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Grifferty G, Shirley H, O'Brien K, Hirsch JL, Orriols AM, Amechi KL, Lo J, Chanda N, El Hamzaoui S, Kahn J, Yap SV, Watson KE, Curran C, Atef AbdelAlim A, Bose N, Cilfone AL, Wamai R. The leishmaniases in Kenya: A scoping review. PLoS Negl Trop Dis 2023; 17:e0011358. [PMID: 37262045 DOI: 10.1371/journal.pntd.0011358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/07/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The leishmaniases are a group of four vector-borne neglected tropical diseases caused by 20 species of protozoan parasites of the genus Leishmania and transmitted through a bite of infected female phlebotomine sandflies. Endemic in over 100 countries, the four types of leishmaniasis-visceral leishmaniasis (VL) (known as kala-azar), cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and post-kala-azar dermal leishmaniasis (PKDL)-put 1.6 billion people at risk. In Kenya, the extent of leishmaniasis research has not yet been systematically described. This knowledge is instrumental in identifying existing research gaps and designing appropriate interventions for diagnosis, treatment, and elimination. METHODOLOGY/PRINCIPAL FINDINGS This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to determine the state of leishmaniases research in Kenya and identify research gaps. We searched seven online databases to identify articles published until January 2022 covering VL, CL, MCL, and/or PKDL in Kenya. A total of 7,486 articles were found, of which 479 underwent full-text screening, and 269 met our eligibility criteria. Most articles covered VL only (n = 141, 52%), were published between 1980 and 1994 (n = 108, 39%), and focused on the theme of "vectors" (n = 92, 34%). The most prevalent study types were "epidemiological research" (n = 88, 33%) tied with "clinical research" (n = 88, 33%), then "basic science research" (n = 49, 18%) and "secondary research" (n = 44, 16%). CONCLUSION/SIGNIFICANCE While some studies still provide useful guidance today, most leishmaniasis research in Kenya needs to be updated and focused on prevention, co-infections, health systems/policy, and general topics, as these themes combined comprised less than 4% of published articles. Our findings also indicate minimal research on MCL (n = 1, <1%) and PKDL (n = 2, 1%). We urge researchers to renew and expand their focus on these neglected diseases in Kenya.
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Affiliation(s)
- Grace Grifferty
- Department of Cellular and Molecular Biology, College of Science, Northeastern University, Boston, Massachusetts, United States of America
- African Centre for Community Investment in Health, Nginyang, Baringo County, Kenya
| | - Hugh Shirley
- African Centre for Community Investment in Health, Nginyang, Baringo County, Kenya
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Katherine O'Brien
- African Centre for Community Investment in Health, Nginyang, Baringo County, Kenya
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Jason L Hirsch
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Adrienne M Orriols
- African Centre for Community Investment in Health, Nginyang, Baringo County, Kenya
- University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Kiira Lani Amechi
- Department of International Affairs, College of Social Sciences and Humanities, Northeastern University, Boston, Massachusetts, United States of America
| | - Joshua Lo
- Department of Mathematics and Department of Psychology, College of Science, Northeastern University, Boston, Massachusetts, United States of America
| | - Neeharika Chanda
- Department of Cellular and Molecular Biology, College of Science, Northeastern University, Boston, Massachusetts, United States of America
| | - Sarra El Hamzaoui
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Jorja Kahn
- Department of Behavioral Neuroscience, College of Science, Northeastern University, Boston, Massachusetts, United States of America
| | - Samantha V Yap
- Department of Biology, College of Science, Northeastern University, Boston, Massachusetts, United States of America
| | - Kyleigh E Watson
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Christina Curran
- Department of Biochemistry, College of Science, Northeastern University, Boston, Massachusetts, United States of America
| | - Amina Atef AbdelAlim
- Department of Biology, College of Science, Northeastern University, Boston, Massachusetts, United States of America
| | - Neeloy Bose
- Department of Bioengineering, College of Engineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Alissa Link Cilfone
- Northeastern University Library, Northeastern University, Boston, Massachusetts, United States of America
| | - Richard Wamai
- African Centre for Community Investment in Health, Nginyang, Baringo County, Kenya
- Department of Cultures, Societies and Global Studies, College of Social Sciences and Humanities, Integrated Initiative for Global Health, Northeastern University, Boston, Massachusetts, United States of America
- Department of Global and Public Health, University of Nairobi, Nairobi, Kenya
- Nigerian Institute of Medical Research, Federal Ministry of Health, Lagos, Nigeria
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Kumari S, Kumar V, Tiwari RK, Ravidas V, Pandey K, Kumar A. - Amphotericin B: A drug of choice for Visceral Leishmaniasis. Acta Trop 2022; 235:106661. [PMID: 35998680 DOI: 10.1016/j.actatropica.2022.106661] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/01/2022]
Abstract
Visceral leishmaniasis or Kala-azar is a vector-borne disease caused by an intracellular parasite of the genus leishmania. In India, Amphotericin B (AmB) is a first-line medication for treating leishmaniasis. After a large-scale resistance to pentavalent antimony therapy developed in Bihar state, it was rediscovered as an effective treatment for Leishmania donovani infection. AmB which binds to the ergosterol of protozoan cells causes a change in membrane integrity resulting in ions leakage, and ultimately leading to cell death. The treatment effect of liposomal AmB can be seen more quickly than deoxycholate AmB because, it has some toxic effects, but liposomal AmB is significantly less toxic. Evidence from studies suggested that ABLC (Abelcet) and ABCD (Amphotec) are as effective as L-AmB but Liposomal form (Ambisome) is a more widely accepted treatment option than conventional ones. Nevertheless, the world needs some way more efficient antileishmanial drugs that are less toxic and less expensive for people living with parasitic infections caused by Leishmania. So, academics, researchers, and sponsors need to focus on finding such drugs. This review provides a summary of the chemical, pharmacokinetic, drug-target interactions, stability, dose efficacy, and many other characteristics of the AmB and their various formulations. We have also highlighted the clinically significant aspects of PKDL and VL co-infection with HIV/TB.
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Affiliation(s)
- Shobha Kumari
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, Bihar, India
| | - Vikash Kumar
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, Bihar, India
| | - Ritesh Kumar Tiwari
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, Bihar, India
| | - Vidyanand Ravidas
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, Bihar, India
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, Bihar, India
| | - Ashish Kumar
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, Bihar, India.
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Takele Y, Adem E, Mulaw T, Müller I, Cotton JA, Kropf P. Following successful anti-leishmanial treatment, neutrophil counts, CD10 expression and phagocytic capacity remain reduced in visceral leishmaniasis patients co-infected with HIV. PLoS Negl Trop Dis 2022; 16:e0010681. [PMID: 35969625 PMCID: PMC9410551 DOI: 10.1371/journal.pntd.0010681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 08/25/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Visceral leishmaniasis (VL) patients co-infected with HIV (VL/HIV patients) experience frequent treatment failures, VL relapses, opportunistic infections, and higher mortality. Their immune system remains profoundly suppressed after clinical cure and they maintain higher parasite load. This is in contrast with patients with VL alone (VL patients). Since neutrophils play a critical role in the control of Leishmania replication and the regulation of immune responses, we tested the hypothesis that neutrophil activation status and effector functions are fully restored in VL, but not in VL/HIV patients. Our results show the neutrophil counts and all activation markers and effector functions tested in our study were reduced at the time of diagnosis in VL and VL/HIV patients as compared to controls. CD62L, CD63, arginase 1 expression levels and reactive oxygen species production were restored at the end of treatment in both groups. However, neutrophil counts, CD10 expression and phagocytosis remained significantly lower throughout follow-up in VL/HIV patients; suggesting that dysregulated neutrophils contribute to the impaired host defence against pathogens in VL/HIV patients.
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Affiliation(s)
- Yegnasew Takele
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- Leishmaniasis Research and Treatment Centre, University of Gondar, Ethiopia
| | - Emebet Adem
- Leishmaniasis Research and Treatment Centre, University of Gondar, Ethiopia
| | - Tadele Mulaw
- Leishmaniasis Research and Treatment Centre, University of Gondar, Ethiopia
| | - Ingrid Müller
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | | | - Pascale Kropf
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- * E-mail:
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Burza S, Mahajan R, Kazmi S, Alexander N, Kumar D, Kumar V, Lasry E, Harshana A, de Lima Pereira A, Das P, Verma N, Das VNR, Lal CS, Rewari B, Goyal V, Rijal S, Alves F, Gill N, Pandey K. AmBisome monotherapy and combination AmBisome - miltefosine therapy for the treatment of visceral leishmaniasis in patients co-infected with HIV in India: a randomised open label, parallel arm, phase 3 trial. Clin Infect Dis 2022; 75:1423-1432. [PMID: 35147680 PMCID: PMC9555838 DOI: 10.1093/cid/ciac127] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 11/14/2022] Open
Abstract
Background Visceral leishmaniasis (VL) in patients with human immunodeficiency virus (HIV) presents an increasingly important patient cohort in areas where both infections are endemic. Evidence for treatment is sparce, with no high-quality studies from the Indian subcontinent. Methods This is a randomized, open-label, parallel-arm, phase 3 trial conducted within a single hospital in Patna, India. One hundred and fifty patients aged ≥18 years with serologically confirmed HIV and parasitologically confirmed VL were randomly allocated to 1 of 2 treatment arms, either a total 40 mg/kg intravenous liposomal amphotericin B (AmBisome; Gilead Pharmaceuticals) administered in 8 equal doses over 24 days or a total 30 mg/kg intravenous AmBisome administered in 6 equal doses given concomitantly with a total 1.4 g oral miltefosine administered through 2 daily doses of 50 mg over 14 days. The primary outcome was intention-to-treat relapse-free survival at day 210, defined as absence of signs and symptoms of VL or, if symptomatic, negative parasitological investigations. Results Among 243 patients assessed for eligibility, 150 were recruited between 2 January 2017 and 5 April 2018, with no loss to follow-up. Relapse-free survival at day 210 was 85% (64/75; 95% CI, 77–100%) in the monotherapy arm, and 96%, (72/75; 90–100%) in the combination arm. Nineteen percent (28/150) were infected with concurrent tuberculosis, divided equally between arms. Excluding those with concurrent tuberculosis, relapse-free survival at day 210 was 90% (55/61; 82–100%) in the monotherapy and 97% (59/61; 91–100%) in the combination therapy arm. Serious adverse events were uncommon and similar in each arm. Conclusions Combination therapy appears to be safe, well tolerated, and effective, and halves treatment duration of current recommendations. Clinical Trials Registration Clinical Trial Registry India (CTRI/2015/05/005807; the protocol is available online at https://osf.io/avz7r).
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Affiliation(s)
- Sakib Burza
- Médecins Sans Frontières, New Delhi, India.,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Neal Alexander
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Neena Verma
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | | | - Bharat Rewari
- National Aids Control Organisation, New Delhi, India
| | - Vishal Goyal
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Suman Rijal
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Naresh Gill
- National Vector Borne Disease Control Programme, New Delhi, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
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Zijlstra EE. Precision Medicine in Control of Visceral Leishmaniasis Caused by L. donovani. Front Cell Infect Microbiol 2021; 11:707619. [PMID: 34858865 PMCID: PMC8630745 DOI: 10.3389/fcimb.2021.707619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
Precision medicine and precision global health in visceral leishmaniasis (VL) have not yet been described and could take into account how all known determinants improve diagnostics and treatment for the individual patient. Precision public health would lead to the right intervention in each VL endemic population for control, based on relevant population-based data, vector exposures, reservoirs, socio-economic factors and other determinants. In anthroponotic VL caused by L. donovani, precision may currently be targeted to the regional level in nosogeographic entities that are defined by the interplay of the circulating parasite, the reservoir and the sand fly vector. From this 5 major priorities arise: diagnosis, treatment, PKDL, asymptomatic infection and transmission. These 5 priorities share the immune responses of infection with L. donovani as an important final common pathway, for which innovative new genomic and non-genomic tools in various disciplines have become available that provide new insights in clinical management and in control. From this, further precision may be defined for groups (e.g. children, women, pregnancy, HIV-VL co-infection), and eventually targeted to the individual level.
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Affiliation(s)
- Eduard E Zijlstra
- Clinical Sciences, Rotterdam Centre for Tropical Medicine, Rotterdam, Netherlands
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Warrell CE, Pichl T, Cropley I, Mahungu T, Miller RF. An immunocompromised Albanian farmer with a Mediterranean menace. Br J Hosp Med (Lond) 2020; 81:1-4. [PMID: 33263478 DOI: 10.12968/hmed.2020.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Clare E Warrell
- Infectious Diseases Department, Royal Free London NHS Foundation Trust, London, UK
| | - Thomas Pichl
- Infectious Diseases Department, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Cropley
- Infectious Diseases Department, Royal Free London NHS Foundation Trust, London, UK
| | - Tabitha Mahungu
- Infectious Diseases Department, Royal Free London NHS Foundation Trust, London, UK
| | - Robert F Miller
- Infectious Diseases Department, Royal Free London NHS Foundation Trust, London, UK.,Institute for Global Health, University College London, London, UK
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Bélard S, Stratta E, Zhao A, Ritmeijer K, Moretó-Planas L, Fentress M, Nadimpalli A, Grobusch MP, Heller T, Heuvelings CC. Sonographic findings in visceral leishmaniasis - A narrative review. Travel Med Infect Dis 2020; 39:101924. [PMID: 33227498 DOI: 10.1016/j.tmaid.2020.101924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Visceral leishmaniasis (VL) is predominantly a neglected tropical parasitic disease but may also be acquired by travellers. We aimed at summarizing knowledge on sonographic presentation of VL to better understand sonographic features of VL. METHODS PubMed was searched for studies and case reports presenting original data on sonographic findings of VL, published before August 13th, 2019. Demographic, clinical, and sonographic data were extracted and summarized in a qualitative approach. RESULTS A total of 36 publications were included in this review; 27 of these were case reports and the remainder were prospective or retrospective studies. No study reported systematic cross-sectional comparative imaging. Overall, publications reported on 512 patients with VL of whom 12 were reported HIV-infected. Spleno- and hepatomegaly were the most frequently reported findings. Further relevant and repeatedly reported findings were splenic and hepatic lesions, abdominal lymphadenopathy, pleural and pericardial effusion and ascites. Reported focal splenic lesions were heterogeneous in size, shape, and echogenicity. Several publications reported gradual diminution and resolution of sonographic findings with VL treatment. CONCLUSION Available literature on sonographic findings of VL is limited. Available reports indicate that spleno- and hepatomegaly, free fluid, abdominal lymphadenopathy, and focal splenic lesions may be common sonographic features in patients with VL. Because of the apparent overlap of sonographic features of VL, extrapulmonary tuberculosis and other conditions, interpretation of sonographic findings needs to be made with particular caution.
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Affiliation(s)
- Sabine Bélard
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Erin Stratta
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Amelia Zhao
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Koert Ritmeijer
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, the Netherlands.
| | - Laura Moretó-Planas
- Médecins Sans Frontières, Medical Department, Carrer Zamora 54, Barcelona, 08005, Spain.
| | - Matthew Fentress
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK; Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA; University of California, Davis, 4860 Y St., Suite 2300, Sacramento, CA 95817, USA.
| | - Adi Nadimpalli
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Tom Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Kamuzu Central Hospital Area 33 Mzimba Street, P.O. Box 106, Lilongwe, Malawi.
| | - Charlotte C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
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Quality of life perceptions amongst patients co-infected with Visceral Leishmaniasis and HIV: A qualitative study from Bihar, India. PLoS One 2020; 15:e0227911. [PMID: 32040525 PMCID: PMC7010301 DOI: 10.1371/journal.pone.0227911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Co-infection with Visceral Leishmaniasis (commonly known as Kala Azar, KA) and Human Immunodeficiency Virus (HIV) is increasingly being diagnosed among patients in Bihar. This qualitative study is the first assessment of self-reported quality of life among patients co-infected with KA-HIV in the Asian context. Methods We conducted semi-structured, in-depth interviews and adopted an inductive thematic analysis to generate evidence on the quality of life of patients co-infected with KA and HIV. Patients were purposively sampled until saturation was attained. Results We found that patients highly valued income or livelihood potential and health as indicators of a good quality life, and routinely went into debt accessing care in the private setup. This was due to perceptions of poor quality of care in the government setup and a lack of knowledge regarding available government services at the district level. KA symptoms were often misdiagnosed in the private sector as seasonal fever, while care providers found it difficult to disentangle the clinical symptoms of KA and HIV; hence, patients presented late to district hospitals. Patients perceived a high level of stigma, largely due to their HIV status, and routinely reported that HIV had “destroyed” their life. Conclusions Inadequate social support and referral pathways that were not conducive to patient needs negatively impacted patients’ quality of life. The dual burden of poverty interacting with the severity and chronicity of KA-HIV co-infection means financial support, increased community engagement, and collaborative decision making are crucial for co-infected patients. Increased provider awareness of co-infection and effective stigma-reduction interventions should be integrated to ensure that appropriate and effective access to care is possible for this vulnerable population. A sustainable long-term strategy requires a people-centered approach wherein the perceptions and life circumstances of patients are taken into account in the medical decision making process.
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Whittaker E, López-Varela E, Broderick C, Seddon JA. Examining the Complex Relationship Between Tuberculosis and Other Infectious Diseases in Children. Front Pediatr 2019; 7:233. [PMID: 31294001 PMCID: PMC6603259 DOI: 10.3389/fped.2019.00233] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/22/2019] [Indexed: 12/21/2022] Open
Abstract
Millions of children are exposed to tuberculosis (TB) each year, many of which become infected with Mycobacterium tuberculosis. Most children can immunologically contain or eradicate the organism without pathology developing. However, in a minority, the organism overcomes the immunological constraints, proliferates and causes TB disease. Each year a million children develop TB disease, with a quarter dying. While it is known that young children and those with immunodeficiencies are at increased risk of progression from TB infection to TB disease, our understanding of risk factors for this transition is limited. The most immunologically disruptive process that can happen during childhood is infection with another pathogen and yet the impact of co-infections on TB risk is poorly investigated. Many diseases have overlapping geographical distributions to TB and affect similar patient populations. It is therefore likely that infection with viruses, bacteria, fungi and protozoa may impact on the risk of developing TB disease following exposure and infection, although disentangling correlation and causation is challenging. As vaccinations also disrupt immunological pathways, these may also impact on TB risk. In this article we describe the pediatric immune response to M. tuberculosis and then review the existing evidence of the impact of co-infection with other pathogens, as well as vaccination, on the host response to M. tuberculosis. We focus on the impact of other organisms on the risk of TB disease in children, in particularly evaluating if co-infections drive host immune responses in an age-dependent way. We finally propose priorities for future research in this field. An improved understanding of the impact of co-infections on TB could assist in TB control strategies, vaccine development (for TB vaccines or vaccines for other organisms), TB treatment approaches and TB diagnostics.
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Affiliation(s)
- Elizabeth Whittaker
- Department of Paediatrics, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, United Kingdom
| | - Elisa López-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Claire Broderick
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - James A. Seddon
- Department of Paediatrics, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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