral leishmaniasis relapses in HIV co-infected patients are characterized by less efficient immune responses and higher parasite load. iScience 2023; 26:105867. [PMID: 36685039 PMCID: PMC9845767 DOI: 10.1016/j.isci.2022.105867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Visceral leishmaniasis (VL) and HIV co-infection (VL/HIV) has emerged as a significant public health problem in Ethiopia, with up to 30% of patients with VL co-infected with HIV. These patients suffer from recurrent VL relapses and increased mortality. Those with a previous history of VL relapses (recurrent VL/HIV) experience increased VL relapses as compared to patients with HIV presenting with their first episode of VL (primary VL/HIV). Our aim was to identify drivers that account for the higher rate of VL relapses in patients with recurrent VL/HIV (n = 28) as compared to primary VL/HIV (n = 21). Our results show that the relapse-free survival in patients with recurrent VL/HIV was shorter, that they had higher parasite load, lower weight gain, and lower recovery of all blood cell lineages. Their poorer prognosis was characterized by lower production of IFN-gamma, lower CD4+ T cell counts, and higher expression of programmed cell death protein 1 (PD1) on T cells.
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Affiliation(s)
- Yegnasew Takele
- Department of Infectious Disease, Imperial College London, London, UK
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Tadele Mulaw
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Emebet Adem
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Rebecca Womersley
- Department of Infectious Disease, Imperial College London, London, UK
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Michael Levin
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Ingrid Müller
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Pascale Kropf
- Department of Infectious Disease, Imperial College London, London, UK
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Li Z, Fang Y, Zhang Y, Zhou X. RNA-seq analysis of differentially expressed LncRNAs from leishmaniasis patients compared to uninfected humans. Acta Trop 2023; 238:106738. [PMID: 36379256 DOI: 10.1016/j.actatropica.2022.106738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/02/2022] [Accepted: 10/31/2022] [Indexed: 11/14/2022]
Abstract
Leishmaniasis is a parasitic disease that seriously endangers human health. Furthermore, among the parasitic diseases, leishmaniasis is the third most common cause of death after malaria and schistosomiasis. However, the potential function of LncRNAs in leishmaniasis remain unclear. This study aimed to explore the differentially expressed LncRNAs in leishmaniasis. The sera of leishmaniasis patients and uninfected persons for controls were obtained and analyzed by high-throughput sequencing. Moreover, the expression of key LncRNAs was detected by qPCR. The results showed that 970 differentially expressed LncRNAs and 1692 differentially expressed mRNAs were screened compared to control groups. Then, 520 target genes were identified by using bioinformation analysis and the ENCORI database. The bioinformatics analysis revealed that the differentially expressed target genes were enriched in autophagy animal, FoxO signaling pathway, mTOR signaling pathway, and apoptosis, et al. Among those differentially expressed LncRNAs, nine key LncRNAs were selected (MALAT1, NUTM2A-AS1, and LINC00963 had high expression; LINC00622, MAPKAPK5-AS1, LINC02289, XPC-AS1, ZFAS1 and SNHG5 had low expression) by qPCR. This study suggests that different expressions of LncRNAs may involve in the potential function in leishmaniasis and provide a novel insight for diagnosis of this zoonotic disease.
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Affiliation(s)
- Zhongqiu Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai 200025, China
| | - Yuan Fang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai 200025, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yi Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai 200025, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Xiaonong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai 200025, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Dial NJ, Croft SL, Chapman LAC, Terris-Prestholt F, Medley GF. Challenges of using modelling evidence in the visceral leishmaniasis elimination programme in India. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001049. [PMID: 36962829 PMCID: PMC10021829 DOI: 10.1371/journal.pgph.0001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/25/2022] [Indexed: 06/18/2023]
Abstract
As India comes closer to the elimination of visceral leishmaniasis (VL) as a public health problem, surveillance efforts and elimination targets must be continuously revised and strengthened. Mathematical modelling is a compelling research discipline for informing policy and programme design in its capacity to project incidence across space and time, the likelihood of achieving benchmarks, and the impact of different interventions. To gauge the extent to which modelling informs policy in India, this qualitative analysis explores how and whether policy makers understand, value, and reference recently produced VL modelling research. Sixteen semi-structured interviews were carried out with both users- and producers- of VL modelling research, guided by a knowledge utilisation framework grounded in knowledge translation theory. Participants reported that barriers to knowledge utilisation include 1) scepticism that models accurately reflect transmission dynamics, 2) failure of modellers to apply their analyses to specific programme operations, and 3) lack of accountability in the process of translating knowledge to policy. Political trust and support are needed to translate knowledge into programme activities, and employment of a communication intermediary may be a necessary approach to improve this process.
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Affiliation(s)
- Natalie J. Dial
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon L. Croft
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lloyd A. C. Chapman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graham F. Medley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Livestock and rodents within an endemic focus of Visceral Leishmaniasis are not reservoir hosts for Leishmania donovani. PLoS Negl Trop Dis 2022; 16:e0010347. [PMID: 36264975 PMCID: PMC9624431 DOI: 10.1371/journal.pntd.0010347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/01/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Leishmaniasis on the Indian subcontinent is thought to have an anthroponotic transmission cycle. There is no direct evidence that a mammalian host other than humans can be infected with Leishmania donovani and transmit infection to the sand fly vector. The aim of the present study was to evaluate the impact of sand fly feeding on other domestic species and provide clinical evidence regarding possible non-human reservoirs through experimental sand fly feeding on cows, water buffalo goats and rodents. We performed xenodiagnosis using colonized Phlebotomus argentipes sand flies to feed on animals residing in villages with active Leishmania transmission based on current human cases. Xenodiagnoses on mammals within the endemic area were performed and blood-fed flies were analyzed for the presence of Leishmania via qPCR 48hrs after feeding. Blood samples were also collected from these mammals for qPCR and serology. Although we found evidence of Leishmania infection within some domestic mammals, they were not infectious to vector sand flies. Monitoring infection in sand flies and non-human blood meal sources in endemic villages leads to scientific proof of exposure and parasitemia in resident mammals. Lack of infectiousness of these domestic mammals to vector sand flies indicates that they likely play no role, or a very limited role in Leishmania donovani transmission to people in Bihar. Therefore, a surveillance system in the peri-/post-elimination phase of visceral leishmaniasis (VL) must monitor absence of transmission. Continued surveillance of domestic mammals in outbreak villages is necessary to ensure that a non-human reservoir is not established, including domestic mammals not present in this study, specifically dogs.
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Mahajan R, Owen SI, Kumar S, Pandey K, Kazmi S, Kumar V, Adams ER, Harshana A, Burza S. Prevalence and determinants of asymptomatic Leishmania infection in HIV-infected individuals living within visceral leishmaniasis endemic areas of Bihar, India. PLoS Negl Trop Dis 2022; 16:e0010718. [PMID: 36040931 PMCID: PMC9467307 DOI: 10.1371/journal.pntd.0010718] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/12/2022] [Accepted: 08/05/2022] [Indexed: 11/22/2022] Open
Abstract
People living with HIV (PLHIV) have an increased risk of developing visceral leishmaniasis (VL) and poor outcomes compared to HIV negative individuals. Here, we aim to establish the prevalence and determinants of asymptomatic Leishmania infection (ALI) in a cohort of PLHIV in Bihar, India. We hoped to evaluate optimal diagnostic algorithms to detect ALI in PLHIV. We conducted a cross-sectional survey of PLHIV ≥18 years of age with no history or current diagnosis of VL or post kala-azar dermal leishmaniasis (PKDL) at anti-retroviral therapy centres within VL endemic districts of Bihar. ALI was defined as a positive rK39 enzyme-linked immunosorbent assay (ELISA), rK39 rapid diagnostic test (RDT) and/or quantitative polymerase chain reaction (qPCR). Additionally, the urinary Leishmania antigen ELISA was evaluated. Determinants for ALI were established using logistic regression and agreement between diagnostic tests calculated using Cohen’s Kappa. A total of 1,296 PLHIV enrolled in HIV care, 694 (53.6%) of whom were female and a median age of 39 years (interquartile range 33–46), were included in the analysis. Baseline prevalence of ALI was 7.4% (n = 96). All 96 individuals were positive by rK39 ELISA, while 0.5% (n = 6) and 0.4% (n = 5) were positive by qPCR and rK39 RDT, respectively. Negligible or weak agreement was seen between assays. Independent risk factors for ALI were CD4 counts <100 (OR 3.1; 95% CI 1.2–7.6) and CD4 counts 100–199 (OR = 2.1;95% CI:1.1–4.0) compared to CD4 counts ≥300, and a household size ≥5 (OR = 1.9;95% CI:1.1–3.1). A total of 2.2% (n = 28) participants were positive by Leishmania antigen ELISA, detecting 20 additional participants to the asymptomatic cohort. Prevalence of ALI in PLHIV in VL endemic villages in Bihar was relatively high. Using the Leishmania antigen ELISA, prevalence increased to 9.0%. Patients with low CD4 counts and larger household size were found to have significantly higher risk of ALI. Trial Registration: Clinical Trial Registration CTRI/2017/03/008120. People living with HIV (PLHIV) are more likely to develop visceral leishmaniasis (VL) and are more likely to have poor outcomes associated with VL-HIV coinfection than HIV-negative individuals. While an estimated 3–14% of immunocompetent individuals living in endemic areas show serological evidence of asymptomatic infection with VL, such data on Leishmania infection in PLHIV in India are lacking. As such we sought to establish the prevalence and determinants of asymptomatic Leishmania infection (ALI) in PLHIV in VL endemic districts of Bihar, India using a combination of molecular and serological assays. We further expand our definition of ALI to include the urinary Leishmania antigen ELISA. The prevalence of ALI in a population of PLHIV residing in VL endemic districts of Bihar, India was found to be as high as 9.0% (n = 116). The majority of individuals were detected by the rK39 enzyme-linked immunosorbent assay (ELISA) (7.4%, n = 96), and very few individuals were detected by quantitative polymerase chain reaction (qPCR) (0.5%, n = 6) or the rK39 rapid diagnostic test (RDT) (0.4%, n = 5). In total, 2.2% (n = 28) were positive by urinary Leishmania antigen ELISA. Low CD4 counts and larger household size were found to be risk factors for ALI. Here, we add to the evidence base for Leishmania-HIV coinfection on the Indian subcontinent.
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Affiliation(s)
| | - Sophie I. Owen
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Shiril Kumar
- Rajendra Memorial Research Institute of Medical Science, Patna, Bihar, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Science, Patna, Bihar, India
| | | | | | - Emily R. Adams
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Sakib Burza
- Médecins Sans Frontières, New Delhi, India
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review. Pathogens 2022; 11:pathogens11080921. [PMID: 36015042 PMCID: PMC9415673 DOI: 10.3390/pathogens11080921] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Leishmaniases are human and animal parasitic diseases transmitted by phlebotomine sand flies. Globalization is an important driver of the burden and in the current dynamics of these diseases. A systematic review of articles published between 2000 and 2021 was conducted using the PubMed search engine to identify the epidemiology and clinical management of imported human leishmaniases as a fundamental step to better manage individual cases and traveler and migrant health from a global perspective. A total of 275 articles were selected, representing 10,341 human imported cases. Identified drivers of changing patterns in epidemiology include conflict and war, as well as host factors, such as immunosuppression, natural and iatrogenic. Leishmania species diversity associated with different clinical presentations implies diagnostic and treatment strategies often complex to select and apply, especially in non-endemic settings. Thus, diagnostic and management algorithms for medical clinical decision support are proposed. Increased surveillance of non-endemic cases, whether in vulnerable populations such as refugees/migrants and immunocompromised individuals or travelers, could improve individual health and mitigate the public health risk of introducing Leishmania species into new areas.
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Expression Profile Analysis of Circular RNAs in Leishmaniasis. Trop Med Infect Dis 2022; 7:tropicalmed7080176. [PMID: 36006268 PMCID: PMC9415058 DOI: 10.3390/tropicalmed7080176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 12/02/2022] Open
Abstract
Leishmaniasis is a neglected tropical disease that seriously influences global public health. Among all the parasitic diseases, leishmaniasis is the third most common cause of morbidity after malaria and schistosomiasis. Circular RNAs (circRNAs) are a new type of noncoding RNAs that are involved in the regulation of biological and developmental processes. However, there is no published research on the function of circRNAs in leishmaniasis. This is the first study to explore the expression profiles of circRNAs in leishmaniasis. GO and KEGG analyses were performed to determine the potential function of the host genes of differentially expressed circRNAs. CircRNA–miRNA–mRNA (ceRNA) regulatory network analysis and protein–protein interaction (PPI) networks were analyzed by R software and the STRING database, respectively. A total of 4664 significant differentially expressed circRNAs were identified and compared to those in control groups; a total of 1931 were up-regulated and 2733 were down-regulated. The host genes of differentially expressed circRNAs were enriched in ubiquitin-mediated proteolysis, endocytosis, the MAPK signaling pathway, renal cell carcinoma, autophagy and the ErbB signaling pathway. Then, five hub genes (BRCA1, CREBBP, EP300, PIK3R1, and CRK) were identified. This study provides new evidence of the change of differentially expressed circRNAs and its potential function in leishmaniasis. These results may provide novel insights and evidence for the diagnosis and treatment of leishmaniasis.
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Saha S, Vashishtha S, Kundu B, Ghosh M. In-silico design of an immunoinformatics based multi-epitope vaccine against Leishmania donovani. BMC Bioinformatics 2022; 23:319. [PMID: 35931960 PMCID: PMC9354309 DOI: 10.1186/s12859-022-04816-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is a fatal vector-borne parasitic disorder occurring mainly in tropical and subtropical regions. VL falls under the category of neglected tropical diseases with growing drug resistance and lacking a licensed vaccine. Conventional vaccine synthesis techniques are often very laborious and challenging. With the advancement of bioinformatics and its application in immunology, it is now more convenient to design multi-epitope vaccines comprising predicted immuno-dominant epitopes of multiple antigenic proteins. We have chosen four antigenic proteins of Leishmania donovani and identified their T-cell and B-cell epitopes, utilizing those for in-silico chimeric vaccine designing. The various physicochemical characteristics of the vaccine have been explored and the tertiary structure of the chimeric construct is predicted to perform docking studies and molecular dynamics simulations. RESULTS The vaccine construct is generated by joining the epitopes with specific linkers. The predicted tertiary structure of the vaccine has been found to be valid and docking studies reveal the construct shows a high affinity towards the TLR-4 receptor. Population coverage analysis shows the vaccine can be effective on the majority of the world population. In-silico immune simulation studies confirms the vaccine to raise a pro-inflammatory response with the proliferation of activated T and B cells. In-silico codon optimization and cloning of the vaccine nucleic acid sequence have also been achieved in the pET28a vector. CONCLUSION The above bioinformatics data support that the construct may act as a potential vaccine. Further wet lab synthesis of the vaccine and in vivo works has to be undertaken in animal model to confirm vaccine potency.
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Affiliation(s)
- Subhadip Saha
- Department of Biotechnology, National Institute of Technology Durgapur, Durgapur, 713209, India
| | - Shubham Vashishtha
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Bishwajit Kundu
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Monidipa Ghosh
- Department of Biotechnology, National Institute of Technology Durgapur, Durgapur, 713209, India.
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Validation of a mixture of rK26 and rK39 antigens from Iranian strain of Leishmania infantum to detect anti-Leishmania antibodies in human and reservoir hosts. Sci Rep 2022; 12:10426. [PMID: 35729270 PMCID: PMC9213479 DOI: 10.1038/s41598-022-14490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/08/2022] [Indexed: 11/08/2022] Open
Abstract
Mediterranean type of visceral leishmaniasis (VL) is a zoonotic parasitic infection. Some provinces of Iran are endemic for VL while other parts are considered as sporadic areas. This study aimed to assess a combination of recombinant K26 and rK39 antigens as well as crude antigen (CA), derived from an Iranian strain of L. infantum, compared to direct agglutination test (DAT) for the detection of VL in humans and domestic dogs as animal reservoir hosts of the disease. A combination of rK26 and rK39 antigens and also CA was evaluated using indirect ELISA on serum samples of 171 VL confirmed humans (n = 84) and domestic dogs (n = 87) as well as 176 healthy humans (n = 86) and domestic dogs (n = 90). Moreover, 36 serum samples of humans (n = 20) and canines (n = 16) with other potentially infectious diseases were collected and tested for finding cross- reactivity. The results of ELISA were compared to DAT, currently considered as gold standard for the serodiagnosis of VL. The sensitivity and specificity, positive predictive and negative predictive values were calculated compared to DAT. The positive sera had previously shown a positive DAT titer ≥ 1:800 for humans and ≥ 1:80 for dogs. Analysis was done by MedCalc and SPSS softwares. Using the combination of rK26 and rK39 in ELISA, a sensitivity of 95.2% and a specificity of 93.0% % were found in human sera at a 1:800 (cut-off) titer when DAT-confirmed cases were compared with healthy controls; a sensitivity of 98.9% and specificity of 96.7%% were found at a 1:80 (cut-off) titer compared with DAT. A good degree of agreement was found between the combined rK39 and rK26-ELISA with DAT in human (0.882) and dog serum samples (0.955) by kappa analysis (p < 0.05). The ELISA using the CA test showed 75% sensitivity in human and 93.1% in dog serum samples as well as 53.5% specificity in human and 83.3% in dog,s sera, respectively. The combination of rK26 and rK39 recombinant antigen prepared from Iranian strain of Leishmania infantum showed high accuracy for the serodiagnosis of VL in human and domestic dogs. Further extended field trial with a larger sample size is recommended.
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Singh SS, Chauhan SB, Ng SSS, Corvino D, de Labastida Rivera F, Engel JA, Waddell N, Mukhopadhay P, Johnston RL, Koufariotis LT, Nylen S, Prakash Singh O, Engwerda CR, Kumar R, Sundar S. Increased amphiregulin expression by CD4 + T cells from individuals with asymptomatic Leishmania donovani infection. Clin Transl Immunology 2022; 11:e1396. [PMID: 35663920 PMCID: PMC9136704 DOI: 10.1002/cti2.1396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/08/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives There is an urgent need to be able to identify individuals with asymptomatic Leishmania donovani infection, so their risk of progressing to VL and transmitting parasites can be managed. This study examined transcriptional markers expressed by CD4+ T cells that could distinguish asymptomatic individuals from endemic controls and visceral leishmaniasis (VL) patients. Methods CD4+ T cells were isolated from individuals with asymptomatic L. donovani infection, endemic controls and VL patients. RNA was extracted and RNAseq employed to identify differentially expressed genes. The expression of one gene and its protein product during asymptomatic infection were evaluated. Results Amphiregulin (AREG) was identified as a distinguishing gene product in CD4+ T cells from individuals with asymptomatic L. donovani infection, compared to VL patients and healthy endemic control individuals. AREG levels in plasma and antigen-stimulated whole-blood assay cell culture supernatants were significantly elevated in asymptomatic individuals, compared to endemic controls and VL patients. Regulatory T (Treg) cells were identified as an important source of AREG amongst CD4+ T-cell subsets in asymptomatic individuals. Conclusion Increased Treg cell AREG expression was identified in individuals with asymptomatic L. donovani infection, suggesting the presence of an ongoing inflammatory response in these individuals required for controlling infection and that AREG may play an important role in preventing inflammation-induced tissue damage and subsequent disease in asymptomatic individuals.
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Affiliation(s)
- Siddharth Sankar Singh
- Department of Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
| | - Shashi Bhushan Chauhan
- Department of Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
| | - Susanna SS Ng
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
- Institute for Experimental OncologyUniversity of BonnBonnGermany
| | - Dillon Corvino
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
- Institute for Experimental OncologyUniversity of BonnBonnGermany
| | | | | | - Nic Waddell
- Department of Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
| | - Pamela Mukhopadhay
- Department of Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
| | - Rebecca L Johnston
- Department of Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
| | - Lambros T Koufariotis
- Department of Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
| | - Susanne Nylen
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstituteStockholmSweden
| | | | | | - Rajiv Kumar
- Centre of Experimental Medicine and SurgeryInstitute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
| | - Shyam Sundar
- Department of Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
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Arumugam S, Scorza BM, Petersen C. Visceral Leishmaniasis and the Skin: Dermal Parasite Transmission to Sand Flies. Pathogens 2022; 11:610. [PMID: 35745464 PMCID: PMC9228576 DOI: 10.3390/pathogens11060610] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 12/10/2022] Open
Abstract
Visceral leishmaniasis is a parasitic disease with significant dermal tropism. The skin is an important site of infection contributing to parasite transmission to naïve sand flies, but understanding how parasitism of host skin and the related immune microenvironment supports or prevents skin parasite replication is now the focus of major investigation in the field of leishmaniasis research. Here, we review dermatoimmunology during visceral leishmaniasis (VL), dermal Leishmania parasite burden, and the role of skin parasitism in transmissibility to sand fly vectors. First, we discuss the epidemiology of VL amongst dogs, the primary zoonotic reservoir for human infection. We explore the association between spatial distribution and the burden of parasites in the skin in driving outward transmission. Factors associated with parasite persistence in the skin are examined. We discuss systemic immunity during VL and what is known about immunological correlates in the skin microenvironment. Finally, we touch on factors egested into the skin during Leishmania inoculation by sand flies. Throughout, we discuss factors associated with the early and chronic establishment of Leishmania parasites in the skin and the role of the dermal immune response.
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Affiliation(s)
- Sahaana Arumugam
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (S.A.); (B.M.S.)
- Immunology Program, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Breanna M. Scorza
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (S.A.); (B.M.S.)
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, IA 52241, USA
| | - Christine Petersen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (S.A.); (B.M.S.)
- Immunology Program, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, IA 52241, USA
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40
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Gupta AK, Das S, Kamran M, Ejazi SA, Ali N. The Pathogenicity and Virulence of Leishmania - interplay of virulence factors with host defenses. Virulence 2022; 13:903-935. [PMID: 35531875 PMCID: PMC9154802 DOI: 10.1080/21505594.2022.2074130] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Leishmaniasis is a group of disease caused by the intracellular protozoan parasite of the genus Leishmania. Infection by different species of Leishmania results in various host immune responses, which usually lead to parasite clearance and may also contribute to pathogenesis and, hence, increasing the complexity of the disease. Interestingly, the parasite tends to reside within the unfriendly environment of the macrophages and has evolved various survival strategies to evade or modulate host immune defense. This can be attributed to the array of virulence factors of the vicious parasite, which target important host functioning and machineries. This review encompasses a holistic overview of leishmanial virulence factors, their role in assisting parasite-mediated evasion of host defense weaponries, and modulating epigenetic landscapes of host immune regulatory genes. Furthermore, the review also discusses the diagnostic potential of various leishmanial virulence factors and the advent of immunomodulators as futuristic antileishmanial drug therapy.
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Affiliation(s)
- Anand Kumar Gupta
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata 700032, India
| | - Sonali Das
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata 700032, India
| | - Mohd Kamran
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata 700032, India
| | - Sarfaraz Ahmad Ejazi
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata 700032, India
| | - Nahid Ali
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata 700032, India
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41
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Diagnosis of Visceral Leishmaniasis in an Elimination Setting: A Validation Study of the Diagnostic Algorithm in India. Diagnostics (Basel) 2022; 12:diagnostics12030670. [PMID: 35328223 PMCID: PMC8947297 DOI: 10.3390/diagnostics12030670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
Visceral leishmaniasis (VL) is on the verge of elimination on the Indian subcontinent. Nonetheless, the currently low VL-incidence setting brings along new challenges, one of which is the validity of the diagnostic algorithm, based on a combination of suggestive clinical symptoms in combination with a positive rK39 Rapid Diagnostic Test (RDT). With this study, we aimed to assess the positive predictive value of the diagnostic algorithm in the current low-endemic setting in India by re-assessing newly diagnosed VL patients with a qPCR analysis on venous blood as the reference test. In addition, we evaluated the specificity of the rK39 RDT by testing non-VL cases with the rK39 RDT. Participants were recruited in Bihar and Uttar Pradesh, India. VL patients diagnosed based on the diagnostic algorithm were recruited through six primary health care centers (PHCs); non-VL cases were identified through a door-to-door survey in currently endemic, previously endemic, and non-endemic clusters, and tested with rK39 RDT, as well as—if positive—with qPCR on peripheral blood. We found that 95% (70/74; 95% CI 87–99%) of incident VL cases diagnosed at the PHC level using the current diagnostic algorithm were confirmed by qPCR. Among 15,422 non-VL cases, 39 were rK39 RDT positive, reflecting a specificity of the test of 99.7% (95% CI 99.7–99.8%). The current diagnostic algorithm combining suggestive clinical features with a positive rK39 RDT still seems valid in the current low-endemic setting in India.
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Kushwaha AK, Scorza BM, Singh OP, Rowton E, Lawyer P, Sundar S, Petersen CA. Domestic mammals as reservoirs for Leishmania donovani on the Indian subcontinent: Possibility and consequences on elimination. Transbound Emerg Dis 2022; 69:268-277. [PMID: 33686764 PMCID: PMC8455064 DOI: 10.1111/tbed.14061] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 01/19/2023]
Abstract
Leishmania donovani is the causative agent of historically anthroponotic visceral leishmaniasis (VL) on the Indian subcontinent (ISC). L. donovani is transmitted by the sand fly species Phlebotomus argentipes. Our collaborative group and others have shown that sand flies trapped outside in endemic villages have fed on cattle and dogs in addition to people. Domestic animals are reservoirs for L. donovani complex spp., particularly L. infantum, in other endemic areas. Multiple studies using quantitative PCR or serological detection methods have demonstrated that goats, cattle, rats and dogs were diagnostically positive for L. donovani infection or exposure in eastern Africa, Bangladesh, Nepal and India. There is a limited understanding of the extent to which L. donovani infection of domestic animals drives transmission to other animals or humans on the ISC. Evidence from other vector-borne disease elimination strategies indicated that emerging infections in domestic species hindered eradication. The predominant lesson learned from these other situations is that non-human reservoirs must be identified, controlled and/or prevented. Massive efforts are underway for VL elimination on the Indian subcontinent. Despite these herculean efforts, residual VL incidence persists. The spectre of an animal reservoir complicating elimination efforts haunts the final push towards full VL control. Better understanding of L. donovani transmission on the Indian subcontinent and rigorous consideration of how non-human reservoirs alter VL ecology are critical to sustain elimination goals.
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Affiliation(s)
- Anurag Kumar Kushwaha
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Breanna M. Scorza
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Om Prakash Singh
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Edgar Rowton
- Division of Entomology, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Phillip Lawyer
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Christine A. Petersen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
- Center for Emerging Infectious Diseases, University of Iowa, Coralville, Iowa, USA
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Tiwari P, Bashir A, Sahu G, Rashid I. Efficacy and safety of pharmacotherapeutic interventions used in visceral leishmaniasis clinical trials: A systematic review and network meta-analysis. ASIAN PAC J TROP MED 2022. [DOI: 10.4103/1995-7645.354419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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44
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Doehl JSP, Ashwin H, Brown N, Romano A, Carmichael S, Pitchford JW, Kaye PM. Spatial Point Pattern Analysis Identifies Mechanisms Shaping the Skin Parasite Landscape in Leishmania donovani Infection. Front Immunol 2021; 12:795554. [PMID: 34975901 PMCID: PMC8716623 DOI: 10.3389/fimmu.2021.795554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
Increasing evidence suggests that in hosts infected with parasites of the Leishmania donovani complex, transmission of infection to the sand fly vector is linked to parasite repositories in the host skin. However, a detailed understanding of the dispersal (the mechanism of spread) and dispersion (the observed state of spread) of these obligatory-intracellular parasites and their host phagocytes in the skin is lacking. Using endogenously fluorescent parasites as a proxy, we apply image analysis combined with spatial point pattern models borrowed from ecology to characterize dispersion of parasitized myeloid cells (including ManR+ and CD11c+ cells) and predict dispersal mechanisms in a previously described immunodeficient model of L. donovani infection. Our results suggest that after initial seeding of infection in the skin, heavily parasite-infected myeloid cells are found in patches that resemble innate granulomas. Spread of parasites from these initial patches subsequently occurs through infection of recruited myeloid cells, ultimately leading to self-propagating networks of patch clusters. This combination of imaging and ecological pattern analysis to identify mechanisms driving the skin parasite landscape offers new perspectives on myeloid cell behavior following parasitism by L. donovani and may also be applicable to elucidating the behavior of other intracellular tissue-resident pathogens and their host cells.
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MESH Headings
- Animals
- CD11 Antigens/metabolism
- Cluster Analysis
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Disease Models, Animal
- Host-Parasite Interactions
- Image Processing, Computer-Assisted
- Insect Vectors/parasitology
- Leishmania donovani/immunology
- Leishmania donovani/pathogenicity
- Leishmaniasis, Visceral/immunology
- Leishmaniasis, Visceral/metabolism
- Leishmaniasis, Visceral/parasitology
- Leishmaniasis, Visceral/transmission
- Mannose Receptor/metabolism
- Mice, Inbred C57BL
- Mice, Knockout
- Microscopy, Confocal
- Microscopy, Fluorescence
- Models, Theoretical
- Myeloid Cells/immunology
- Myeloid Cells/metabolism
- Myeloid Cells/parasitology
- Phlebotomus/parasitology
- Skin/immunology
- Skin/metabolism
- Skin/parasitology
- Spatial Analysis
- Mice
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Affiliation(s)
- Johannes S. P. Doehl
- York Biomedical Research Institute, Hull York Medical School, University of York, York, United Kingdom
| | - Helen Ashwin
- York Biomedical Research Institute, Hull York Medical School, University of York, York, United Kingdom
| | - Najmeeyah Brown
- York Biomedical Research Institute, Hull York Medical School, University of York, York, United Kingdom
| | - Audrey Romano
- York Biomedical Research Institute, Hull York Medical School, University of York, York, United Kingdom
| | - Samuel Carmichael
- Departments of Biology and Mathematics, University of York, York, United Kingdom
| | - Jon W. Pitchford
- Departments of Biology and Mathematics, University of York, York, United Kingdom
| | - Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, York, United Kingdom
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Zijlstra EE. Precision Medicine in Control of Visceral Leishmaniasis Caused by L. donovani. Front Cell Infect Microbiol 2021; 11:707619. [PMID: 34858865 PMCID: PMC8630745 DOI: 10.3389/fcimb.2021.707619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
Precision medicine and precision global health in visceral leishmaniasis (VL) have not yet been described and could take into account how all known determinants improve diagnostics and treatment for the individual patient. Precision public health would lead to the right intervention in each VL endemic population for control, based on relevant population-based data, vector exposures, reservoirs, socio-economic factors and other determinants. In anthroponotic VL caused by L. donovani, precision may currently be targeted to the regional level in nosogeographic entities that are defined by the interplay of the circulating parasite, the reservoir and the sand fly vector. From this 5 major priorities arise: diagnosis, treatment, PKDL, asymptomatic infection and transmission. These 5 priorities share the immune responses of infection with L. donovani as an important final common pathway, for which innovative new genomic and non-genomic tools in various disciplines have become available that provide new insights in clinical management and in control. From this, further precision may be defined for groups (e.g. children, women, pregnancy, HIV-VL co-infection), and eventually targeted to the individual level.
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Affiliation(s)
- Eduard E Zijlstra
- Clinical Sciences, Rotterdam Centre for Tropical Medicine, Rotterdam, Netherlands
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Kaye PM, Mohan S, Mantel C, Malhame M, Revill P, Le Rutte E, Parkash V, Layton AM, Lacey CJ, Malvolti S. Overcoming roadblocks in the development of vaccines for leishmaniasis. Expert Rev Vaccines 2021; 20:1419-1430. [PMID: 34727814 PMCID: PMC9844205 DOI: 10.1080/14760584.2021.1990043] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/04/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The leishmaniases represent a group of parasitic diseases caused by infection with one of several species of Leishmania parasites. Disease presentation varies because of differences in parasite and host genetics and may be influenced by additional factors such as host nutritional status or co-infection. Studies in experimental models of Leishmania infection, vaccination of companion animals and human epidemiological data suggest that many forms of leishmaniasis could be prevented by vaccination, but no vaccines are currently available for human use. AREAS COVERED We describe some of the existing roadblocks to the development and implementation of an effective leishmaniasis vaccine, based on a review of recent literature found on PubMed, BioRxiv and MedRxiv. In addition to discussing scientific unknowns that hinder vaccine candidate identification and selection, we explore gaps in knowledge regarding the commercial and public health value propositions underpinning vaccine development and provide a route map for future research and advocacy. EXPERT OPINION Despite significant progress, leishmaniasis vaccine development remains hindered by significant gaps in understanding that span the vaccine development pipeline. Increased coordination and adoption of a more holistic view to vaccine development will be required to ensure more rapid progress in the years ahead.
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Affiliation(s)
- Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Sakshi Mohan
- Centre for Health Economics, University of York, Heslington, York, UK
| | | | | | - Paul Revill
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Epke Le Rutte
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vivak Parkash
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Alison M. Layton
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Charles J.N. Lacey
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
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Scorza BM, Mahachi KG, Cox AC, Toepp AJ, Leal-Lima A, Kumar Kushwaha A, Kelly P, Meneses C, Wilson G, Gibson-Corley KN, Bartholomay L, Kamhawi S, Petersen CA. Leishmania infantum xenodiagnosis from vertically infected dogs reveals significant skin tropism. PLoS Negl Trop Dis 2021; 15:e0009366. [PMID: 34613967 PMCID: PMC8523039 DOI: 10.1371/journal.pntd.0009366] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/18/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dogs are the primary reservoir for human visceral leishmaniasis due to Leishmania infantum. Phlebotomine sand flies maintain zoonotic transmission of parasites between dogs and humans. A subset of dogs is infected transplacentally during gestation, but at what stage of the clinical spectrum vertically infected dogs contribute to the infected sand fly pool is unknown. METHODOLOGY/PRINCIPAL FINDINGS We examined infectiousness of dogs vertically infected with L. infantum from multiple clinical states to the vector Lutzomyia longipalpis using xenodiagnosis and found that vertically infected dogs were infectious to sand flies at differing rates. Dogs with mild to moderate disease showed significantly higher transmission to the vector than dogs with subclinical or severe disease. We documented a substantial parasite burden in the skin of vertically infected dogs by RT-qPCR, despite these dogs not having received intradermal parasites via sand flies. There was a highly significant correlation between skin parasite burden at the feeding site and sand fly parasite uptake. This suggests dogs with high skin parasite burden contribute the most to the infected sand fly pool. Although skin parasite load and parasitemia correlated with one another, the average parasite number detected in skin was significantly higher compared to blood in matched subjects. Thus, dermal resident parasites were infectious to sand flies from dogs without detectable parasitemia. CONCLUSIONS/SIGNIFICANCE Together, our data implicate skin parasite burden and earlier clinical status as stronger indicators of outward transmission potential than blood parasite burden. Our studies of a population of dogs without vector transmission highlights the need to consider canine vertical transmission in surveillance and prevention strategies.
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Affiliation(s)
- Breanna M. Scorza
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Kurayi G. Mahachi
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Arin C. Cox
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Angela J. Toepp
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Adam Leal-Lima
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | | | - Patrick Kelly
- Department of Microbiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Claudio Meneses
- National Institute of Allergy and Infectious Disease, NIH, Rockville, Maryland, United States of America
| | - Geneva Wilson
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | | | - Lyric Bartholomay
- Department of Epidemiology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Shaden Kamhawi
- National Institute of Allergy and Infectious Disease, NIH, Rockville, Maryland, United States of America
| | - Christine A. Petersen
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
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Volpedo G, Huston RH, Holcomb EA, Pacheco-Fernandez T, Gannavaram S, Bhattacharya P, Nakhasi HL, Satoskar AR. From infection to vaccination: reviewing the global burden, history of vaccine development, and recurring challenges in global leishmaniasis protection. Expert Rev Vaccines 2021; 20:1431-1446. [PMID: 34511000 DOI: 10.1080/14760584.2021.1969231] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Leishmaniasis is a major public health problem and the second most lethal parasitic disease in the world due to the lack of effective treatments and vaccines. Even when not lethal, leishmaniasis significantly affects individuals and communities through life-long disabilities, psycho-sociological trauma, poverty, and gender disparity in treatment. AREAS COVERED This review discusses the most relevant and recent research available on Pubmed and GoogleScholar highlighting leishmaniasis' global impact, pathogenesis, treatment options, and lack of effective control strategies. An effective vaccine is necessary to prevent morbidity and mortality, lower health care costs, and reduce the economic burden of leishmaniasis for endemic low- and middle-income countries. Since there are several forms of leishmaniasis, a pan-Leishmania vaccine without geographical restrictions is needed. This review also focuses on recent advances and common challenges in developing prophylactic strategies against leishmaniasis. EXPERT OPINION Despite advances in pre-clinical vaccine research, approval of a human leishmaniasis vaccine still faces major challenges - including manufacturing of candidate vaccines under Good Manufacturing Practices, developing well-designed clinical trials suitable in endemic countries, and defined correlates of protection. In addition, there is a need to explore Challenge Human Infection Model to avoid large trials because of fluctuating incidence and prevalence of leishmanasis.
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Affiliation(s)
- Greta Volpedo
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ryan H Huston
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Erin A Holcomb
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Thalia Pacheco-Fernandez
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Sreenivas Gannavaram
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Parna Bhattacharya
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Hira L Nakhasi
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Abhay R Satoskar
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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Malvolti S, Malhame M, Mantel CF, Le Rutte EA, Kaye PM. Human leishmaniasis vaccines: Use cases, target population and potential global demand. PLoS Negl Trop Dis 2021; 15:e0009742. [PMID: 34547025 PMCID: PMC8486101 DOI: 10.1371/journal.pntd.0009742] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/01/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
The development of vaccines against one or all forms of human leishmaniasis remains hampered by a paucity of investment, at least in part resulting from the lack of well-evidenced and agreed estimates of vaccine demand. Starting from the definition of 4 main use cases (prevention of visceral leishmaniasis, prevention of cutaneous leishmaniasis, prevention of post-kala-azar dermal leishmaniasis and treatment of post-kala-azar dermal leishmaniasis), we have estimated the size of each target population, focusing on those endemic countries where incidence levels are sufficiently high to justify decisions to adopt a vaccine. We assumed a dual vaccine delivery strategy, including a wide age-range catch-up campaign before the start of routine immunisation. Vaccine characteristics and delivery parameters reflective of a target product profile and the likely duration of the clinical development effort were considered in forecasting the demand for each of the four indications. Over a period of 10 years, this demand is forecasted to range from 300-830 million doses for a vaccine preventing visceral leishmaniasis and 557-1400 million doses for a vaccine preventing cutaneous leishmaniasis under the different scenarios we simulated. In a scenario with an effective prophylactic visceral leishmaniasis vaccine, demand for use to prevent or treat post-kala-azar dermal leishmaniasis would be more limited (over the 10 years ~160,000 doses for prevention and ~7,000 doses for treatment). Demand would rise to exceed 330,000 doses, however, in the absence of an effective vaccine for visceral leishmaniasis. Because of the sizeable demand and potential for public health impact, a single-indication prophylactic vaccine for visceral or cutaneous leishmaniasis, and even more so a cross-protective prophylactic vaccine could attract the interest of commercial developers. Continuous refinement of these first-of-their kind estimates and confirmation of country willingness and ability to pay will be paramount to inform the decisions of policy makers and developers in relation to a leishmaniasis vaccine. Positive decisions can provide a much-needed contribution towards the achievement of global leishmaniasis control.
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Affiliation(s)
| | | | | | - Epke A. Le Rutte
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, United Kingdom
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Utility of Blood as the Clinical Specimen for the Molecular Diagnosis of Post-Kala-Azar Dermal Leishmaniasis. J Clin Microbiol 2021; 59:e0013221. [PMID: 34160275 DOI: 10.1128/jcm.00132-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The countries in the Indian subcontinent have reported a dramatic decline in visceral leishmaniasis (VL) cases. However, the presence of the parasite reservoir in the form of post-kala-azar dermal leishmaniasis (PKDL), a dermal sequel of VL, is a hurdle in attaining VL elimination. Presently employed clinical specimens for the diagnosis of PKDL include skin biopsy specimens and slit skin smears. In this study, the use of blood as a clinical specimen was investigated in different manifestations of PKDL in India. This is a bicentric study (National Institute of Pathology, Indian Council of Medical Research [ICMR], New Delhi, and Institute of Medical Sciences [IMS], Banaras Hindu University, Varanasi), with 215 participants (120 PKDL patients and 95 controls). Highly sensitive quantitative real-time PCR (Q-PCR) and field-deployable loop-mediated isothermal amplification (LAMP) were employed using blood samples for diagnosis. Promising sensitivities of 77.50% (95% confidence interval [CI], 69.24 to 84.05%) for Q-PCR and 70.83% (95% CI, 62.16 to 78.22%) for LAMP were obtained for the diagnosis of PKDL. Further, enhanced sensitivities of 83.33% (95% CI, 71.28 to 90.98%) and 77.78% (95% CI, 65.06 to 86.80%) for Q-PCR and LAMP, respectively, were recorded for the detection of macular cases. The study revealed an inverse correlation between the parasite load estimated in slit and blood samples, thereby favoring the use of blood for the diagnosis of the macular variant, which may be missed due to scant parasite loads in the slit. This study is the first to propose the promising potential of blood as a clinical specimen for accurate diagnosis of PKDL, which would aid in fast-tracking VL elimination.
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