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Araujo S, Mabille D, Garcia AB, Caljon G. A breath of fresh air: impact of insect-borne protozoan parasites on the respiratory system. Trends Parasitol 2024; 40:717-730. [PMID: 39013660 DOI: 10.1016/j.pt.2024.06.010] [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: 05/09/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/18/2024]
Abstract
The protozoan parasites Plasmodium, Leishmania, and Trypanosoma are transmitted by hematophagous insects and cause severe diseases in humans. These infections pose a global threat, particularly in low-resource settings, and are increasingly extending beyond the current endemic regions. Tropism of parasites is crucial for their development, and recent studies have revealed colonization of noncanonical tissues, aiding their survival and immune evasion. Despite receiving limited attention, cumulative evidence discloses the respiratory system as a significant interface for host-pathogen interactions, influencing the course of (co)infection and disease onset. Due to its pathophysiological and clinical implications, we emphasize that further research is needed to better understand the involvement of the respiratory system and its potential to improve prevention, diagnosis, treatment, and interruption of the chain of transmission.
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Affiliation(s)
- Sergio Araujo
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium
| | - Dorien Mabille
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium
| | - Alvaro Baeza Garcia
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium
| | - Guy Caljon
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium.
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Ávila IR, Silva ADC, Cardoso DT, Silva TAMD, Carneiro M, Barbosa DS, Bezerra JMT. Clinical-epidemiological aspects and prognostic factors associated with death from visceral leishmaniasis between the years 2010 to 2019 in the Central-West region of Brazil. Parasitol Int 2024; 98:102824. [PMID: 37977488 DOI: 10.1016/j.parint.2023.102824] [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: 09/01/2023] [Revised: 10/19/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023]
Abstract
In Brazil, the fatality rate for visceral leishmaniasis is high, and it is important to investigate its associated factors. The aim of this study was to analyze the clinical-epidemiological profile and prognostic factors associated with death from visceral leishmaniasis (VL) in the Central-West region of Brazil, between 2010 and 2019. A study of series of VL cases was carried out using data obtained from the Sistema de Informação de Agravos de Notificação (SINAN). Multivariate logistic regression was performed to identify variables associated with deaths. Male (64.96%); age group ≤5 years (28.51%); mixed race/color (59.20%); and level of education incomplete primary education (45.16%) were the most affected. The most frequent symptoms were fever (87.65%), weakness (77.56%), enlarged spleen (70.22%) and liver (67.33%), weight loss (67.22%) and pallor (63.41%). Co-infection with HIV was observed in 15.84% of patients. The parasitological diagnosis was positive in 74.17% and the Indirect Immunofluorescence (IIF) in 82.80%. The drug most used for treatment was pentavalent antimony (41.96%). Regarding the evolution of VL, cure was recorded for 82.90% of patients and death from VL in 8.30%. Factors associated with death from VL were: age group ≥20 and <60 (OR 2.95; 95% CI 1.98-4.38) and ≥60 (OR 5.84; 95% CI 3.63-9.38), edema (OR 2.27; 95% CI 1.64-3.13), pallor (OR 1.53; 95% CI 1.06-2.20), infectious condition (OR 1.56; 95% CI 1.12-2.15) and hemorrhagic phenomena (OR 2.87; 95% CI 2.02-4.08). New studies are needed in order to better manage VL control, monitoring, prevention and primary care strategies.
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Affiliation(s)
- Isabela Resende Ávila
- Programa de Pós-Graduação em Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Aline do Carmo Silva
- Programa de Pós-Graduação em Ciência Animal, Centro de Ciências Agrárias, Universidade Estadual do Maranhão, São Luís, Maranhão, Brazil
| | - Diogo Tavares Cardoso
- Programa de Pós-Graduação em Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Mariângela Carneiro
- Programa de Pós-Graduação em Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - David Soeiro Barbosa
- Programa de Pós-Graduação em Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Maria Trindade Bezerra
- Programa de Pós-Graduação em Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciência Animal, Centro de Ciências Agrárias, Universidade Estadual do Maranhão, São Luís, Maranhão, Brazil; Curso de Licenciatura em Ciências Biológicas, Campus de Lago da Pedra, Universidade Estadual do Maranhão, Lago da Pedra, Maranhão, Brazil.
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Costa CHN, Chang KP, Costa DL, Cunha FVM. From Infection to Death: An Overview of the Pathogenesis of Visceral Leishmaniasis. Pathogens 2023; 12:969. [PMID: 37513817 PMCID: PMC10384967 DOI: 10.3390/pathogens12070969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/02/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Kala-azar, also known as visceral leishmaniasis (VL), is a disease caused by Leishmania infantum and L. donovani. Patients experience symptoms such as fever, weight loss, paleness, and enlarged liver and spleen. The disease also affects immunosuppressed individuals and has an overall mortality rate of up to 10%. This overview explores the literature on the pathogenesis of preclinical and clinical stages, including studies in vitro and in animal models, as well as complications and death. Asymptomatic infection can result in long-lasting immunity. VL develops in a minority of infected individuals when parasites overcome host defenses and multiply in tissues such as the spleen, liver, and bone marrow. Hepatosplenomegaly occurs due to hyperplasia, resulting from parasite proliferation. A systemic inflammation mediated by cytokines develops, triggering acute phase reactants from the liver. These cytokines can reach the brain, causing fever, cachexia and vomiting. Similar to sepsis, disseminated intravascular coagulation (DIC) occurs due to tissue factor overexpression. Anemia, hypergammaglobulinemia, and edema result from the acute phase response. A regulatory response and lymphocyte depletion increase the risk of bacterial superinfections, which, combined with DIC, are thought to cause death. Our understanding of VL's pathogenesis is limited, and further research is needed to elucidate the preclinical events and clinical manifestations in humans.
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Affiliation(s)
- Carlos H N Costa
- Centro de Investigações em Agravos Tropicais Emergentes e Negligenciados, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Rua Artur de Vasconcelos 151-Sul, Teresina 64002-510, PI, Brazil
| | - Kwang-Poo Chang
- Department of Microbiology/Immunology, Center for Cancer Cell Biology, Immunology & Infection, Chicago Medical School, Rosalind Franklin University, North Chicago, IL 60064, USA
| | - Dorcas L Costa
- Centro de Investigações em Agravos Tropicais Emergentes e Negligenciados, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Rua Artur de Vasconcelos 151-Sul, Teresina 64002-510, PI, Brazil
| | - Francisco Valmor M Cunha
- Departament of Physiotherapy, Centro Universitário Uninovafapi, Rua Vitorino Orthiges Fernandes, 6123-Uruguai, Teresina 64073-505, PI, Brazil
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Carvalho AG, Kuhn ALM, Dias JVL, Luz JGG. Epidemiological patterns related to deaths caused by visceral leishmaniasis in the southern Amazon region of Brazil. Trans R Soc Trop Med Hyg 2022; 117:326-335. [PMID: 36479897 DOI: 10.1093/trstmh/trac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/07/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
ABSTRACT
Background
We analysed the spatial and spatiotemporal patterns of visceral leishmaniasis (VL) mortality at the municipality level in an endemic state in the southern Amazon region of Brazil. Individual-level factors associated with death due to VL were also investigated.
Methods
All VL cases and deaths reported between 2007 and 2018 were included. The global and local bivariate Moran's index assessed the space–time autocorrelation of smoothed triennial VL mortality. Kulldorff's scan statistics investigated spatial and spatiotemporal clusters. A multivariable logistic regression explored sociodemographic, diagnostic and clinical variables associated with death due to VL.
Results
We observed an overall VL mortality and lethality of 0.14 cases/100 000 inhabitants and 11.2%, respectively. A total of 14% of the municipalities registered at least one VL-related death. In the southeastern mesoregion of the state, we detected high-risk spatial (relative risk [RR] 14.14; p<0.001) and spatiotemporal (RR 15.91; p<0.001) clusters for VL mortality. Bivariate Moran's analysis suggested a high space–time autocorrelation of VL mortality. Death by VL was associated with age ≥48 y (odds ratio [OR] 7.2 [95% confidence interval {CI} 3.4 to 15.3]), displacement for notification (OR 3.3 [95% CI 1.5 to 7.2]) and occurrence of oedema (OR 2.8 [95% CI 1.3 to 6.1]) and bleeding (OR 5.8 [95% CI 2.6 to 12.8]).
Conclusions
VL mortality has a heterogeneous spatiotemporal distribution. The death-related factors suggest late diagnosis as an underlying cause of mortality.
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Affiliation(s)
- Amanda G Carvalho
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
| | - André Luiz M Kuhn
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
| | - João Victor L Dias
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys , 1 Cruzeiro St. Teófilo Otoni, Minas Gerais, 39803-371, Brazil
| | - João Gabriel G Luz
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis , 5055 dos Estudantes Ave. Rondonópolis, Mato Grosso, 78736-900, Brazil
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Mathematical Modelling Using Predictive Biomarkers for the Outcome of Canine Leishmaniasis upon Chemotherapy. Microorganisms 2020; 8:microorganisms8050745. [PMID: 32429309 PMCID: PMC7285289 DOI: 10.3390/microorganisms8050745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022] Open
Abstract
Prediction parameters of possible outcomes of canine leishmaniasis (CanL) therapy might help with therapeutic decisions and animal health care. Here, we aimed to develop a diagnostic method with predictive value by analyzing two groups of dogs with CanL, those that exhibited a decrease in parasite load upon antiparasitic treatment (group: responders) and those that maintained high parasite load despite the treatment (group: non-responders). The parameters analyzed were parasitic load determined by q-PCR, hemogram, serum biochemistry and immune system-related gene expression signature. A mathematical model was applied to the analysis of these parameters to predict how efficient their response to therapy would be. Responder dogs restored hematological and biochemical parameters to the reference values and exhibited a Th1 cell activation profile with a linear tendency to reach mild clinical alteration stages. Differently, non-responders developed a mixed Th1/Th2 response and exhibited markers of liver and kidney injury. Erythrocyte counts and serum phosphorus were identified as predictive markers of therapeutic response at an early period of assessment of CanL. The results presented in this study are highly encouraging and may represent a new paradigm for future assistance to clinicians to interfere precociously in the therapeutic approach, with a more precise definition in the patient's prognosis.
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