1
|
Karampas G, Koulouraki S, Daikos GL, Nanou C, Aravantinos L, Eleftheriades M, Metallinou D, Christopoulos P. Visceral Leishmaniasis in a Twin Pregnancy: A Case Report and Review of the Literature. J Clin Med 2024; 13:2400. [PMID: 38673673 PMCID: PMC11051246 DOI: 10.3390/jcm13082400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of clinical manifestations from cutaneous ulcers to multisystem disease. Differential diagnosis is challenging as symptoms and signs are insidious, mimicking other diseases. Misdiagnosis can result in severe adverse perinatal outcomes, even maternal/neonatal death. Early treatment with liposomal amphotericin-B (LAmB) is currently the first choice with adequate effectiveness. We report a rare case of VL in a twin pregnancy with onset at the second trimester, presenting with periodic fever with rigors, right flank pain, and gradual dysregulation of all three cell lines. The positive rK39 enzyme-linked immunosorbent assay test confirmed the diagnosis. Treatment with LAmB resulted in clinical improvement within 48 h and in the delivery of two late-preterm healthy neonates with no symptoms or signs of vertical transmission. The one-year follow-up, of the mother and the neonates, was negative for recurrence. To our knowledge, this is the first reported case of VL in a twin pregnancy, and consequently treatment and perinatal outcome are of great importance.
Collapse
Affiliation(s)
- Grigorios Karampas
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Sevasti Koulouraki
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - George L. Daikos
- Mitera Hospital, 6, Erythrou Stavrou Str., 151 23 Athens, Greece;
| | - Christina Nanou
- Department of Midwifery, University of West Attica, 122 43 Athens, Greece;
| | - Leon Aravantinos
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Makarios Eleftheriades
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 122 43 Athens, Greece;
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| |
Collapse
|
2
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
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.
| | | |
Collapse
|
3
|
King A. In search of a vaccine for leishmaniasis. Nature 2023:10.1038/d41586-023-02580-y. [PMID: 37592126 DOI: 10.1038/d41586-023-02580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
|
4
|
Alvar J, Beca-Martínez MT, Argaw D, Jain S, Aagaard-Hansen J. Social determinants of visceral leishmaniasis elimination in Eastern Africa. BMJ Glob Health 2023; 8:e012638. [PMID: 37380365 PMCID: PMC10410987 DOI: 10.1136/bmjgh-2023-012638] [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: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Visceral leishmaniasis is a vector-borne, protozoan disease with severe public health implications. Following the successful implementation of an elimination programme in South Asia, there is now a concerted endeavour to replicate these efforts in Eastern Africa based on the five essential elimination pillars of case management, integrated vector management, effective surveillance, social mobilisation and operational research. This article highlights how key social determinants (SD) of health (poverty, sociocultural factors and gender, housing and clustering, migration and the healthcare system) operate at five different levels (socioeconomic context and position, differential exposure, differential vulnerability, differential outcomes and differential consequences). These SD should be considered within the context of increasing the success of the five-pillar elimination programme and reducing inequity in health.
Collapse
Affiliation(s)
- Jorge Alvar
- Social Medicine, Royal Academy of Medicine, Madrid, Spain
| | | | - Daniel Argaw
- Neglected Tropical Diseases, World Health Organization, Geneva, GE, Switzerland
| | - Saurabh Jain
- Neglected Tropical Diseases, World Health Organization, Geneva, GE, Switzerland
| | - Jens Aagaard-Hansen
- Health Promotion, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
- Health Research, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| |
Collapse
|
5
|
Kumar VU, Kt MF, Sharma A, Bisht P, Dhingra S, Ravichandiran V, Ramesh M, Murti K. The Possible Role of Selected Vitamins and Minerals in the Therapeutic Outcomes of Leishmaniasis. Biol Trace Elem Res 2023; 201:1672-1688. [PMID: 35779182 DOI: 10.1007/s12011-022-03311-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Abstract
Leishmaniasis is a protozoal disease declared as an endemic in areas suffering from severe malnutrition and poverty. The factors associated with poverty like low income, ecological factors, and malnutrition cause disruption in immunity and host defense increasing risk of infection. Altered resistance to infection and host susceptibility are associated with low micronutrient levels in undernourished patients. Malnutrition has been recognized as a poor predictive marker for leishmaniasis, in particular the deficiency of trace elements like zinc, iron, and vitamin A, B, C, D which has a prominent function in the regulation of innate and adaptive immunity, cell proliferation, human physiology, etc. Malnourishment can exacerbate host sensitivity and pathophysiologic intensity to infection in variety of ways, whereas infection can enhance underlying poor nutrition or enhance host vulnerability and sandfly's urge to attack specific hosts. The intensity of leishmaniasis can be influenced by body mass and micronutrient availability in the blood. Vitamin D, C, zinc, and iron are proved effective in inhibiting the growth of leishmaniasis in both amastigote or promastigote forms, either directly or by acting as precursor for a pathway which inhibits the parasite growth. This article elucidates a new perception to the crucial role of micronutrients and their probable role in the therapeutic outcomes of leishmaniasis. Since there is requirement of novel drugs to fight drug resistance and relapse of leishmaniasis, this article may pave way to understand the importance of micronutrients and their role in therapeutic outcomes of leishmaniasis.
Collapse
Affiliation(s)
- V Udaya Kumar
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER)-Hajipur, Bihar, India
| | - Muhammed Favas Kt
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER)- SAS Nagar, Mohali, Punjab, India
| | - Ayush Sharma
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER)-Hajipur, Bihar, India
| | - Priya Bisht
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) Hajipur, Bihar, India
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER)-Hajipur, Bihar, India
| | - V Ravichandiran
- Department of Natural Products, National Institute of Pharmaceutical Education and Research (NIPER) Kolkata, West Bengal, Kolkata, India
| | - M Ramesh
- Department of Pharmacy Practice, JSS College of Pharmacy Mysuru, Karnataka, Bengaluru, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER)-Hajipur, Bihar, India.
| |
Collapse
|
6
|
Boodman C, van Griensven J, Gupta N, Diro E, Ritmeijer K. Anticipating visceral leishmaniasis epidemics due to the conflict in Northern Ethiopia. PLoS Negl Trop Dis 2023; 17:e0011188. [PMID: 36952454 PMCID: PMC10035745 DOI: 10.1371/journal.pntd.0011188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Affiliation(s)
- Carl Boodman
- Clinical Investigator Program, University of Manitoba, Winnipeg, Canada
- Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Johan van Griensven
- Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, India
| | - Ermias Diro
- Department of Internal Medicine, University of Washington, Seattle, United States of America
| | | |
Collapse
|
7
|
Abdulslam Abdullah A, Ahmed M, Gadeed A, Eltayeb A, Ahmed S, Hamad S, Hussein M. Five-year retrospective hospital-based study on epidemiological data regarding human leishmaniasis in West Kordofan state, Sudan. World J Clin Infect Dis 2022; 12:61-68. [DOI: 10.5495/wjcid.v12.i2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/15/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Leishmaniasis is a neglected zoonotic disease, endemic in Sudan. Estimating this disease is very important to inform the health care policymakers and the governments to apply proper health and economic policies.
AIM To find out the frequency and distribution of human leishmaniasis based on sex and age for 5 years in the West Kordofan state, Sudan.
METHODS A 5-year retrospective study from 2016 through 2020 was carried out using local hospital records of leishmaniasis patients. The positive results were recorded after performing at least one of the following leishmaniasis standard tests: direct agglutination test, enzyme-linked immunosorbent assay and leishmania skin test. The sex and age of each patient were recorded. The collected data were analyzed using STATA package version 16.
RESULTS A total of 162443 patient records from 2016 to 2020 were retrieved. Of these, 4.39% were found to be positive for leishmaniasis. The disease has been more common in males (65.3%) than in females (34.7%). The highest reported prevalence (6.58%) was in patients 15-44 years, and the lowest prevalence (1.95%) was among patients ≥ 65 years.
CONCLUSION The results of the current study indicate that leishmaniasis is endemic in the study area even though the numbers of patients in the 5 consecutive years were varying. In addition, the disease was common in males and adults. The interpretation of these findings should take into consideration the absence of information about some important confounding factors.
Collapse
Affiliation(s)
- Abdullah Abdulslam Abdullah
- Department of Biomedical Sciences, Faculty of Veterinary Sciences, University of Gadarif, Gadarif 208, Sudan
- Department of Reproductive Health Sciences, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan 119, Oyo State, Nigeria
| | - Musa Ahmed
- Department of Reproductive Health Sciences, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan 119, Oyo State, Nigeria
- Department of Veterinary Surgery and Anaesthesia, Faculty of Veterinary Medicine, ALsalam University, Al-fula 120, West Kordofan State, Sudan
| | - Ahmed Gadeed
- Environmental Studies and Research Center, Al-Salam University, Al-fula 120, West Kordofan State, Sudan
| | - Adam Eltayeb
- Environmental Studies and Research Center, Al-Salam University, Al-fula 120, West Kordofan State, Sudan
| | - Safa Ahmed
- Al-Sadaga Hospital, Al-fula 124, West Kordofan State, Sudan
| | - Suad Hamad
- Department of Zoonotic Disease and Disease Control, Ministry of Animal Resources, Al-Hamadi 215, South Kordofan State, Sudan
| | - Mohammed Hussein
- Department of Statistics and Health Information, Ministry of Health, Al-fula 127, West Kordofan State, Sudan
| |
Collapse
|
8
|
Ahmed M, Abdulslam Abdullah A, Bello I, Hamad S, Bashir A. Prevalence of human leishmaniasis in Sudan: A systematic review and meta-analysis. World J Methodol 2022; 12:305-318. [PMID: 36159098 PMCID: PMC9350725 DOI: 10.5662/wjm.v12.i4.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/31/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are three main forms of leishmaniasis in humans: cutaneous leishmaniasis (CL), visceral leishmaniasis (VL), and mucocutaneous leishmaniasis. The prevalence of human leishmaniasis varies widely in different countries and different regions of the same country. To date, there is no overall estimation of the prevalence of human leishmaniasis in Sudan.
AIM To determine the pooled prevalence of human leishmaniasis and the disease risk factors among Sudanese citizens.
METHODS From all articles written in English or Arabic languages conducted before the 4th of August 2021 from [Scopus, Web of Science, PubMed, and MEDLINE, African Journals Online (AJOL), ResearchGate, direct Google search, Google Scholar, and universities websites], just 20 articles with a total of 230960 participants were eligible for this study. Data synthesis and analysis were done using STATA software, version 16. EndNote citation manager version X9.3.3 and Reference Citation Analysis (RCA) were used to remove the duplicated studies and manage the citation respectively.
RESULTS The overall pooled prevalence of human leishmaniasis in Sudan was 21% (with confidence interval 12%-30%). CL was the most common type of leishmaniasis in Sudan, with a pooled prevalence of 26% followed by VL (18%). Nevertheless, the pooled prevalence of human leishmaniasis in Sudan was higher in males compared with females (60% vs 40%). The current results revealed that the people in the age group between 15 and 44 were the most affected group (60%), and central Sudan has the highest pooled prevalence of human leishmaniasis (27%) compared with other regions of Sudan. Finally, the prevalence of human leishmaniasis seems to decrease with time.
CONCLUSION This study showed that human leishmaniasis infection is still endemic in many regions in Sudan and highly prevalent in central and eastern Sudan, and CL is the most prevalent in the country. Males and adults were more susceptible to infection compared with females and children. However, the human leishmaniasis prevalence decreased relatively over time.
Collapse
Affiliation(s)
- Musa Ahmed
- Department of Reproductive Health Sciences, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan 119, Oyo state, Nigeria
- Department of Veterinary Surgery and Anaesthesia, Faculty of Veterinary Medicine, ALsalam University, Al-fula 120, West Kordofan state, Sudan
| | - Abdullah Abdulslam Abdullah
- Department of Reproductive Health Sciences, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan 119, Oyo state, Nigeria
- Department of Biomedical Sciences, Faculty of Veterinary Sciences, University of Gadarif, Gadarif 208, Sudan
| | - Idris Bello
- Department of Reproductive Health Sciences, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan 119, Oyo state, Nigeria
- Department of Animal Health and Production Technology, Oyo State College of Agriculture and Technology, Igboora 120, Oyo state, Nigeria
| | - Suad Hamad
- Department of Zoonotic Disease and Disease Control, Ministry of Animal Resources, Al-Hamadi 215, South Kordofan state, Sudan
| | - Aboelgassim Bashir
- Department of Pre-Clinical Sciences, Faculty of Veterinary Medicine, AL-Salam University, Al-Fulla 209, West Kordofan state, Sudan
| |
Collapse
|
9
|
Alvar J, den Boer M, Dagne DA. Towards the elimination of visceral leishmaniasis as a public health problem in east Africa: reflections on an enhanced control strategy and a call for action. THE LANCET GLOBAL HEALTH 2021; 9:e1763-e1769. [PMID: 34798033 PMCID: PMC8609279 DOI: 10.1016/s2214-109x(21)00392-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022] Open
Abstract
East Africa is the world region most affected by visceral leishmaniasis, accounting for 45% of cases globally that were reported to WHO in 2018, with an annual incidence that is only slightly decreasing. Unlike southeast Asia, east Africa does not have a regional approach to achieving elimination of visceral leishmaniasis as a public health problem. The goal of the WHO 2021–30 Neglected Tropical Diseases road map is to reduce mortality caused by the disease to less than 1%. To achieve this goal in east Africa, it will be necessary to roll out diagnosis and treatment at the primary health-care level and implement evidence-based personal protection methods and measures to reduce human–vector contact. Investment and collaboration to develop the necessary tools are scarce. In this Health Policy paper, we propose a strategic framework for a coordinated regional approach in east Africa for the elimination of visceral leishmaniasis as a public health problem.
Collapse
|
10
|
Grifferty G, Shirley H, McGloin J, Kahn J, Orriols A, Wamai R. Vulnerabilities to and the Socioeconomic and Psychosocial Impacts of the Leishmaniases: A Review. Res Rep Trop Med 2021; 12:135-151. [PMID: 34188584 PMCID: PMC8236266 DOI: 10.2147/rrtm.s278138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
The leishmaniases are a group of four vector-borne neglected tropical diseases (NTDs) with 1.6 billion people in some 100 countries at risk. They occur in certain eco-epidemiological foci that reflect manipulation by human activities, such as migration, urbanization and deforestation, of which poverty, conflict and climate change are key drivers. Given their synergistic impacts, risk factors and the vulnerabilities of poor populations and the launch of a new 2030 roadmap for NTDs in the context of the global sustainability agenda, it is warranted to update the state of knowledge of the leishmaniases and their effects. Using existing literature, we review socioeconomic and psychosocial impacts of leishmaniasis within a framework of risk factors and vulnerabilities to help inform policy interventions. Studies show that poverty is an overarching primary risk factor. Low-income status fosters inadequate housing, malnutrition and lack of sanitation, which create and exacerbate complexities in access to care and treatment outcomes as well as education and awareness. The co-occurrence of the leishmaniases with malnutrition and HIV infection further complicate diagnosis and treatment, leading to poor diagnostic outcomes and therapeutic response. Even with free treatment, households may suffer catastrophic health expenditure from direct and indirect medical costs, which compounds existing financial strain in low-income communities for households and healthcare systems. The dermatological presentations of the leishmaniases may result in long-term severe disfigurement, leading to stigmatization, reduced quality of life, discrimination and mental health issues. A substantial amount of recent literature points to the vulnerability pathways and burden of leishmaniasis on women, in particular, who disproportionately suffer from these impacts. These emerging foci demonstrate a need for continued international efforts to address key risk factors and population vulnerabilities if leishmaniasis control, and ultimately elimination, is to be achieved by 2030.
Collapse
Affiliation(s)
- Grace Grifferty
- Department of Biology, Northeastern University, College of Science, Boston, MA, USA
| | - Hugh Shirley
- Department of Biochemistry, Northeastern University, College of Science, Boston, MA, USA.,Program in Medical Education, Harvard Medical School, Boston, MA, USA
| | - Jamie McGloin
- Department of Health Sciences, Northeastern University, Bouvé College of Health Sciences, Boston, MA, USA
| | - Jorja Kahn
- Department of Behavioral Neuroscience, Northeastern University, College of Science, Boston, MA, USA
| | - Adrienne Orriols
- Department of Behavioral Neuroscience, Northeastern University, College of Science, Boston, MA, USA
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, College of Social Sciences and Humanities, Integrated Initiative for Global Health, Boston, MA, USA
| |
Collapse
|
11
|
Elnaiem DEA, Dakein O, Alawad AMA, Alsharif B, Khogali A, Jibreel T, Osman OF, Has’san H, Atia AM, Elhag M, Den Boer M, Ritmeijer K, Bern C, Alvar J, Khalid N, Courtenay O. Outdoor Residual Insecticide Spraying (ODRS), a New Approach for the Control of the Exophilic Vectors of Human Visceral Leishmaniasis: Phlebotomus orientalis in East Africa. PLoS Negl Trop Dis 2020; 14:e0008774. [PMID: 33079934 PMCID: PMC7598920 DOI: 10.1371/journal.pntd.0008774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/30/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023] Open
Abstract
Visceral Leishmaniasis (VL) due to Leishmania donovani is a neglected protozoan parasitic disease in humans, which is usually fatal if untreated. Phlebotomus orientalis, the predominant VL vector in East Africa, is a highly exophilic/exophagic species that poses a major challenge to current Integrated Vector Management (IVM). Here we report results of pilot studies conducted in rural villages in Gedarif state, Sudan, to evaluate outdoor residual spraying of 20mg active ingredient (a.i.) /m2 deltamethrin insecticide applied to the characteristic household compound boundary reed fence and to the outside of household buildings (Outdoor Residual Insecticide Spraying, ODRS), and as an alternative, spraying restricted to the boundary fence only (Restricted Outdoor Residual Insecticide Spraying, RODRS). Four to six clusters of 20 households were assigned to insecticide treatments or control in three experiments. Changes in sand fly numbers were monitored over 2,033 trap-nights over 43–76 days follow-up in four sentinel houses per cluster relative to unsprayed control clusters. Sand fly numbers were monitored by sticky traps placed on the ground on the inside (“outdoor”) and the outside (“peridomestic”) of the boundary fence, and by CDC light traps suspended outdoors in the household compound. The effects of ODRS on sand fly numbers inside sleeping huts were monitored by insecticide knockdown. After a single application, ODRS reduced P. orientalis abundance by 83%-99% in outdoor and peridomestic trap locations. ODRS also reduced numbers of P. orientalis found resting inside sleeping huts. RODRS reduced outdoor and peridomestic P. orientalis by 60%-88%. By direct comparison, RODRS was 58%-100% as effective as ODRS depending on the trapping method. These impacts were immediate on intervention and persisted during follow-up, representing a large fraction of the P. orientalis activity season. Relative costs of ODRS and RODRS delivery were $5.76 and $3.48 per household, respectively. The study demonstrates the feasibility and high entomological efficacy of ODRS and RODRS, and the expected low costs relative to current IVM practises. These methods represent novel sand fly vector control tools against predominantly exophilic/exophagic sand fly vectors, aimed to lower VL burdens in Sudan, with potential application in other endemic regions in East Africa. Phlebotomus orientalis is the predominant vector of visceral leishmaniasis (VL, kala azar) in Sudan and other countries of East Africa, where the disease causes high morbidity and mortality. This sylvatic sand fly species is abundant in wild habitats characterized by presence of black cotton soil and vegetation dominated by Balanites aegyptiaca and/or Acacia seyal trees. In villages, the vector bites people in the household yard and in nearby peri-domestic locations, exhibiting limited indoor resting behaviour. The marked exophagic and exophilic behaviours of P. orientalis represent a profound challenge for VL control by excluding indoor residual spraying of insecticides (IRS) and compromising the efficacy of insecticide-impregnated bednets (ITNs). In this study, we evaluated the entomological efficacy of residual pyrethroid applied outdoors to household boundary fences and the exterior walls of household huts (outdoor residual insecticide spraying, ODRS), to reduce the abundance of P. orientalis inside and outside houses. We also evaluated the entomological impact of a restricted outdoor residual insecticide spraying (RODRS), whereby insecticide was applied only to the boundary fence. The study was carried out in June 2016-June 2017 in Jebel-Algana and Umsalala villages, Gedarif state, eastern Sudan, which are highly endemic for VL. The results showed that a single ODRS application of 20mg a.i. /m2 2.8% deltamethrin provided average reductions of 83%-99% in outdoor and peridomestic P. orientalis sand fly numbers relative to unsprayed control clusters. RODRS reduced outdoor and peridomestic P. orientalis by 60%-88%. The average cost of ODRS and RODRS per household were $5.76 and $3.48, respectively. The costs of these community-based control measures were substantially lower than the costs of LLINs, which is the only evidence-based tool used to protect against VL in the area. Future studies should evaluate the impact of ODRS/RODRS transmission of VL incidence in endemic villages and in seasonal agricultural farms.
Collapse
Affiliation(s)
- Dia-Eldin A. Elnaiem
- Department of Natural Sciences, University of Maryland Eastern Shore, MD, United States of America
- * E-mail: (DEAE); (OC)
| | - Osman Dakein
- Department of Zoology, Faculty of Science, University of Khartoum, Sudan
- Kala azar Research Centre, Faculty of Medicine and Health Sciences, University for Gedarif, Gedarif, Sudan
| | - Ahmed Mohammed-Ali Alawad
- Ministry of Health, Gedarif state, Sudan
- Blue Nile Health Institute, Gezira University, Wad Medani, Sudan
| | - Bashir Alsharif
- Departamento de Entomologia, CPqAM, Fundação Oswaldo Cruz, Recife, Brasil and Dept of Medical Entomology, National Public Health Laboratory, Ministry of Health, Sudan
| | - Altayeb Khogali
- Blue Nile Health Institute, Gezira University, Wad Medani, Sudan
| | - Tayseer Jibreel
- Blue Nile Health Institute, Gezira University, Wad Medani, Sudan
| | - Omran F. Osman
- Department of Zoology, Faculty of Science, University of Khartoum, Sudan
| | - Hassan Has’san
- Ministry of Health, Gedarif state, Sudan
- Blue Nile Health Institute, Gezira University, Wad Medani, Sudan
| | | | - Mousab Elhag
- Director, Directorate of Communicable Diseases, Federal Ministry of Health, Khartoum, Sudan
| | | | | | - Caryn Bern
- University of California San Francisco, San Francisco, California, United States of America
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Noteila Khalid
- Department of Zoology, Ibn Sina University, Khartoum, Sudan
| | - Orin Courtenay
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, CV4 7AL, United Kingdom
- * E-mail: (DEAE); (OC)
| |
Collapse
|
12
|
Kumar A, Pandey SC, Samant M. A spotlight on the diagnostic methods of a fatal disease Visceral Leishmaniasis. Parasite Immunol 2020; 42:e12727. [PMID: 32378226 DOI: 10.1111/pim.12727] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/26/2023]
Abstract
Leishmania donovani (a causative agent of visceral leishmaniasis) poses a serious health threat to the human population which is fatal if left untreated. The life cycle of Leishmania alternates between vertebrate host and Phlebotomine fly as intermediate ones. Due to the difficulties linked to vector (sandfly) control and the lack of an effective vaccine, the control of leishmaniasis relies mostly on chemotherapy. Unfortunately, the prevalence of parasites becoming resistant to the first-line drug pentavalent antimonial (SbV )/sodium antimony gluconate (SAG) and some other anti-leishmanial drug is increasing in several parts of the world. With the alarming rise of drug resistance and other issues related to VL, there is an urgent need to focus on early detection and quick diagnosis of VL case. Therefore, we have reviewed most of the methods used in the diagnostic process of VL. Along with existing diagnostic methods, developing more effective and sensitive diagnostic methods and biomarkers is also vital for enhancing VL identification and control programs. This review gathers the comprehensive information on diagnostics methods of VL under a single umbrella that could be the prominent tools for the development of rapid, accurate and cost-effective diagnostic kits for VL which can be used in field conditions.
Collapse
Affiliation(s)
- Awanish Kumar
- Department of Biotechnology, National Institute of Technology, Raipur, India
| | - Satish Chandra Pandey
- Cell and Molecular Biology Laboratory, Department of Zoology, Kumaun University, Almora, India.,Department of Biotechnology, Kumaun University, Nainital, India
| | - Mukesh Samant
- Cell and Molecular Biology Laboratory, Department of Zoology, Kumaun University, Almora, India
| |
Collapse
|
13
|
Abongomera C, van Henten S, Vogt F, Buyze J, Verdonck K, van Griensven J. Prognostic factors for mortality among patients with visceral leishmaniasis in East Africa: Systematic review and meta-analysis. PLoS Negl Trop Dis 2020; 14:e0008319. [PMID: 32413028 PMCID: PMC7255612 DOI: 10.1371/journal.pntd.0008319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 05/28/2020] [Accepted: 04/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a vector-borne disease that is deadly if left untreated. Understanding which factors have prognostic value may help to focus clinical management and reduce case fatality. However, information about prognostic factors is scattered and conflicting. We conducted a systematic review and meta-analysis to identify prognostic factors for mortality among VL patients in East Africa. METHODOLOGY/PRINCIPAL FINDINGS The review protocol was registered in PROSPERO (CRD42016043112). We included studies published in English after 1970 describing VL patients treated in East African health facilities. To be included, studies had to report on associations between clinical or laboratory factors and mortality during admission or during VL treatment, with a minimal study size of ten patients. Conference abstracts and evaluations of genetic or immunological prognostic factors were excluded. We searched for studies in MEDLINE and four other databases in December 2018. To assess the risk of bias in observational studies and clinical trials, we used the Quality in Prognostic Studies (QUIPS) tool. We included 48 studies in the systematic review, describing 150,072 VL patients of whom 7,847 (5.2%) died. Twelve prognostic factors were evaluated in five or more studies and these results were submitted to meta-analysis producing one pooled crude odds ratio (OR) per prognostic factor. The following factors were strongly (OR>3) and significantly (P-value<0.05) associated with mortality: jaundice (OR = 8.27), HIV (OR = 4.60), tuberculosis (OR = 4.06), age >45 years (OR = 3.69), oedema (OR = 3.52), bleeding (OR = 3.37), and haemoglobin ≤6.5 g/dl (OR = 3.26). Factors significantly and moderately (OR between one and three) associated with death were severe malnutrition, long duration of illness, young age (<5 years), and large spleen size. CONCLUSIONS/SIGNIFICANCE These prognostic factors can be identified by health professionals in resource-constrained settings. They should be considered as "core" prognostic factors in future studies that aim at improving the prognosis of VL patients.
Collapse
Affiliation(s)
- Charles Abongomera
- Médecins Sans Frontières, Abdurafi, Ethiopia
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jozefien Buyze
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
14
|
El Safi S, Elshikh H, El Sanousi E, El Amin N, Mohammed A, Verdonck K, Jacobs J, Boelaert M, Chappuis F. Case Report: Visceral Leishmaniasis with Salmonella Paratyphi and Brucella melitensis Coinfection as a Cause of Persistent Fever in a Patient from Sudan. Am J Trop Med Hyg 2019; 99:1150-1152. [PMID: 30255832 PMCID: PMC6221239 DOI: 10.4269/ajtmh.18-0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe the case of a 12-year-old boy from Sudan who presented with fever of 1-week duration, headache, cough, and vomiting. A set of diagnostic tests led to the diagnosis of three infectious diseases: visceral leishmaniasis (probable diagnosis based on positive direct agglutination test), enteric fever (blood culture grown with Salmonella Paratyphi), and brucellosis (blood culture grown with Brucella melitensis). The patient received specific treatment of the three infections and recovered. This case illustrates the occurrence and possible implications of coinfections in patients with persistent fever, including conditions that are hard to diagnose in field settings, such as brucellosis and enteric fever.
Collapse
Affiliation(s)
- Sayda El Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Hussam Elshikh
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Enaam El Sanousi
- Brucella Department, Veterinary Research Institute, Khartoum, Sudan
| | - Nagwa El Amin
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | | | - Jan Jacobs
- Department of Microbiology and Immunology, KU Leuven, University of Leuven, Leuven, Belgium.,Institute of Tropical Medicine, Antwerp, Belgium
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
15
|
Schwartz T, Jensenius M, Blomberg B, Fladeby C, Mæland A, Pettersen FO. Imported visceral leishmaniasis and immunosuppression in seven Norwegian patients. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:16. [PMID: 31463070 PMCID: PMC6704524 DOI: 10.1186/s40794-019-0092-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/09/2019] [Indexed: 01/20/2023]
Abstract
Background Visceral leishmaniasis (VL) is a protozoal disease that may be aggravated by immunosuppression. In recent years, a growing number of patients with chronic diseases use biological treatment. When such immunosuppressed patients travel to endemic areas, they are facing the risk of VL. Increased incidence of leishmaniasis is reported in endemic areas like the Mediterranean basin, an area frequently visited by Norwegian tourists. This may lead to an increased number of patients, many presenting to health personnel unfamiliar with the disease, in their home countries. Methods We reviewed the files of seven immunosuppressed patients with VL, admitted to Oslo and Haukeland University Hospitals in Norway in the period 2009-2018. Results The patients were 41-83 (median 66) years of age; four had rheumatic disease all of whom used methotrexate; one had advanced HIV infection, one had inflammatory bowel disease and one had myelofibrosis. Leishmania infantum was confirmed in five patients by polymerase chain reaction (PCR) and sequencing. In the remaining two patients, a definite Leishmania species could not be identified. All patients had a history of recent recreational travel to Spain. Most patients underwent extensive diagnostic work-up before diagnosed with VL. All received treatment with liposomal amphotericin B and all were cured; albeit two after re-treatment due to relapse. Conclusions Visceral leishmaniasis is a potentially life-threatening but usually treatable condition. It is endemic in Southern Europe, including popular tourist destinations such as the Mediterranean basin. It is relatively unknown to most medical practitioners in non-endemic areas and clinical vigilance is required to identify those who are infected.
Collapse
Affiliation(s)
- Thomas Schwartz
- 1Department of Infectious Diseases, Ullevål, Oslo University Hospital, Oslo, Norway.,Department of Medical Microbiology, Vestre Viken, Drammen, Norway
| | - Mogens Jensenius
- 1Department of Infectious Diseases, Ullevål, Oslo University Hospital, Oslo, Norway
| | - Bjørn Blomberg
- 3Norwegian National Advisory Unit on Tropical Infectious Diseases. Department of Medicine, Haukeland University Hospital, Bergen, Norway.,4Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Cathrine Fladeby
- 5Department of Microbiology, Ullevål, Oslo University Hospital, Oslo, Norway
| | - Arild Mæland
- 1Department of Infectious Diseases, Ullevål, Oslo University Hospital, Oslo, Norway
| | - Frank O Pettersen
- 1Department of Infectious Diseases, Ullevål, Oslo University Hospital, Oslo, Norway.,6Regional Advisory Unit of Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
16
|
Sunyoto T, Potet J, den Boer M, Ritmeijer K, Postigo JAR, Ravinetto R, Alves F, Picado A, Boelaert M. Exploring global and country-level barriers to an effective supply of leishmaniasis medicines and diagnostics in eastern Africa: a qualitative study. BMJ Open 2019; 9:e029141. [PMID: 31152044 PMCID: PMC6549606 DOI: 10.1136/bmjopen-2019-029141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/14/2019] [Accepted: 04/18/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To understand stakeholders' perceptions of the access barriers to quality-assured diagnostics and medicines for leishmaniasis in the high-burden region of eastern Africa, and to identify key bottlenecks to improve the supply of commodities for neglected tropical diseases. DESIGN Desk reviews and qualitative in-depth interview study with purposive sampling. METHODS A landscape analysis through literature and desk review was performed. Next, 29 representatives from international organisations, non-governmental agencies, national control programmes from six countries (Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) and manufacturers were interviewed between May and July 2018. Participants were selected purposively and expanded through a snowballing technique.Data analysis was aided by NVivo, applying the framework method as a part of the thematic content analysis approach. RESULTS The barriers along the visceral leishmaniasis (VL) supply chain were identified as emerging themes, grouped across supply chain activities and health systems component(s). Stakeholders expressed the perception of progress, but bottlenecks persist. VL medicines, in general, lack multisource production capacity and with small market volume, expansion of suppliers is difficult. Procurement is plagued by forecasting difficulties, complex regulatory policies and procedures, and distribution challenges. Weak communication and coordination across different levels resulted in shortages and loss of trust among different actors. Cross-cutting issues spanned from limited political and resource commitment due to low awareness and limited in-country capacity. However, study respondents were optimistic to pursue several remedies, most importantly to build bridges between supply and demand sides through continued dialogue and collaborations. Diagnostics supply has mostly been overlooked; thus, improved investment in this area is needed. CONCLUSIONS Addressing supply barriers in eastern Africa requires consistent, specific efforts at the global and national levels, progressing from current partnerships and agreements. Priority actions include pooled procurement, improved forecast, and increased commitment and resources. Sustainability remains an elusive goal, yet to be integrated into discussions moving forward.
Collapse
Affiliation(s)
- Temmy Sunyoto
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Julien Potet
- Medical Department, Médecins Sans Frontières Access Campaign, Paris, France
| | - Margriet den Boer
- Medical Department, Artsen zonder Grenzen, Amsterdam, The Netherlands
| | - Koert Ritmeijer
- Medical Department, Artsen zonder Grenzen, Amsterdam, The Netherlands
| | - Jose A R Postigo
- Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Raffaella Ravinetto
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Fabiana Alves
- VL Clinical Program, Drugs for Neglected Disease Initiative, Geneva, Switzerland
| | - Albert Picado
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Neglected Tropical Diseases Department, FIND, Geneva, Switzerland
| | - Marleen Boelaert
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| |
Collapse
|
17
|
El Harith A, Mahamoud A, Awad Y, Mansour D, Abass EM, El Agib A, Riscala Madi R, Semiao-Santos SJ, Osman HA. Are We Now Well Prepared for Another Major Visceral Leishmaniasis Epidemic in Sudan? Open Forum Infect Dis 2019; 6:ofz226. [PMID: 31660326 PMCID: PMC6778318 DOI: 10.1093/ofid/ofz226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/14/2019] [Indexed: 11/13/2022] Open
Abstract
To minimize the chance for future visceral leishmaniasis (VL) epidemics such as the 1988-1991 epidemic in Sudan, several VL detection tools have been introduced. There are many VL diagnostics with excellent sensitivities, specificities, and ease of use reported. However, additional test characteristics should be considered for use in the detection of future VL epidemics. The potential for local production or uninterrupted availability, low production and application costs, and stability at ≥45°C are of the utmost importance. Of the antibody-, antigen-, or DNA-based methods introduced, only a liquid direct agglutination test (LQ-DAT) remains in routine use. The LQ-DAT test may be the ideal diagnostic for detection of VL epidemics due to its low cost ($0.50/patient), stability under frequent and long-duration electric failures, and high level of reproducibility. The improved reliability for VL detection achieved locally through incorporating autochthonous L. donovani strains in antigen processing and precluding toxicants in test execution provides optimal sensitivity and safety for routine and mass application.
Collapse
Affiliation(s)
- Abdallah El Harith
- Laboratory of Biomedical Research, Ahfad University for Women, Omdurman, Sudan
| | | | - Yousif Awad
- Laboratory of Biomedical Research, Ahfad University for Women, Omdurman, Sudan
| | - Durria Mansour
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Aljouf, Saudi Arabia
| | - Elfadil Mustafa Abass
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Atif El Agib
- Tropical Medicine Research Institute, Khartoum, Sudan
| | - Rubens Riscala Madi
- Post-graduate Program in Health and Environment, University of Tiradentes, Aracaju, Brazil
| | | | - Hussam Ali Osman
- Laboratory of Biomedical Research, Ahfad University for Women, Omdurman, Sudan
| |
Collapse
|
18
|
Grillet ME, Hernández-Villena JV, Llewellyn MS, Paniz-Mondolfi AE, Tami A, Vincenti-Gonzalez MF, Marquez M, Mogollon-Mendoza AC, Hernandez-Pereira CE, Plaza-Morr JD, Blohm G, Grijalva MJ, Costales JA, Ferguson HM, Schwabl P, Hernandez-Castro LE, Lamberton PHL, Streicker DG, Haydon DT, Miles MA, Acosta-Serrano A, Acquattela H, Basañez MG, Benaim G, Colmenares LA, Conn JE, Espinoza R, Freilij H, Graterol-Gil MC, Hotez PJ, Kato H, Lednicky JA, Martinez CE, Mas-Coma S, Morris JG, Navarro JC, Ramirez JL, Rodriguez M, Urbina JA, Villegas L, Segovia MJ, Carrasco HJ, Crainey JL, Luz SLB, Moreno JD, Noya Gonzalez OO, Ramírez JD, Alarcón-de Noya B. Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region. THE LANCET. INFECTIOUS DISEASES 2019; 19:e149-e161. [PMID: 30799251 DOI: 10.1016/s1473-3099(18)30757-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 11/14/2018] [Accepted: 11/28/2018] [Indexed: 01/19/2023]
Abstract
In the past 5-10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.
Collapse
Affiliation(s)
- Maria E Grillet
- Instituto de Zoología y Ecología Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Martin S Llewellyn
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.
| | - Alberto E Paniz-Mondolfi
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Instituto de Investigaciones Biomédicas IDB, Clinica IDB Cabudare, Cabudare, Venezuela; Instituto de Estudios Avanzados, Caracas, Venezuela
| | - Adriana Tami
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Venezuela
| | - Maria F Vincenti-Gonzalez
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marilianna Marquez
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Instituto de Investigaciones Biomédicas IDB, Clinica IDB Cabudare, Cabudare, Venezuela; Health Sciences Department, College of Medicine, Universidad Centrooccidental Lisandro Alvarado, Barquisimeto, Lara State, Venezuela
| | - Adriana C Mogollon-Mendoza
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Instituto de Investigaciones Biomédicas IDB, Clinica IDB Cabudare, Cabudare, Venezuela; Health Sciences Department, College of Medicine, Universidad Centrooccidental Lisandro Alvarado, Barquisimeto, Lara State, Venezuela
| | - Carlos E Hernandez-Pereira
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Instituto de Investigaciones Biomédicas IDB, Clinica IDB Cabudare, Cabudare, Venezuela; Health Sciences Department, College of Medicine, Universidad Centrooccidental Lisandro Alvarado, Barquisimeto, Lara State, Venezuela
| | - Juan D Plaza-Morr
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Instituto de Investigaciones Biomédicas IDB, Clinica IDB Cabudare, Cabudare, Venezuela; Health Sciences Department, College of Medicine, Universidad Nacional Experimental Francisco de Miranda, Punto Fijo, Falcón State, Venezuela
| | - Gabriella Blohm
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Department of Tropical Medicine and Infectious Diseases, Instituto de Investigaciones Biomédicas IDB, Clinica IDB Cabudare, Cabudare, Venezuela; Emerging Pathogens Institute, Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Mario J Grijalva
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Jaime A Costales
- Center for Research on Health in Latin America, Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Heather M Ferguson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Philipp Schwabl
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | - Poppy H L Lamberton
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Daniel G Streicker
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK; MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Daniel T Haydon
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Michael A Miles
- Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alvaro Acosta-Serrano
- Department of Vector Biology and Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Maria G Basañez
- Department of Vector Biology and Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gustavo Benaim
- Instituto de Biología Experimental, Universidad Central de Venezuela, Caracas, Venezuela; Instituto de Estudios Avanzados, Caracas, Venezuela
| | - Luis A Colmenares
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Jan E Conn
- Griffin Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA; School of Public Health, University at Albany, NY, USA
| | - Raul Espinoza
- Hospital Miguel Pérez Carreño, Instituto Venezolano de los Seguros Sociales, Caracas, Venezuela
| | - Hector Freilij
- Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Mary C Graterol-Gil
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hirotomo Kato
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
| | - John A Lednicky
- Emerging Pathogens Institute, Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Clara E Martinez
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Santiago Mas-Coma
- Departamento de Parasitología, Universidad de Valencia, Valencia, Spain
| | - J Glen Morris
- Emerging Pathogens Institute, Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Juan C Navarro
- Enfermedades Emergentes y Salud Ambiental, Centro de Biodiversidad, Universidad Internacional SEK, Quito, Ecuador
| | - Jose L Ramirez
- Biotechnology Center, Instituto de Estudios Avanzados, Caracas, Venezuela
| | - Marlenes Rodriguez
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Julio A Urbina
- Venezuelan Institute for Scientific Research, Caracas, Venezuela
| | | | - Maikell J Segovia
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Hernan J Carrasco
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - James L Crainey
- Instituto Leônidas e Maria Deane ILMD/FIOCRUZ, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
| | - Sergio L B Luz
- Instituto Leônidas e Maria Deane ILMD/FIOCRUZ, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
| | - Juan D Moreno
- Centro de Investigaciones de Campo "Dr Francesco Vitanza", Servicio Autónomo Instituto de Altos Estudios "Dr Arnoldo Gabaldon", MPPS, Tumeremo, Venezuela
| | - Oscar O Noya Gonzalez
- Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela; Centro de Investigaciones de Campo "Dr Francesco Vitanza", Servicio Autónomo Instituto de Altos Estudios "Dr Arnoldo Gabaldon", MPPS, Tumeremo, Venezuela
| | - Juan D Ramírez
- Grupo de Investigaciones Microbiológicas-UR, Programa de Biología, Universidad del Rosario, Bogotá, Colombia
| | | |
Collapse
|
19
|
Recent Development of Visceral Leishmaniasis Treatments: Successes, Pitfalls, and Perspectives. Clin Microbiol Rev 2018; 31:31/4/e00048-18. [PMID: 30158301 DOI: 10.1128/cmr.00048-18] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Research in visceral leishmaniasis in the last decade has been focused on how better to use the existing medicines as monotherapy or in combination. Systematic research by geographical regions has shown that a universal treatment is far from today's reality. Substantial progress has been made in the elimination of kala-azar in South Asia, with a clear strategy on first- and second-line therapy options of single-dose liposomal amphotericin B and a combination of paromomycin and miltefosine, respectively, among other interventions. In Eastern Africa, sodium stibogluconate (SSG) and paromomycin in combination offer an advantage compared to the previous SSG monotherapy, although not exempted of limitations, as this therapy requires 17 days of painful double injections and bears the risk of SSG-related cardiotoxicity. In this region, attempts to improve the combination therapy have been unsuccessful. However, pharmacokinetic studies have led to a better understanding of underlying mechanisms, like the underexposure of children to miltefosine treatment, and an improved regimen using an allometric dosage. Given this global scenario of progress and pitfalls, we here review what steps need to be taken with existing medicines and highlight the urgent need for oral drugs. Furthermore, it should be noted that six candidates belonging to five new chemical classes are reaching phase I, ensuring an optimistic near future.
Collapse
|
20
|
Abongomera C, Ritmeijer K, Vogt F, Buyze J, Mekonnen Z, Admassu H, Colebunders R, Mohammed R, Lynen L, Diro E, van Griensven J. Development and external validation of a clinical prognostic score for death in visceral leishmaniasis patients in a high HIV co-infection burden area in Ethiopia. PLoS One 2017; 12:e0178996. [PMID: 28582440 PMCID: PMC5459471 DOI: 10.1371/journal.pone.0178996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 05/22/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In Ethiopia, case fatality rates among subgroups of visceral leishmaniasis (VL) patients are high. A clinical prognostic score for death in VL patients could contribute to optimal management and reduction of these case fatality rates. We aimed to identify predictors of death from VL, and to develop and externally validate a clinical prognostic score for death in VL patients, in a high HIV co-infection burden area in Ethiopia. METHODOLOGY/PRINCIPAL FINDINGS We conducted a retrospective cohort study in north west Ethiopia. Predictors with an adjusted likelihood ratio ≥1.5 or ≤0.67 were retained to calculate the predictor score. The derivation cohort consisted of 1686 VL patients treated at an upgraded health center and the external validation cohort consisted of 404 VL patients treated in hospital. There were 99 deaths in the derivation cohort and 53 deaths in the external validation cohort. The predictors of death were: age >40 years (score +1); HIV seropositive (score +1); HIV seronegative (score -1); hemoglobin ≤6.5 g/dl (score +1); bleeding (score +1); jaundice (score +1); edema (score +1); ascites (score +2) and tuberculosis (score +1). The total predictor score per patient ranged from -1 to +5. A score of -1, indicated a low risk of death (1.0%), a score of 0 an intermediate risk of death (3.8%) and a score of +1 to +5, a high risk of death (10.4-85.7%). The area under the receiver operating characteristic curve was 0.83 (95% confidence interval: 0.79-0.87) in derivation, and 0.78 (95% confidence interval: 0.72-0.83) in external validation. CONCLUSIONS/SIGNIFICANCE The overall performance of the score was good. The score can enable the early detection of VL cases at high risk of death, which can inform operational, clinical management guidelines, and VL program management. Implementation of focused strategies could contribute to optimal management and reduction of the case fatality rates.
Collapse
Affiliation(s)
- Charles Abongomera
- Médecins Sans Frontières, Abdurafi, Ethiopia
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koert Ritmeijer
- Public Health Department, Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jozefien Buyze
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Robert Colebunders
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Rezika Mohammed
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
21
|
Zacarias DA, Rolão N, de Pinho FA, Sene I, Silva JC, Pereira TC, Costa DL, Costa CHN. Causes and consequences of higher Leishmania infantum burden in patients with kala-azar: a study of 625 patients. Trop Med Int Health 2017; 22:679-687. [PMID: 28380279 DOI: 10.1111/tmi.12877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND An infected host's Leishmania infantum load in blood is considered to be an estimate of his or her total parasite burden. Therefore, the measurement of blood parasite burden is important in the identification of factors involved in parasite control. METHODS Quantitative polymerase chain reaction was performed on blood samples from 625 patients with kala-azar consecutively admitted to a reference hospital in Teresina, Brazil. Primers were used to amplify a segment of kDNA using the TaqMan system. Non-parametric statistical tests were applied. RESULTS The median blood parasite burden was 499.2 amastigote equivalents (AE)/ml. Children <1 year old (yo) had a high parasite burden, which dropped sharply after the first year of life (192.8, AE/ml at 1 < 2 yo) and remained lower until adolescence. Following adolescence, the parasite burden increased with age, peaking among elderly individuals. Men had a higher parasite burden than women. HIV-infected patients had a much higher parasite burden than non-infected patients. The parasite burden of children under 5 years with acute moderate to severe malnourishment (weight-for-age and body mass index z-scores <-2) was almost three times greater than that of better-nourished children. The parasite burden identified in deceased patients was more than twice that of surviving patients; those with a higher risk of death, sepsis, pneumonia and jaundice also had increased parasite burdens. All of these differences were statistically significant at P-values <0.05. CONCLUSIONS These data indicate that the parasite burden in patients with kala-azar was associated with age- and gender-associated factors and with HIV infection status. Acute malnutrition could be either a cause or a consequence of a higher parasite burden. An individual's parasite burden influences his or her clinical profile, disease severity and mortality risk. The best explanation for the presence of a higher parasite burden in individuals with these immunoregulatory conditions and severe disease is the occurrence of acquired immunosuppression followed by heightened innate immunity.
Collapse
Affiliation(s)
- Danielle A Zacarias
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Nuno Rolão
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Flaviane A de Pinho
- Setor de Patologia Animal, Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | - Ingridi Sene
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Jailthon C Silva
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Teresinha C Pereira
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Dorcas L Costa
- Departamento Materno-Infantil, Universidade Federal do Piauí, Teresina, Brazil
| | - Carlos H N Costa
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| |
Collapse
|
22
|
Kimutai R, Musa AM, Njoroge S, Omollo R, Alves F, Hailu A, Khalil EAG, Diro E, Soipei P, Musa B, Salman K, Ritmeijer K, Chappuis F, Rashid J, Mohammed R, Jameneh A, Makonnen E, Olobo J, Okello L, Sagaki P, Strub N, Ellis S, Alvar J, Balasegaram M, Alirol E, Wasunna M. Safety and Effectiveness of Sodium Stibogluconate and Paromomycin Combination for the Treatment of Visceral Leishmaniasis in Eastern Africa: Results from a Pharmacovigilance Programme. Clin Drug Investig 2017; 37:259-272. [PMID: 28066878 PMCID: PMC5315726 DOI: 10.1007/s40261-016-0481-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In 2010, WHO recommended a new first-line treatment for visceral leishmaniasis (VL) in Eastern Africa. The new treatment, a combination of intravenous (IV) or intramuscular (IM) sodium stibogluconate (SSG) and IM paromomycin (PM) was an improvement over SSG monotherapy, the previous first-line VL treatment in the region. To monitor the new treatment's safety and effectiveness in routine clinical practice a pharmacovigilance (PV) programme was developed. METHODS A prospective PV cohort was developed. Regulatory approval was obtained in Sudan, Kenya, Uganda and Ethiopia. Twelve sentinel sites sponsored by the Ministries of Health, Médecins Sans Frontières (MSF) and Drugs for Neglected Diseases initiative (DNDi) participated. VL patients treated using the new treatment were consented and included in a common registry that collected demographics, baseline clinical characteristics, adverse events, serious adverse events and treatment outcomes. Six-monthly periodic safety update reports (PSUR) were prepared and reviewed by a PV steering committee. RESULTS Overall 3126 patients were enrolled: 1962 (62.7%) from Sudan, 652 (20.9%) from Kenya, 322 (10.3%) from Ethiopia and 190 (6.1%) from Uganda. Patients were mostly male children (68.1%, median age 11 years) with primary VL (97.8%). SSG-PM initial cure rate was 95.1%; no geographical differences were noted. HIV/VL co-infected patients and patients older than 50 years had initial cure rates of 56 and 81.4%, respectively, while 1063 (34%) patients had at least one adverse event (AE) during treatment and 1.92% (n = 60) had a serious adverse event (SAE) with a mortality of 1.0% (n = 32). There were no serious unexpected adverse drug reactions. CONCLUSIONS This first regional PV programme in VL supports SSG-PM combination as first-line treatment for primary VL in Eastern Africa. SSG-PM was effective and safe except in HIV/VL co-infected or older patients. Active PV surveillance of targeted safety, effectiveness and key VL outcomes such us VL relapse, PKDL and HIV/VL co-infection should continue and PV data integrated to national and WHO PV databases.
Collapse
Affiliation(s)
- Robert Kimutai
- Centre for Clinical Research, Kenya Medical Research Institute, PO Box 20778-00202, Off Mbagathi Rd, Nairobi, Kenya.
- Drugs for Neglected Diseases Initiative (DNDi), Nairobi, Kenya.
| | - Ahmed M Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Simon Njoroge
- Centre for Clinical Research, Kenya Medical Research Institute, PO Box 20778-00202, Off Mbagathi Rd, Nairobi, Kenya
| | - Raymond Omollo
- Drugs for Neglected Diseases Initiative (DNDi), Nairobi, Kenya
| | - Fabiana Alves
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Asrat Hailu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Peninah Soipei
- Drugs for Neglected Diseases Initiative (DNDi), Nairobi, Kenya
| | - Brima Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Khalid Salman
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | - Francois Chappuis
- Médecins Sans Frontières, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Juma Rashid
- Centre for Clinical Research, Kenya Medical Research Institute, PO Box 20778-00202, Off Mbagathi Rd, Nairobi, Kenya
| | | | - Asfaw Jameneh
- Arba Minch Hospital, Regional Health Bureau of SNNPR State, Arba Minch, Ethiopia
| | - Eyasu Makonnen
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Nathalie Strub
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Sally Ellis
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | | | - Emilie Alirol
- Médecins Sans Frontières, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Monique Wasunna
- Centre for Clinical Research, Kenya Medical Research Institute, PO Box 20778-00202, Off Mbagathi Rd, Nairobi, Kenya
- Drugs for Neglected Diseases Initiative (DNDi), Nairobi, Kenya
| |
Collapse
|
23
|
Sunyoto T, Potet J, Boelaert M. Visceral leishmaniasis in Somalia: A review of epidemiology and access to care. PLoS Negl Trop Dis 2017; 11:e0005231. [PMID: 28278151 PMCID: PMC5344316 DOI: 10.1371/journal.pntd.0005231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Somalia, ravaged by conflict since 1991, has areas endemic for visceral leishmaniasis (VL), a deadly parasitic disease affecting the rural poor, internally displaced, and pastoralists. Very little is known about VL burden in Somalia, where the protracted crisis hampers access to health care. We reviewed evidence about VL epidemiology in Somalia and appraised control options within the context of this fragile state's health system. VL has been reported in Somalia since 1934 and has persisted ever since in foci in the southern parts of the country. The only feasible VL control option is early diagnosis and treatment, currently mostly provided by nonstate actors. The availability of VL care in Somalia is limited and insufficient at best, both in coverage and quality. Precarious security remains a major obstacle to reach VL patients in the endemic areas, and the true VL burden and its impact remain unknown. Locally adjusted, innovative approaches in VL care provision should be explored, without undermining ongoing health system development in Somalia. Ensuring VL care is accessible is a moral imperative, and the limitations of the current VL diagnostic and treatment tools in Somalia and other endemic settings affected by conflict should be overcome.
Collapse
Affiliation(s)
- Temmy Sunyoto
- Institute of Tropical Medicine, Antwerp, Belgium
- Médecins sans Frontières Campaign for Access to Medicines, Geneva, Switzerland
| | - Julien Potet
- Médecins sans Frontières Campaign for Access to Medicines, Geneva, Switzerland
| | | |
Collapse
|
24
|
Ahmed MAA, Ahmed AA, Omar SM, Adam GK, Abdallah TM, Ali AA. Epidemiology of visceral leishmaniasis among children in Gadarif hospital, eastern Sudan. BMC Public Health 2016; 16:1234. [PMID: 27927185 PMCID: PMC5142353 DOI: 10.1186/s12889-016-3875-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 1900s, visceral leishmaniasis (VL) has been among the most important health problems in Sudan, particularly in the endemic areas such as eastern and central regions. METHODS This was a cross sectional, hospital-based study conducted from 1st January 2015 to 31st December 2015 to investigate the epidemiological factors of VL in Gadarif hospital, eastern Sudan. RESULTS During the study period there were 47 identified children with VL among 145 suspected cases. The most common clinical presentations were fever (47, 100%), pallor (47, 100%), weight loss (40, 85.1%), splenomegaly (37, 78.7%), lymphadenopathy (33, 70.2%), vomiting (32, 68%) cough (28, 59%), loss of appetite (22, 46.8%), diarrhoea (17, 36.1%) and jaundice (5, 10.6%). With regard to the outcome after short term follow up 37 patients (78.8%) improved without complications, while 3 (6.4%, 2 (4.3%), 2 (4.3%), 1 (2.1%), 1 (2.1%) and 1 (2.1%) developed pneumonia, otitis media, septicaemia, urinary tract infection, parasitic infestation and PKDL respectively. Lower mean of haemoglobin level was observed among the VL cases in comparison with the suspected cases (in whom VL was excluded) haemoglobin level {8.9 (3.1) Vs 11 (6.3), P = 0.021}. Again more proportion of anaemic (47 (100%) Vs 14 (14.2%), P = 0.000) and severely anaemic (23 (48.9%) Vs 2 (2%), P = 0.006) patients was detected among the infected children. Using logistic regression analyses there was significant association between rural residence (CI = 1.5-24, OR = 19.1, P = 0.023), male gender (CI = 6.6-18.7, OR = 6.4, P = 0.001) and VL among children. CONCLUSIONS While there is an advance in prevention and management of visceral leishmaniasis our results indicate that VL is still a public health problem with its severe complications among children in eastern Sudan.
Collapse
Affiliation(s)
| | | | - Saeed M. Omar
- Faculty of Medicine, Gadarif University, Gadarif, Sudan
| | - Gamal K. Adam
- Faculty of Medicine, Gadarif University, Gadarif, Sudan
| | - Tajeldin M. Abdallah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, P.O. Box 496, Kassala, Sudan
| | - AbdelAziem A. Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, P.O. Box 496, Kassala, Sudan
| |
Collapse
|
25
|
Elnaiem DA, Ward RD, Hassan HK, Miles MA, Frame IA. Infection rates ofLeishmania donovaniinPhlebotomus orientalisfrom a focus of visceral leishmaniasis in eastern Sudan. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.1998.11813284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
26
|
Elnaiem DA, Connor SJ, Thomson MC, Hassan MM, Hassan HK, Aboud MA, Ashford RW. Environmental determinants of the distribution ofPhlebotomus orientalisin Sudan. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.1998.11813353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
27
|
Berry I, Berrang-Ford L. Leishmaniasis, conflict, and political terror: A spatio-temporal analysis. Soc Sci Med 2016; 167:140-9. [DOI: 10.1016/j.socscimed.2016.04.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 03/06/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
|
28
|
Abstract
Visceral leishmaniasis (VL or kala-azar) is most endemic in Asia and Africa and commonly affects young children. It is usually caused by Leishmania donovani or Leishmania infantum that are transmitted by Phlebotomine sand flies. Transmission may be anthroponotic or zoonotic or both, depending on the endemic area. Clinical features include fever, hepatosplenomegaly, weight loss and pancytopenia. Younger age, malnutrition and immunosuppression (HIV infection, use of immunosuppressive drugs) are risk factors. Many infections remain asymptomatic. Diagnosis is made by demonstration of the Leishmania parasite in aspirates of lymph node, bone marrow or spleen. Serological tests such as rK39 strip test are widely used but the sensitivity varies. qPCR is useful to detect low numbers of parasites and to monitor treatment. Treatment is with AmBisome monotherapy in most areas but with drug combinations elsewhere. HIV co-infected patients are most difficult to treat and often relapse. Control efforts focus on case finding, availability of diagnostic tools, reservoir control and protection from sand flies (insecticides, bed nets). There is no human vaccine.
Collapse
|
29
|
Du R, Hotez PJ, Al-Salem WS, Acosta-Serrano A. Old World Cutaneous Leishmaniasis and Refugee Crises in the Middle East and North Africa. PLoS Negl Trop Dis 2016; 10:e0004545. [PMID: 27227772 PMCID: PMC4882064 DOI: 10.1371/journal.pntd.0004545] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Rebecca Du
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Peter J. Hotez
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- James A. Baker III Institute, Rice University, Houston, Texas, United States of America
| | - Waleed S. Al-Salem
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
| | - Alvaro Acosta-Serrano
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
| |
Collapse
|
30
|
Gillespie PM, Beaumier CM, Strych U, Hayward T, Hotez PJ, Bottazzi ME. Status of vaccine research and development of vaccines for leishmaniasis. Vaccine 2016; 34:2992-2995. [PMID: 26973063 DOI: 10.1016/j.vaccine.2015.12.071] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 12/31/2015] [Indexed: 01/15/2023]
Abstract
A number of leishmaniasis vaccine candidates are at various stages of pre-clinical and clinical development. Leishmaniasis is a vector-borne neglected tropical disease (NTD) caused by a protozoan parasite of the genus Leishmania and transmitted to humans by the bite of a sand fly. Visceral leishmaniasis (VL, kala-azar) is a high mortality NTD found mostly in South Asia and East Africa, while cutaneous leishmaniasis (CL) is a disfiguring NTD highly endemic in the Middle East, Central Asia, North Africa, and the Americas. Estimates attribute 50,000 annual deaths and 3.3 million disability-adjusted life years to leishmaniasis. There are only a few approved drug treatments, no prophylactic drug and no vaccine. Ideally, an effective vaccine against leishmaniasis will elicit long-lasting immunity and protect broadly against VL and CL. Vaccines such as Leish-F1, F2 and F3, developed at IDRI and designed based on selected Leishmania antigen epitopes, have been in clinical trials. Other groups, including the Sabin Vaccine Institute in collaboration with the National Institutes of Health are investigating recombinant Leishmania antigens in combination with selected sand fly salivary gland antigens in order to augment host immunity. To date, both VL and CL vaccines have been shown to be cost-effective in economic modeling studies.
Collapse
Affiliation(s)
- Portia M Gillespie
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA
| | - Coreen M Beaumier
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA
| | - Ulrich Strych
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA
| | | | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA; Sabin Vaccine Institute, Washington, DC, USA; Department of Biology, Baylor University, Waco, TX, USA; Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA; Sabin Vaccine Institute, Washington, DC, USA; Department of Biology, Baylor University, Waco, TX, USA; Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
31
|
Georgiadou SP, Makaritsis KP, Dalekos GN. Leishmaniasis revisited: Current aspects on epidemiology, diagnosis and treatment. J Transl Int Med 2015; 3:43-50. [PMID: 27847886 PMCID: PMC4936444 DOI: 10.1515/jtim-2015-0002] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Leishmaniasis is a vector-borne disease caused by protozoan parasites of the genus Leishmania. It is transmitted by phlebotomine female sand flies of the genera Phlebotomus and Lutzomyia in the old and new world, respectively. More than 20 well-recognized Leishmania species are known to infect humans and cause visceral (VL), cutaneous (CL) and mucocutaneous (ML) forms of the disease. Approximately 350 million people are at risk of contracting the disease and an estimated 1.6 million new cases occur annually. The disease mainly affects poor people in Africa, Asia and Latin America, and is associated with malnutrition, population migration, poor residency conditions, frail immune system and lack of resources. Previously, diagnosis of leishmaniasis relied mainly on invasive techniques of detecting parasites in splenic and bone marrow aspirates. Nevertheless, serological tests using the recombinant kinesin antigen (rK39) and molecular methods (polymerase chain reaction) are considered the best options for diagnosis today, despite problems related to varying sensitivities and specificities and field adaptability. Therapy of leishmaniasis ranges from local treatment of cutaneous lesions to systemic often toxic, therapy for disseminated CL, ML and VL. Agents with efficacy against leishmaniasis include amphotericin B, pentavalent antimonial drugs, paromomycin and miltefosine. No single therapy of VL currently offers satisfactory efficacy along with safety. This article provides a brief and updated systematic review on the epidemiology, diagnosis and treatment of this neglected disease.
Collapse
Affiliation(s)
- Sarah P Georgiadou
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Konstantinos P Makaritsis
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| |
Collapse
|
32
|
Lemma W, Tekie H, Yared S, Balkew M, Gebre-Michael T, Warburg A, Hailu A. Sero-prevalence of Leishmania donovani infection in labour migrants and entomological risk factors in extra-domestic habitats of Kafta-Humera lowlands - kala-azar endemic areas in the northwest Ethiopia. BMC Infect Dis 2015; 15:99. [PMID: 25884167 PMCID: PMC4347912 DOI: 10.1186/s12879-015-0830-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/11/2015] [Indexed: 01/07/2023] Open
Abstract
Background Visceral leishmaniasis (VL) or kala-azar cases in seasonal labour migrants from highland areas are addressed to travel history to the Metema–Humera lowlands, northwestern Ethiopia. Factors that affect the incidence of VL in extra-domestic habitats were not evaluated. The aim of this study was to evaluate sero-prevalence of Leishmania donovani infection in randomly selected labour migrant workers and entomological risk factors which might affect the incidence of kala-azar. Methods Sero-prevalence of L. donovani infection in labour migrants was obtained from Direct Agglutination Test (DAT) using blood samples. Logistic regression analysis was used to correlate the possible risk factors with L. donovani infection. The season for L. donovani infection or Phlebotomus orientalis bite was estimated from the study of population dynamic of P. orientalis in areas where the blood was sampled. Result A total of 7, 443 P. orientalis (1,748 female and 5,695 male) were collected from agricultural fields and thickets of Acacia seyal using 461 CDC light traps. The highest mean number of P. orientalis/trap in the thickets of A. seyal and agricultural fields were 46.9 and 43.9 in March and April respectively. The mean P. orientalis/trap for November – May dry season in agricultural fields (11.39) and thickets of A. seyal (25.30) were higher compared to 0.66 in fields and 3.92 in thickets during June – August weeding season. Of the total 359 labour migrants screened using DAT, 45 (12.5%) were DAT-positive (≥1:800) for L. donovani infections. Very high titers (1:12800) were found in 3 (0.8%) individuals who had the risk of kala-azar development. Statistically significant p-values and odd ratio (OR) for staying in the areas both in the weeding and harvesting seasons (p = 0.035; OR = 2.83) and sleeping in the agricultural fields (p = 0.01; OR = 15.096) were positively correlated with L. donovani infection. Night harvest (p = 0.028; OR = 0.133) and knowledge about sign or symptoms (p = 0.042; OR = 0.383) were negatively associated with this infection. Conclusions Sleeping in open agricultural fields was related with L. donovani infections in labour migrants during June-August weeding season.
Collapse
Affiliation(s)
- Wossenseged Lemma
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Department of Zoological Sciences, College of Natural Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Habte Tekie
- Department of Zoological Sciences, College of Natural Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Solomon Yared
- Department of Biology, College of Natural Science, Jigjiga University, Jigjiga, Ethiopia.
| | - Meshesha Balkew
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Teshome Gebre-Michael
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Alon Warburg
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research Israel-Canada, The Kuvin Centre for the Study of Infectious & Tropical Diseases, The Hebrew University - Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel.
| | - Asrat Hailu
- Department of Microbiology, Immunology & Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| |
Collapse
|
33
|
Lemma W, Tekie H, Abassi I, Balkew M, Gebre-Michael T, Warburg A, Hailu A. Nocturnal activities and host preferences of Phlebotomus orientalis in extra-domestic habitats of Kafta-Humera lowlands, Kala-azar endemic, Northwest Ethiopia. Parasit Vectors 2014; 7:594. [PMID: 25515239 PMCID: PMC4279602 DOI: 10.1186/s13071-014-0594-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/06/2014] [Indexed: 11/24/2022] Open
Abstract
Background Phlebotomus orientalis feeds on a variety of wild and domestic animals and transmits Leishmania donovani from hitherto unknown reservoir hosts to humans in extra-domestic habitats in the Metema - Humera lowlands. The aim of this study was to determine the nocturnal activities of P. orientalis and its preferred blood meal hosts. Methods Collections of Phlebotomus orientalis were made by using CDC light traps to determine the density as P. orientalis/hour CDC trap and preference to rodents by using Turner’s traps in agricultural fields, animal shelters and thickets of Acacia seyal in Baeker site-1 and Gelanzeraf site-2. The blood meal sources were detected by Reverse Line Blot (RLB) of cytochrome b polymerase chain reaction (PCR) amplification in August, 2012 from collections of sand flies in thickets of A. seyal (March 2011) and dense mixed forest (July 2011) in Baeker site 1. RLB PCR involved first amplification of animal specific sequences of cytochrome b using PCR techniques. Then the amplified sequence was hybridized with 11 species-specific probes for domestic animals adsorbed on nitrocellulose membrane for calorimetric color detection. Results A total of 6,083 P. orientalis (2,702 males and 3,381 females) were collected at hourly intervals using 22 CDC traps from January to May 2013. The peak activities of P. orientalis were at 1.00 a.m (134.0 ± 7.21) near animal shelters, 3.00 a.m (66.33 ± 46.40) in agricultural fields and 21:00 pm (40.6 ± 30.06) in thickets of A. seyal. This species was not attracted to the different species of rodents in trials carried out in March and April 2013. RLB PCR identified 7 human (28%), 9 mixed (human and cattle) (36%) and 2 cattle (8%) blood meals while 7 were unknown (28%). Conclusion Female P. orientalis can bite humans in extra-domestic habitats of Kafta-Humera lowlands at any hour of the night with peak biting after midnight.
Collapse
Affiliation(s)
- Wossenseged Lemma
- Department of Parasitology, School of Biomedical & Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Department of Zoological Sciences, College of Natural Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Habte Tekie
- Department of Zoological Sciences, College of Natural Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ibrahim Abassi
- Department of Microbiology & Molecular Genetics, The Institute for Medical Research Israel-Canada, Jerusalem, Israel. .,The Kuvin Centre for the Study of Infectious & Tropical Diseases, The Hebrew University - Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel.
| | - Meshesha Balkew
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Teshome Gebre-Michael
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Alon Warburg
- Department of Microbiology & Molecular Genetics, The Institute for Medical Research Israel-Canada, Jerusalem, Israel. .,The Kuvin Centre for the Study of Infectious & Tropical Diseases, The Hebrew University - Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel.
| | - Asrat Hailu
- Department of Microbiology, Immunology & Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| |
Collapse
|
34
|
Leishmania donovani populations in Eastern Sudan: temporal structuring and a link between human and canine transmission. Parasit Vectors 2014; 7:496. [PMID: 25410888 PMCID: PMC4255451 DOI: 10.1186/s13071-014-0496-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL), caused by the members of the Leishmania donovani complex, has been responsible for devastating VL epidemics in the Sudan. Multilocus microsatellite and sequence typing studies can provide valuable insights into the molecular epidemiology of leishmaniasis, when applied at local scales. Here we present population genetic data for a large panel of strains and clones collected in endemic Sudan between 1993 and 2001. METHODS Genetic diversity was evaluated at fourteen microsatellite markers and eleven nuclear sequence loci across 124 strains and clones. RESULTS Microsatellite data defined six genetic subpopulations with which the nuclear sequence data were broadly congruent. Pairwise estimates of FST (microsatellite) and KST (sequence) indicated small but significant shifts among the allelic repertoires of circulating strains year on year. Furthermore, we noted the co-occurrence of human and canine L. donovani strains in three of the six clusters defined. Finally, we identified widespread deficit in heterozygosity in all four years tested but strong deviation from inter-locus linkage equilibrium in two years. CONCLUSIONS Significant genetic diversity is present among L. donovani in Sudan, and minor population structuring between years is characteristic of entrenched, endemic disease transmission. Seasonality in vector abundance and transmission may, to an extent, explain the shallow temporal clines in allelic frequency that we observed. Genetically similar canine and human strains highlight the role of dogs as important local reservoirs of visceral leishmaniasis.
Collapse
|
35
|
Alawieh A, Musharrafieh U, Jaber A, Berry A, Ghosn N, Bizri AR. Revisiting leishmaniasis in the time of war: the Syrian conflict and the Lebanese outbreak. Int J Infect Dis 2014; 29:115-9. [PMID: 25449245 DOI: 10.1016/j.ijid.2014.04.023] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 04/17/2014] [Accepted: 04/22/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Leishmaniasis is a neglected tropical disease, endemic in many worldwide foci including the Middle East. Several outbreaks have occurred in the Middle East over the past decades, mostly related to war-associated population migration. With the start of the Syrian war, the frequency and magnitude of these outbreaks increased alarmingly. We describe the epidemiology of Leishmania infection in Lebanon and the most recent outbreak relevant to the Syrian war. METHODS We reviewed all leishmaniasis cases reported to the Epidemiologic Surveillance Department at the Lebanese Ministry of Public Health between 2001 and the first quarter of 2014. The demographics and distribution of Syrian refugees in Lebanon were linked to reports of new Leishmania cases. RESULTS In total, 1033 new cases of leishmaniasis were reported in 2013 compared to a previous annual number in the range of 0-6 cases. The majority of cases reported in 2013 involved Syrian refugees and their relevant areas of concentration. CONCLUSIONS This new outbreak of leishmaniasis in Lebanon is the first of its kind for more than a decade. The sudden increase in Leishmania cases in Lebanon in 2013 is attributed to the increasing numbers and wide distribution of Syrian refugees in Lebanon. This serves as an example of the risks associated with military conflicts and the ability of communicable diseases to cross borders.
Collapse
Affiliation(s)
- Ali Alawieh
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA; Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Umayya Musharrafieh
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amani Jaber
- Faculty of Medicine, Lebanese American University, Jbeil, Lebanon
| | - Atika Berry
- Communicable Diseases Department, Ministry of Public Health, Beirut, Lebanon
| | - Nada Ghosn
- Epidemiological Surveillance Department, Ministry of Public Health, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
36
|
Abstract
Leishmaniasis is a major health problem worldwide, with several countries reporting cases of leishmaniasis resulting in loss of human life or a lifelong stigma because of bodily scars. The Middle East is endemic for cutaneous leishmaniasis, with countries like Syria reporting very high incidence of the disease. Despite several countries establishing national control programs for containing the sandfly vector and treatment of infection, the disease continues to spread. In addition to the endemicity of the region for leishmaniasis, the Middle East has seen a great deal of human migration either for earning of livelihood or due to political upheaval in the region. These factors contribute to the spread and proliferation of the causative species Leishmania and its sandfly host. This review discusses the current epidemiological scenario in Iraq, Syria, Saudi Arabia, and Jordan, emphasizing the number of cases reported, vector species, Leishmania species, and treatment available. The data is primarily from WHO reports for each country and current and old literature.
Collapse
Affiliation(s)
- Nasir Salam
- Department of Biochemistry, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
- * E-mail:
| | - Waleed Mohammed Al-Shaqha
- Department of Pharmacology, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Arezki Azzi
- Department of Pharmacology, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| |
Collapse
|
37
|
Diro E, Lynen L, Ritmeijer K, Boelaert M, Hailu A, van Griensven J. Visceral Leishmaniasis and HIV coinfection in East Africa. PLoS Negl Trop Dis 2014; 8:e2869. [PMID: 24968313 PMCID: PMC4072530 DOI: 10.1371/journal.pntd.0002869] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Visceral Leishmaniasis (VL) is an important protozoan opportunistic disease in HIV patients in endemic areas. East Africa is second to the Indian subcontinent in the global VL caseload and first in VL-HIV coinfection rate. Because of the alteration in the disease course, the diagnostic challenges, and the poor treatment responses, VL with HIV coinfection has become a very serious challenge in East Africa today. Field experience with the use of liposomal amphotericin B in combination with miltefosine, followed by secondary prophylaxis and antiretroviral drugs, looks promising. However, this needs to be confirmed through clinical trials. Better diagnostic and follow-up methods for relapse and prediction of relapse should also be looked for. Basic research to understand the immunological interaction of the two infections may ultimately help to improve the management of the coinfection.
Collapse
Affiliation(s)
- Ermias Diro
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koert Ritmeijer
- Public Health Department, Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Asrat Hailu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
38
|
Boelaert M, Verdonck K, Menten J, Sunyoto T, van Griensven J, Chappuis F, Rijal S. Rapid tests for the diagnosis of visceral leishmaniasis in patients with suspected disease. Cochrane Database Syst Rev 2014; 2014:CD009135. [PMID: 24947503 PMCID: PMC4468926 DOI: 10.1002/14651858.cd009135.pub2] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The diagnosis of visceral leishmaniasis (VL) in patients with fever and a large spleen relies on showing Leishmania parasites in tissue samples and on serological tests. Parasitological techniques are invasive, require sophisticated laboratories, consume time, or lack accuracy. Recently, rapid diagnostic tests that are easy to perform have become available. OBJECTIVES To determine the diagnostic accuracy of rapid tests for diagnosing VL in patients with suspected disease presenting at health services in endemic areas. SEARCH METHODS We searched MEDLINE, EMBASE, LILACS, CIDG SR, CENTRAL, SCI-expanded, Medion, Arif, CCT, and the WHO trials register on 3 December 2013, without applying language or date limits. SELECTION CRITERIA This review includes original, phase III, diagnostic accuracy studies of rapid tests in patients clinically suspected to have VL. As reference standards, we accepted: (1) direct smear or culture of spleen aspirate; (2) composite reference standard based on one or more of the following: parasitology, serology, or response to treatment; and (3) latent class analysis. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed quality of included studies using the QUADAS-2 tool. Discrepancies were resolved by a third author. We carried out a meta-analysis to estimate sensitivity and specificity of rapid tests, using a bivariate normal model with a complementary log-log link function. We analysed each index test separately. As possible sources of heterogeneity, we explored: geographical area, commercial brand of index test, type of reference standard, disease prevalence, study size, and risk of bias (QUADAS-2). We also undertook a sensitivity analysis to assess the influence of imperfect reference standards. MAIN RESULTS Twenty-four studies containing information about five index tests (rK39 immunochromatographic test (ICT), KAtex latex agglutination test in urine, FAST agglutination test, rK26 ICT, and rKE16 ICT) recruiting 4271 participants (2605 with VL) were included. We carried out a meta-analysis for the rK39 ICT (including 18 studies; 3622 participants) and the latex agglutination test (six studies; 1374 participants). The results showed considerable heterogeneity. For the rK39 ICT, the overall sensitivity was 91.9% (95% confidence interval (95% CI) 84.8 to 96.5) and the specificity 92.4% (95% CI 85.6 to 96.8). The sensitivity was lower in East Africa (85.3%; 95% CI 74.5 to 93.2) than in the Indian subcontinent (97.0%; 95% CI 90.0 to 99.5). For the latex agglutination test, overall sensitivity was 63.6% (95% CI 40.9 to 85.6) and specificity 92.9% (95% CI 76.7 to 99.2). AUTHORS' CONCLUSIONS The rK39 ICT shows high sensitivity and specificity for the diagnosis of visceral leishmaniasis in patients with febrile splenomegaly and no previous history of the disease, but the sensitivity is notably lower in east Africa than in the Indian subcontinent. Other rapid tests lack accuracy, validation, or both.
Collapse
Affiliation(s)
| | | | | | | | | | - Francois Chappuis
- Geneva University HospitalsDivision of International and Humanitarian MedicineRue Gabrielle‐Perret‐Gentil, 61211GenevaSwitzerland14
| | - Suman Rijal
- BP Koirala Institute of Health SciencesDepartment of Internal MedicineGhopaDharanSunsariNepal056700
| | | |
Collapse
|
39
|
Abubakar A, Ruiz-Postigo JA, Pita J, Lado M, Ben-Ismail R, Argaw D, Alvar J. Visceral leishmaniasis outbreak in South Sudan 2009-2012: epidemiological assessment and impact of a multisectoral response. PLoS Negl Trop Dis 2014; 8:e2720. [PMID: 24675573 PMCID: PMC3967947 DOI: 10.1371/journal.pntd.0002720] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
| | | | - Jane Pita
- World Health Organization, Juba, South Sudan
| | | | | | | | - Jorge Alvar
- World Health Organization, Geneva, Switzerland
| |
Collapse
|
40
|
Silva JM, Zacarias DA, de Figueirêdo LC, Soares MRA, Ishikawa EAY, Costa DL, Costa CHN. Bone marrow parasite burden among patients with New World kala-azar is associated with disease severity. Am J Trop Med Hyg 2014; 90:621-6. [PMID: 24615127 DOI: 10.4269/ajtmh.13-0376] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Kala-azar or visceral leishmaniasis, found mostly throughout the Indian Subcontinent, East Africa, and Brazil, kills 20,000-40,000 persons annually. The agents, Leishmania donovani and Leishmania infantum, are obligatory intracellular protozoa of mononuclear phagocytes found principally in the spleen and bone marrow. Protracted fever, anemia, wasting, hepatosplenomegaly, hemorrhages, and bacterial co-infections are typical features. One hundred and twenty-two (122) in-hospital patients were studied to verify if higher bone marrow parasite load estimated by quantitative polymerase chain reaction is associated with severe disease. The estimated median parasite load was 5.0 parasites/10(6) human nucleated cells. It is much higher in deceased than among survivors (median 75.0 versus 4.2). Patients who lost more weight had a higher parasite burden, as well as patients with epistaxis, abdominal pain, edema, and jaundice. This study suggests that higher parasite load is influenced by wasting, which may lead to more severe disease.
Collapse
Affiliation(s)
- Joyce M Silva
- Laboratory of Leishmaniasis, Institute of Tropical Diseases "Natan Portella", Federal University of Piauí, Teresina, PI, Brazil; Department of Biology, Federal University of Piauí, Floriano at Floriano, PI, Brazil; Maternal and Childhood Department, Federal University of Piauí, Teresina, PI, Brazil; Laboratory of Molecular Biology, Nucleus of Tropical Medicine, Federal University of Pará, Belém, PA, Brazil; Department of Community Medicine, Federal University of Piauí, Teresina, PI, Brazil
| | | | | | | | | | | | | |
Collapse
|
41
|
Bhattacharyya T, Bowes DE, El-Safi S, Sundar S, Falconar AK, Singh OP, Kumar R, Ahmed O, Boelaert M, Miles MA. Significantly lower anti-Leishmania IgG responses in Sudanese versus Indian visceral leishmaniasis. PLoS Negl Trop Dis 2014; 8:e2675. [PMID: 24587456 PMCID: PMC3930516 DOI: 10.1371/journal.pntd.0002675] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL), a widely distributed systemic disease caused by infection with the Leishmania donovani complex (L. donovani and L. infantum), is almost always fatal if symptomatic and untreated. A rapid point-of-care diagnostic test for anti-Leishmania antibodies, the rK39-immunochromatographic test (rK39-ICT), has high sensitivity and specificity in South Asia but is less sensitive in East Africa. One of the underlying reasons may be continent-specific molecular diversity in the rK39 antigen within the L. donovani complex. However, a second reason may be differences in specific IgG anti-Leishmania levels in patients from different geographical regions, either due to variable antigenicity or immunological response. METHODOLOGY/PRINCIPAL FINDINGS We determined IgG titres of Indian and Sudanese VL patients against whole cell lysates of Indian and Sudanese L. donovani strains. Indian VL patients had significantly higher IgG titres against both L. donovani strains compared to Sudanese VL patients (p<0.0001). Mean reciprocal log10 50% end-point titres (1/log10t50) were i) 3.80 and 3.88 for Indian plasma and ii) 2.13 and 2.09 for Sudanese plasma against Indian and Sudanese antigen respectively (p<0.0001). Overall, the Indian VL patients therefore showed a 46.8-61.7 -fold higher mean ELISA titre than the Sudanese VL patients. The higher IgG titres occurred in children (<16 years old) and adults of either sex from India (mean 1/log10t50: 3.60-4.15) versus Sudan (mean 1/log10t50: 1.88-2.54). The greatest difference in IgG responses was between male Indian and Sudanese VL patients of ≥ 16 years old (mean 1/log10t50: 4.15 versus 1.99 = 144-fold (p<0.0001). CONCLUSIONS/SIGNIFICANCE Anti-Leishmania IgG responses among VL patients in Sudan were significantly lower than in India; this may be due to chronic malnutrition with Zn(2+) deficiency, or variable antigenicity and capacity to generate IgG responses to Leishmania antigens. Such differential anti-Leishmania IgG levels may contribute to lower sensitivity of the rK39-ICT in East Africa.
Collapse
Affiliation(s)
- Tapan Bhattacharyya
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Duncan E. Bowes
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sayda El-Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | - Om Prakash Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rajiv Kumar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- Immunology and Infection Laboratory, Queensland Institute of Medical Research, Herston, Queensland, Australia
| | - Osman Ahmed
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Department of Laboratory Medicine, Karolinska Insitutet, Stockholm, Sweden
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Michael A. Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
42
|
Murray HW. Progress in the treatment of a neglected infectious disease: visceral leishmaniasis. Expert Rev Anti Infect Ther 2014; 2:279-92. [PMID: 15482193 DOI: 10.1586/14787210.2.2.279] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Visceral leishmaniasis (kala-azar) is a disseminated intracellular protozoal infection. Most cases (90%) occur in the rural regions of five countries: India, Sudan, Nepal, Bangladesh and Brazil. As with other infectious diseases embedded in high-level poverty, developing and/or delivering new treatments for visceral leishmaniasis had been painfully slow or nonexistent. However, despite persistent unresolved obstacles (e.g., drug affordability), renewed interest in visceral leishmaniasis and numerous successful treatment trials have combined to turn a therapeutic corner in the past 5 years, yielding new alternatives to conventional pentavalent antimony. Advances include the use of low-cost generic pentavalent antimony, rediscovery of amphotericin B, short-course regimens via lipid formulations of amphotericin B, retesting injectible paromyomycin and, of clear-cut importance, identifying miltefosine (Impavido, Zentaris) as the first effective oral therapy for this neglected disease.
Collapse
Affiliation(s)
- Henry W Murray
- Department of Medicine, Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA.
| |
Collapse
|
43
|
M Nail A, M Imam A. Visceral leishmaniasis: Clinical and demographic features in an African population. Pak J Med Sci 2013; 29:485-9. [PMID: 24353561 PMCID: PMC3809264 DOI: 10.12669/pjms.292.3151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 03/13/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical and demographic features of patients with visceral leishmaniasis (VL), from Sudan, Africa. METHODOLOGY A descriptive study was conducted during 5 years period on confirmed VL patients. These patients are, originally, from White Nile Province (WNP) region, a previously non-endemic VL focus which is located in southern part of Sudan. They were referred during the period 2006-2010 for management at Tropical Diseases Hospital (TDH) in the capital Khartoum. The patients data were retrieved from the hospital electronic software system, and were studied. RESULTS A total of 71 patients with VL were reviewed. The main clinical features were: fever 68 (95.8%), splenomegaly 66 (93%), weight loss 61 (85.9%), pallor 59 (83.1%), hepatomegaly 52 (73.2%). The most notable haematology finding was the mean Hb value (7.6 g/dL) on admission to hospital. Gender showed males at higher risk for VL as compared to females with a ratio of 3:1 (53 vs 18). VL was largely a disease of children with 42 (59.1%) aged < 15 year, and around quarter (23.9%) under 5 years. CONCLUSION The clinical features of Sudanese VL in WNP region is, generally, similar to the pattern seen globally in endemic foci. The majority of the study population are paediatric indigenous VL patients, suggesting that adults were immune, and indicating change of disease pattern from previous sporadic to present endemic. This finding emphasizes the need for research to better understand VL in non-endemic areas with the objective of developing effective and sustainable control strategies.
Collapse
Affiliation(s)
- Abdelsalam M Nail
- Abdelsalam M. Nail, MBBS, MD, MSc (Tropical Medicine), Department of Medicine, College of Medicine
| | - Abdelmageed M Imam
- Jouf University, Jouf, Kingdom of Saudi Arabia. Abdelmageed M. Imam, MBBS, PhD, DTM&H, Parasitology Unit, College of Medicine, Qassim University, Qassim, Kingdom of Saudi Arabia
| |
Collapse
|
44
|
Gramiccia M, Scalone A, Di Muccio T, Orsini S, Fiorentino E, Gradoni L. The burden of visceral leishmaniasis in Italy from 1982 to 2012: a retrospective analysis of the multi-annual epidemic that occurred from 1989 to 2009. Euro Surveill 2013. [DOI: 10.2807/1560-7917.es2013.18.29.20535] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
45
|
van den Bogaart E, Berkhout MMZ, Nour ABYM, Mens PF, Talha ABA, Adams ER, Ahmed HBM, Abdelrahman SH, Ritmeijer K, Nour BYM, Schallig HDFH. Concomitant malaria among visceral leishmaniasis in-patients from Gedarif and Sennar States, Sudan: a retrospective case-control study. BMC Public Health 2013; 13:332. [PMID: 23577673 PMCID: PMC3659061 DOI: 10.1186/1471-2458-13-332] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 04/01/2013] [Indexed: 11/15/2022] Open
Abstract
Background In areas where visceral leishmaniasis (VL) and malaria are co-endemic, co-infections are common. Clinical implications range from potential diagnostic delay to increased disease-related morbidity, as compared to VL patients. Nevertheless, public awareness of the disease remains limited. In VL-endemic areas with unstable and seasonal malaria, vulnerability to the disease persists through all age-groups, suggesting that in these populations, malaria may easily co-occur with VL, with potentially severe clinical effects. Methods A retrospective case-control study was performed using medical records of VL patients admitted to Tabarakallah and Gedarif Teaching Hospitals (Gedarif State) and Al`Azaza kala-azar Clinic (Sennar State), Sudan (2005-2010). Patients positively diagnosed with VL and malaria were identified as cases, and VL patients without microscopy-detectable malaria as controls. Associations between patient characteristics and the occurrence of the co-infection were investigated using logistic regression analysis. Confirmation of epidemiological outcomes was obtained with an independently collected dataset, composed by Médecins Sans Frontières (MSF) at Um-el-Kher and Kassab Hospitals, Gedarif State (1998). Results The prevalence of malaria co-infection among VL surveyed patients ranged from 3.8 to 60.8%, with a median of 26.2%. Co-infected patients presented at hospital with deteriorated clinical pictures. Emaciation (Odds Ratio (OR): 2.46; 95% Confidence Interval (95% CI): 1.72-3.50), jaundice (OR: 2.52; 95% CI: 1.04-6.09) and moderate anemia (OR: 1.58; 95% CI: 1.10-2.28) were found to be positively associated with the co-infection, while severity of splenomegaly (OR: 0.53; 95% CI: 0.35-0.81) and, to a less extent, hepatomegaly (OR: 0.52; 95% CI: 0.27-1.01) appeared to be reduced by concomitant VL and malaria. The in-hospital case-fatality rates did not significantly differ between co- and mono-infected patients (OR: 1.13; 95% CI: 0.59-2.17). Conversely, a significantly increased mortality rate (OR: 4.38; 95% CI: 1.83-10.48) was observed by MSF amongst co-infected patients enrolled at Um-el-Kher and Kassab Hospitals, who also suffered an enhanced risk of severe anemia (OR: 3.44; 95% CI: 1.68-7.02) compared to VL mono-infections. Conclusions In endemic VL areas with unstable seasonal malaria, like eastern Sudan, VL patients are highly exposed to the risk of developing concomitant malaria. Prompt diagnosis and effective treatment of malaria are essential to ensure that its co-infection does not result into poor prognoses.
Collapse
Affiliation(s)
- Erika van den Bogaart
- Department of Biomedical Research, Parasitology Unit, Royal Tropical Institute (KIT), Amsterdam, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Elhassan AAM, Hussein AA, Mohamed HS, Rockett K, Kwiatkowski D, Elhassan AM, Ibrahim ME. The 5q31 region in two African populations as a facet of natural selection by infectious diseases. RUSS J GENET+ 2013. [DOI: 10.1134/s1022795413020051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
47
|
Khalid NM, Aboud MA, Alrabba FM, Elnaiem DEA, Tripet F. Evidence for genetic differentiation at the microgeographic scale in Phlebotomus papatasi populations from Sudan. Parasit Vectors 2012; 5:249. [PMID: 23146340 PMCID: PMC3503571 DOI: 10.1186/1756-3305-5-249] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/05/2012] [Indexed: 11/17/2022] Open
Abstract
Background Cutaneous Leishmaniasis (CL) is endemic in Sudan. It is caused by Leishmania major parasites and transmitted by Phlebotomus papatasi sandflies. Recently, uncommon clinical manifestations of CL have been reported. Moreover, L. donovani parasites that cause Visceral Leishmaniasis (VL) have been isolated from CL lesions of some patients who contracted the disease in Khartoum State, Central Sudan with no history of travelling to VL endemic sites on south-eastern Sudan. Because different clinical manifestations and the parasite behaviour could be related to genetic differentiation, or even sub-structuring within sandfly vector populations, a population genetic study was conducted on P. papatasi populations collected from different localities in Khartoum State known for their uncommon CL cases and characterized by contrasting environmental conditions. Methods A set of seven microsatellite loci was used to investigate the population structure of P. papatasi samples collected from different localities in Khartoum State, Central Sudan. Populations from Kassala State, Eastern Sudan and Egypt were also included in the analyses as outgroups. The level of genetic diversity and genetic differentiation among natural populations of P. papatasi was determined using FST statistics and Bayesian assignments. Results Genetic analyses revealed significant genetic differentiation (FST) between the Sudanese and the Egyptian populations. Within the Sudanese P. papatasi populations, one population from Gerif West, Khartoum State, exhibited significant genetic differentiation from all other populations including those collected as near as 22 km. Conclusion The significant genetic differentiation of Gerif West P. papatasi population from other Sudanese populations may have important implication for the epidemiology of leishmaniasis in Khartoum State and needs to be further investigated. Primarily, it could be linked to the unique location of Gerif West which is confined by the River Nile and its tributaries that may act as a natural barrier for gene flow between this site and the other rural sites. The observed high migration rates and lack of genetic differentiation among the other P. papatasi populations could be attributed to the continuous human and cattle movement between these localities.
Collapse
Affiliation(s)
- Noteila M Khalid
- Department of Zoology, Khartoum College of Medical Science, PO Box 10995, Khartoum, Sudan.
| | | | | | | | | |
Collapse
|
48
|
Sordo L, Gadisa E, Custodio E, Cruz I, Simón F, Abraham Z, Moreno J, Aseffa A, Tsegaye H, Nieto J, Chicharro C, Cañavate C. Low prevalence of Leishmania infection in post-epidemic areas of Libo Kemkem, Ethiopia. Am J Trop Med Hyg 2012; 86:955-8. [PMID: 22665599 DOI: 10.4269/ajtmh.2012.11-0436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In Libo Kemkem (a district of Amhara region, Ethiopia), no cases of kala-azar had ever been reported until 2005 when an outbreak occurred. Over one-third of those cases were children under 15 years of age. The aim of the present study was to determine the prevalence of Leishmania infection in children aged 4-15 years. A cross-sectional survey was conducted in 2009. Children participating in the survey were selected using a three-stage cluster sampling method. A total of 386 children were included in the study. The overall prevalence of Leishmania infection (direct agglutination test- and/or rK39 immunochromatographic test- and/or leishmanin skin test-positive subjects) in this population was 1.02% (95% confidence interval = 0-4.54), and prevalence was higher in boys and children older than 12 years. Only one case of active disease was encountered. The results suggest that the conditions responsible for the outbreak no longer reign. However, active surveillance remains necessary.
Collapse
Affiliation(s)
- Luis Sordo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS One 2012. [DOI: 10.1371/journal.pone.0035671 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
|
50
|
Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS One 2012. [DOI: 10.1371/journal.pone.0035671 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
|