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van Griensven J, van Henten S, Kibret A, Kassa M, Beyene H, Abdellati S, de Hondt A, Adriaensen W, Vogt F, Pareyn M, Ritmeijer K, Diro E. Chronic High-Level Parasitemia in HIV-Infected Individuals With or Without Visceral Leishmaniasis in an Endemic Area in Northwest Ethiopia: Potential Superspreaders? Clin Infect Dis 2024; 79:240-246. [PMID: 38193647 PMCID: PMC11259210 DOI: 10.1093/cid/ciae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/22/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND People with human immunodeficiency virus (PWH) with recurrent visceral leishmaniasis (VL) could potentially drive Leishmania transmission in areas with anthroponotic transmission such as East Africa, but studies are lacking. Leishmania parasitemia has been used as proxy for infectiousness. METHODS This study is nested within the Predicting Visceral Leishmaniasis in HIV-InfectedPatients (PreLeisH) prospective cohort study, following 490 PWH free of VL at enrollment for up to 24-37 months in northwest Ethiopia. Blood Leishmania polymerase chain reaction (PCR) was done systematically. This case series reports on 10 PWH with chronic VL (≥3 VL episodes during follow-up) for up to 37 months, and 3 individuals with asymptomatic Leishmania infection for up to 24 months. RESULTS All 10 chronic VL cases were male, on antiretroviral treatment, with 0-11 relapses before enrollment. Median baseline CD4 count was 82 cells/µL. They displayed 3-6 VL treatment episodes over a period up to 37 months. Leishmania blood PCR levels were strongly positive for almost the entire follow-up (median cycle threshold value, 26 [interquartile range, 23-30]), including during periods between VL treatment. Additionally, we describe 3 PWH with asymptomatic Leishmania infection and without VL history, with equally strong Leishmania parasitemia over a period of up to 24 months without developing VL. All were on antiretroviral treatment at enrollment, with baseline CD4 counts ranging from 78 to 350 cells/µL. CONCLUSIONS These are the first data on chronic parasitemia in PWH from Leishmania donovani-endemic areas. PWH with asymptomatic and symptomatic Leishmania infection could potentially be highly infectious and constitute Leishmania superspreaders. Xenodiagnosis studies are required to confirm infectiousness.
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Affiliation(s)
- Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aderajew Kibret
- Public Health Department, Médecins sans Frontières, Amsterdam, The Netherlands
| | - Mekibib Kassa
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Hailemariam Beyene
- Public Health Department, Médecins sans Frontières, Amsterdam, The Netherlands
| | - Saïd Abdellati
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Annelies de Hondt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Wim Adriaensen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- The Kirby Institute, University of New South Wales, Sydney, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Myrthe Pareyn
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koert Ritmeijer
- Public Health Department, Médecins sans Frontières, Amsterdam, The Netherlands
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
- Department of Internal Medicine, University of Washington, Seattle, USA
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Hagos DG, Kiros YK, Abdulkader M, Schallig HDFH, Wolday D. Comparison of the Diagnostic Performances of Five Different Tests in Diagnosing Visceral Leishmaniasis in an Endemic Region of Ethiopia. Diagnostics (Basel) 2024; 14:163. [PMID: 38248040 PMCID: PMC10813839 DOI: 10.3390/diagnostics14020163] [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: 11/29/2023] [Revised: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
The lack of accurate and feasible diagnostic tests poses a significant challenge to visceral leishmaniasis (VL) healthcare services in endemic areas. To date, various VL diagnostic tests have been or are being developed, and their diagnostic performances need to be assessed. In the present study, the diagnostic performances of rk39 RDT, the direct agglutination test (DAT), microscopy, loop-mediated isothermal amplification (LAMP), and miniature direct-on-blood polymerase chain reaction-nucleic acid lateral flow immunoassay (mini-dbPCR-NALFIA) were assessed using quantitative polymerase chain reaction (qPCR) as the reference test in an endemic region of Ethiopia. In this study, 235 suspected VL cases and 104 non-endemic healthy controls (NEHCs) were recruited. Among the suspected VL cases, 144 (61.28%) tested positive with qPCR. The sensitivities for rk39 RDT, DAT, microscopy, LAMP assay, and mini-dbPCR-NALFIA were 88.11%, 96.50%, 76.58%, 94.33%, and 95.80%, respectively. The specificities were 83.33%, 97.96%, 100%, 97.38%, and 98.92% for rk39 RDT, DAT, microscopy, LAMP assay, and mini-dbPCR-NALFIA, respectively. In conclusion, rk39 RDT and microscopy exhibited lower sensitivities, while DAT demonstrated excellent performance. LAMP and mini-dbPCR-NALFIA showed excellent performances with feasibility for implementation in remote endemic areas, although the latter requires further evaluation in such regions.
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Affiliation(s)
- Dawit Gebreegziabiher Hagos
- Department of Medical Microbiology and Immunology, College of Health Sciences, School of Medicine, Mekelle University, Mekelle 1871, Ethiopia; (D.G.H.); (D.W.)
- Laboratory for Experimental Parasitology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Infectious Diseases Programme, Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
| | - Yazezew Kebede Kiros
- Department of Internal Medicine, College of Health Sciences, School of Medicine, Mekelle University, Mekelle 1871, Ethiopia;
| | - Mahmud Abdulkader
- Department of Medical Microbiology and Immunology, College of Health Sciences, School of Medicine, Mekelle University, Mekelle 1871, Ethiopia; (D.G.H.); (D.W.)
| | - Henk D. F. H. Schallig
- Laboratory for Experimental Parasitology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Infectious Diseases Programme, Amsterdam Institute for Infection and Immunity, 1105 AZ Amsterdam, The Netherlands
| | - Dawit Wolday
- Department of Medical Microbiology and Immunology, College of Health Sciences, School of Medicine, Mekelle University, Mekelle 1871, Ethiopia; (D.G.H.); (D.W.)
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
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Ghosh P, Chowdhury R, Faisal K, Khan MAA, Hossain F, Rahat MA, Chowdhury MAA, Mithila NT, Kamal M, Maruf S, Nath R, Kobialka RM, Ceruti A, Cameron M, Duthie MS, Wahed AAE, Mondal D. Evaluation of a Point-of-Need Molecular Diagnostic Tool Coupled with Rapid DNA Extraction Methods for Visceral Leishmaniasis. Diagnostics (Basel) 2023; 13:3639. [PMID: 38132223 PMCID: PMC10742398 DOI: 10.3390/diagnostics13243639] [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: 09/18/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
A rapid, cost-effective, and simple nucleic acid isolation technique coupled with a point-of-need DNA amplification assay is a desirable goal for programmatic use. For diagnosis of Visceral Leishmaniasis (VL), Recombinase Polymerase Amplification (RPA) rapid tests for the detection of Leishmania DNA are versatile and have operational advantages over qPCR. To facilitate the delivery of the RPA test at point-of-need for VL diagnosis, we compared two rapid DNA extraction methods, SwiftDx (SX) and an in-house Boil and Spin (BS) method, coupled with RPA amplification, versus more widely used methods for DNA extraction and amplification, namely Qiagen (Q) kits and qPCR, respectively. A total of 50 confirmed VL patients and 50 controls, matched for age and gender, were recruited from Mymensingh, Bangladesh, a region highly endemic for VL. Blood samples were collected from each participant and DNA was extracted using Q, SX and BS methods. Following DNA extraction, qPCR and RPA assays were performed to detect L. donovani in downstream analysis. No significant differences in sensitivity of the RPA assay were observed between DNA extraction methods, 94.00% (95% CI: 83.45-98.75%), 90% (95% CI: 78.19-96.67%), and 88% (95% CI: 75.69-95.47%) when using Q, SX, and BS, respectively. Similarly, using qPCR, no significant differences in sensitivity were obtained when using Q or SX for DNA extraction, 94.00% (95% CI: 83.45-98.75%) and 92.00% (80.77-97.78%), respectively. It is encouraging that RPA and qPCR showed excellent agreement (k: 0.919-0.980) when different extraction methods were used and that the DNA impurities using BS had no inhibitory effect on the RPA assay. Furthermore, significantly higher DNA yields were obtained using SX and BS versus Q; however, a significantly higher parasite load was detected using qPCR when DNA was extracted using Q versus SX. Considering the cost, execution time, feasibility, and performance of RPA assay, rapid extraction methods such as the Boil and Spin technique appear to have the potential for implementation in resource-limited endemic settings. Further clinical research is warranted prior to broader application.
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Affiliation(s)
- Prakash Ghosh
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Rajashree Chowdhury
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Khaledul Faisal
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Md. Anik Ashfaq Khan
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, D-04103 Leipzig, Germany; (M.A.A.K.); (R.M.K.); (A.C.)
| | - Faria Hossain
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Md. Abu Rahat
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Md. Arko Ayon Chowdhury
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Nishad Tasnim Mithila
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Mostafa Kamal
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Shomik Maruf
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Rupen Nath
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
| | - Rea Maja Kobialka
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, D-04103 Leipzig, Germany; (M.A.A.K.); (R.M.K.); (A.C.)
| | - Arianna Ceruti
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, D-04103 Leipzig, Germany; (M.A.A.K.); (R.M.K.); (A.C.)
| | - Mary Cameron
- London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK;
| | | | - Ahmed Abd El Wahed
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, D-04103 Leipzig, Germany; (M.A.A.K.); (R.M.K.); (A.C.)
| | - Dinesh Mondal
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.C.); (K.F.); (F.H.); (M.A.R.); (M.A.A.C.).; (N.T.M.); (M.K.); (S.M.); (R.N.); (D.M.)
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Samsami S, Namavari S, Ataei S, Ghasemian A, Yazdanpanah A, Sepahi N, Hatam G, Faramarzi H, Mirzaei H, Ranjbar R, Ghanbariasad A. A Novel Multiplex LAMP Assay for the Rapid and Accurate Diagnosis of Visceral Leishmaniasis Caused by Leishmania infantum from Iran. J Trop Med 2023; 2023:9326183. [PMID: 38028028 PMCID: PMC10676275 DOI: 10.1155/2023/9326183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Visceral leishmaniosis (VL) is one of the neglected tropical diseases despite being responsible for serious clinical symptoms, some of which lead to fatal outcomes. Thus, there is a need to apply accurate, rapid, and specific diagnostic measurements in order to control the disease and reduce the mortality rate. We aimed to develop and validate a multiplex LAMP assay for the diagnosis of VL caused by Leishmania infantum (L. infantum). Moreover, a thorough assessment was conducted to determine the effectiveness of multiplex LAMP in identifying various Leishmania species, such as Leishmania tropica (L. tropica) and Leishmania major (L. major) in comparison to Leishmania infantum (L. infantum). The diagnostic performance of the multiplex LAMP method for VL was compared to each LAMP assay, real-time polymerase chain reaction (RT-qPCR), and nested PCR technique. Two separated primers were set and used in a multiplex LAMP assay which was designed based on the ITS2 (internal transcribed spacer II) and were selected on the basis of conserved and high copy number region. Multiplex LAMP primers were designed using an online tool available at https://www.primerexplorer.jp/e. The alignment was performed using MEGA5, and the primers were further adjusted utilizing GENE Runner software. All molecular methods were tested on the serial dilution of cloned plasmid containing ITS region from standard strains of L. infantum, L. tropica, and L. major. Moreover, multiplex LAMP assay was evaluated and compared based on both standard strains and 55 clinical samples from humans as well as dogs. Various approaches were applied to interpret the multiplex LAMP reaction which deciphered a higher sensitivity when compared to the RT-qPCR for L. infantum (one copy number of plasmid, equal to 0.85 femtograms (fg) of plasmid concentration, and 0.004 parasite DNA per μL) detection while these three standard strains of Leishmania were confirmed to contain 40 DNA copies using RT-qPCR. Additionally, the multiplex LAMP detection limit was approximately equivalent to RT-qPCR for L. major and L. tropica, which included 0.342 picograms (pg) and 342 femtograms (fg) of plasmid concentration, 4 × 103 and 4 × 102 copy number of plasmid, and 17.1 and 1.71 parasite DNA per μL for L. major and L. tropica, respectively. Nested PCR exhibited a lower detection limit for L. infantum of 4 × 106 plasmid copy number compared to multiplex LAMP and RT-qPCR. Multiplex LAMP has the potential for accurate and rapid detection of infectious disease, successful treatment, and finding and monitoring asymptomatic cases, especially in low-income countries.
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Affiliation(s)
- Sahar Samsami
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
- Department of Medical Biotechnologies, Fasa University of Medical Sciences, Fasa, Iran
| | - Sahar Namavari
- Department of Medical Biotechnologies, Fasa University of Medical Sciences, Fasa, Iran
| | - Saeed Ataei
- Department of Medical Biotechnologies, Fasa University of Medical Sciences, Fasa, Iran
| | - Abdolmajid Ghasemian
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ava Yazdanpanah
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
- Department of Medical Biotechnologies, Fasa University of Medical Sciences, Fasa, Iran
| | - Neda Sepahi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Gholamreza Hatam
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Faramarzi
- Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Mirzaei
- Department of Medical Genetics, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Razie Ranjbar
- Department of Medical Biotechnologies, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Ghanbariasad
- Department of Medical Biotechnologies, Fasa University of Medical Sciences, Fasa, Iran
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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van Griensven J, Diro E, Yansouni CP. Hidden sources of bias in diagnostic studies: the example of visceral leishmaniasis in east Africa. THE LANCET. INFECTIOUS DISEASES 2023; 23:e108-e114. [PMID: 36400065 DOI: 10.1016/s1473-3099(22)00643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
A clear understanding of the accuracy of diagnostic tests is essential for the management of infections such as visceral leishmaniasis in endemic areas. Using both published and unpublished datasets from field diagnostic trials of visceral leishmaniasis in the past ten years, we show the potential effects of unrecognised sources of bias including work-up bias, referral bias, and reference test bias on the results. We outline why these biases, which can occur in diagnostic studies of any disease, can go unrecognised despite adherence to current STARD and QUADAS-2 guidelines. Using these examples and referring to others seen in studies of bacterial and viral infections, we make specific recommendations on how these biases might be avoided through specific steps in study design, study reporting, and the locations where studies are conducted.
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Affiliation(s)
- Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Ermias Diro
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Cedric P Yansouni
- J D MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC, Canada; Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, QC, Canada
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Gow I, Smith NC, Stark D, Ellis J. Laboratory diagnostics for human Leishmania infections: a polymerase chain reaction-focussed review of detection and identification methods. Parasit Vectors 2022; 15:412. [PMID: 36335408 PMCID: PMC9636697 DOI: 10.1186/s13071-022-05524-z] [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: 07/28/2022] [Accepted: 10/02/2022] [Indexed: 11/08/2022] Open
Abstract
Leishmania infections span a range of clinical syndromes and impact humans from many geographic foci, but primarily the world's poorest regions. Transmitted by the bite of a female sand fly, Leishmania infections are increasing with human movement (due to international travel and war) as well as with shifts in vector habitat (due to climate change). Accurate diagnosis of the 20 or so species of Leishmania that infect humans can lead to the successful treatment of infections and, importantly, their prevention through modelling and intervention programs. A multitude of laboratory techniques for the detection of Leishmania have been developed over the past few decades, and although many have drawbacks, several of them show promise, particularly molecular methods like polymerase chain reaction. This review provides an overview of the methods available to diagnostic laboratories, from traditional techniques to the now-preferred molecular techniques, with an emphasis on polymerase chain reaction-based detection and typing methods.
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Affiliation(s)
- Ineka Gow
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - Nicholas C. Smith
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - Damien Stark
- Department of Microbiology, St Vincent’s Hospital Sydney, Darlinghurst, NSW 2010 Australia
| | - John Ellis
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007 Australia
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Gauging the skin resident Leishmania parasites through a loop mediated isothermal amplification (LAMP) assay in post-kala-azar dermal leishmaniasis. Sci Rep 2022; 12:18069. [PMID: 36302782 PMCID: PMC9614002 DOI: 10.1038/s41598-022-21497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/28/2022] [Indexed: 01/24/2023] Open
Abstract
Despite the availability of highly sensitive polymerase chain reaction (PCR)-based methods, the dearth of remotely deployable diagnostic tools circumvents the early and accurate detection of individuals with post-kala-azar dermal leishmaniasis (PKDL). Here, we evaluate a design-locked loop-mediated isothermal amplification (LAMP) assay to diagnose PKDL. A total of 76 snip-skin samples collected from individuals with probable PKDL (clinical presentation and a positive rK39 rapid diagnostic test (RDT)) were assessed by microscopy, qPCR, and LAMP. An equal number of age and sex-matched healthy controls were included to determine the specificity of the LAMP assay. The LAMP assay with a Qiagen DNA extraction (Q-LAMP) showed a promising sensitivity of 72.37% (95% CI: 60.91-82.01%) for identifying the PKDL cases. LAMP assay sensitivity declined when the DNA was extracted using a boil-spin method. Q-qPCR showed 68.42% (56.75-78.61%) sensitivity, comparable to LAMP and with an excellent agreement, whereas the microscopy exhibited a weak sensitivity of 39.47% (28.44-51.35%). When microscopy and/or qPCR were considered the gold standard, Q-LAMP exhibited an elevated sensitivity of 89.7% (95% CI: 78.83-96.11%) for detection of PKDL cases and Bayesian latent class modeling substantiated the excellent sensitivity of the assay. All healthy controls were found to be negative. Notwithstanding the optimum efficiency of the LAMP assay towards the detection of PKDL cases, further optimization of the boil-spin method is warranted to permit remote use of the assay.
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Makau-Barasa LK, Ochol D, Yotebieng KA, Adera CB, de Souza DK. Moving from control to elimination of Visceral Leishmaniasis in East Africa. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.965609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Visceral leishmaniasis (VL) is arguably one of the deadliest neglected tropical diseases. People in poverty bear the largest burden of the disease. Today, the largest proportion of persons living with VL reside in the Eastern African countries of Ethiopia, Kenya, Somalia, South Sudan, and Sudan. These East African countries are among the top 10 countries reporting the highest number of cases and deaths. If left undiagnosed and untreated, VL almost always results in death. Subsequently, there is a need for integrated efforts across human, animal, and vector-control programs to address the scourge of VL in East Africa. In the East African region, the challenges including socio-cultural beliefs, poor health system, political instability, and limited epidemiological understanding impede the implementation of effective VL control strategies. The availability of funding, as well as diagnostics and treatment options, are also devastatingly limited. Furthermore, given the realities of climate change and population movement in the region, to effectively address the scourge of visceral leishmaniasis in East Africa, a regional approach is imperative. In this paper, we highlight some of the key challenges and opportunities to effectively move towards an effective control, and eventually elimination, of VL in East Africa. To do this, we underline the need for a fully integrated program in East Africa, inclusive of effective diagnostics and treatment, to effectively reduce and eliminate the burden of VL in the region, subsequently paving the way to achieve global elimination goals.
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Sereno D, Oury B, Geiger A, Vela A, Karmaoui A, Desquesnes M. Isothermal Nucleic Acid Amplification to Detect Infection Caused by Parasites of the Trypanosomatidae Family: A Literature Review and Opinion on the Laboratory to Field Applicability. Int J Mol Sci 2022; 23:7543. [PMID: 35886895 PMCID: PMC9322063 DOI: 10.3390/ijms23147543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 12/13/2022] Open
Abstract
Isothermal amplification of nucleic acids has the potential to be applied in resource-limited areas for the detection of infectious agents, as it does not require complex nucleic purification steps or specific and expensive equipment and reagents to perform the reaction and read the result. Since human and animal infections by pathogens of the Tryponasomatidae family occur mainly in resource-limited areas with scant health infrastructures and personnel, detecting infections by these methodologies would hold great promise. Here, we conduct a narrative review of the literature on the application of isothermal nucleic acid amplification for Trypanosoma and Leishmania infections, which are a scourge for human health and food security. We highlight gaps and propose ways to improve them to translate these powerful technologies into real-world field applications for neglected human and animal diseases caused by Trypanosomatidae.
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Affiliation(s)
- Denis Sereno
- Institut de Recherche pour le Développement, Université de Montpellier, UMR INTERTRYP IRD, CIRAD, Parasite Infectiology and Public Health Group, 34032 Montpellier, France
| | - Bruno Oury
- Institut de Recherche pour le Développement, Université de Montpellier, UMR INTERTRYP IRD, CIRAD, Parasite Infectiology and Public Health Group, 34032 Montpellier, France
| | - Anne Geiger
- Centre International de Recherche en Agronomie pour le Développement, Institut de Recherche pour le Développement, Université de Montpellier, UMR INTERTRYP IRD, 34032 Montpellier, France
| | - Andrea Vela
- One Health Research Group, Facultad de Ciencias de la Salud, Universidad de las Américas-Quito, Calle de los Colimes y Avenida De los Granados, Quito 170513, Ecuador
| | - Ahmed Karmaoui
- Bioactives (Health and Environmental, Epigenetics Team), Faculty of Sciences and Techniques, Errachidia (UMI), Moroccan Center for Culture and Sciences, University Moulay Ismail, Meknes 50000, Morocco
| | - Marc Desquesnes
- CIRAD, UMR INTERTRYP, 31076 Toulouse, France
- INTERTRYP, Université de Montpellier, CIRAD, IRD, 34032 Montpellier, France
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10
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Erber AC, Sandler PJ, de Avelar DM, Swoboda I, Cota G, Walochnik J. Diagnosis of visceral and cutaneous leishmaniasis using loop-mediated isothermal amplification (LAMP) protocols: a systematic review and meta-analysis. Parasit Vectors 2022; 15:34. [PMID: 35073980 PMCID: PMC8785018 DOI: 10.1186/s13071-021-05133-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
Sensitive, reliable and fast diagnostic tools that are applicable in low-resource settings, at the point of care (PoC), are seen as crucial in the fight against visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL). Addressing the need for a PoC test, several diagnostic tests, including serological and molecular methods, have been developed and evaluated in the past. One promising molecular method, already implemented for diagnosis of a range of diseases, is the loop-mediated isothermal amplification (LAMP) protocol. In this systematic review and meta-analysis, using a comprehensive search strategy, we focus on studies evaluating the performance of LAMP for the diagnosis of leishmaniasis in humans and other mammals such as dogs, compared with microscopy and/or any other molecular diagnostic method. A meta-analysis, pooling sensitivity and specificity rates and calculating areas under the curve (AUCs) in summary receiver operating characteristic (SROC) plots, was conducted on datasets extracted from studies, grouped by clinical condition and sample type. We found high sensitivity and specificity for LAMP when compared with microscopy and PCR using blood samples, with pooled estimate values of > 90% for all subgroups, corresponding to calculated AUC values > 0.96, except for LAMP compared to microscopy for diagnosis of CL. However, only a limited number of studies were truly comparable. Most of the observed heterogeneity is likely based on true differences between the studies rather than sampling error only. Due to simple readout methods and low laboratory equipment requirements for sample preparation compared to other molecular methods, LAMP is a promising candidate for a molecular (near-)PoC diagnostic method for VL and CL.
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Affiliation(s)
- Astrid Christine Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1st floor, 1090, Vienna, Austria. .,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK.
| | - Peter Julian Sandler
- Department of Applied Life Sciences, FH Campus Wien University of Applied Sciences, Helmut-Qualtinger Gasse 2, 1030, Vienna, Austria
| | - Daniel Moreira de Avelar
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ines Swoboda
- Department of Applied Life Sciences, FH Campus Wien University of Applied Sciences, Helmut-Qualtinger Gasse 2, 1030, Vienna, Austria
| | - Gláucia Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Julia Walochnik
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
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11
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Saar M, Beissner M, Gültekin F, Maman I, Herbinger KH, Bretzel G. RLEP LAMP for the laboratory confirmation of leprosy: towards a point-of-care test. BMC Infect Dis 2021; 21:1186. [PMID: 34823479 PMCID: PMC8620619 DOI: 10.1186/s12879-021-06882-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nucleic acid-based amplification tests (NAAT), above all (q)PCR, have been applied for the detection of Mycobacterium leprae in leprosy cases and household contacts with subclinical infection. However, their application in the field poses a range of technical challenges. Loop-mediated isothermal amplification (LAMP), as a promising point-of-care NAAT does not require sophisticated laboratory equipment, is easy to perform, and is applicable for decentralized diagnosis at the primary health care level. Among a range of gene targets, the M. leprae specific repetitive element RLEP is regarded as highly sensitive and specific for diagnostic applications. METHODS: Our group developed and validated a dry-reagent-based (DRB) RLEP LAMP, provided product specifications for customization of a ready-to-use kit (intended for commercial production) and compared it against the in-house prototype. The assays were optimized for application on a Genie® III portable fluorometer. For technical validation, 40 "must not detect RLEP" samples derived from RLEP qPCR negative exposed and non-exposed individuals, as well as from patients with other conditions and a set of closely related mycobacterial cultures, were tested together with 25 "must detect RLEP" samples derived from qPCR confirmed leprosy patients. For clinical validation, 150 RLEP qPCR tested samples were analyzed, consisting of the following categories: high-positive samples of multibacillary (MB) leprosy patients (> 10.000 bacilli/extract), medium-positive samples of MB leprosy patients (1.001-10.000 bacilli/extract), low-positive samples of MB leprosy patients (1-1.000 bacilli/extract), endemic controls and healthy non-exposed controls; each n = 30. RESULTS: Technical validation: both LAMP formats had a limit of detection of 1.000 RLEP copies, i.e. 43-27 bacilli, a sensitivity of 92% (in-house protocol)/100% (ready-to-use protocol) and a specificity of 100%. Reagents were stable for at least 1 year at 22 °C. Clinical validation: Both formats showed a negativity rate of 100% and a positivity rate of 100% for high-positive samples and 93-100% for medium positive samples, together with a positive predictive value of 100% and semi-quantitative results. The positivity rate for low-positive samples was 77% (in-house protocol)/43% (ready-to-use protocol) and differed significantly between both formats. CONCLUSIONS: The ready-to-use RLEP DRB LAMP assay constitutes an ASSURED test ready for field-based evaluation trials aiming for routine diagnosis of leprosy at the primary health care level.
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Affiliation(s)
- Malkin Saar
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany.
| | - Marcus Beissner
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Fatih Gültekin
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Issaka Maman
- Ministère de la Santé, Institut National d'Hygiène (INH), Lomé, Togo
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
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12
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Abstract
L. donovani is an intracellular protozoan parasite, that causes visceral leishmaniasis (VL), and consequently, post-kala azar dermal leishmaniasis (PKDL). Diagnosis and treatment of leishmaniasis is crucial for decreasing its transmission. Various diagnostic techniques like microscopy, enzyme-linked immunosorbent assays (ELISA) and PCR-based methods are used to detect leishmaniasis infection. More recently, loop-mediated isothermal amplification (LAMP) assay has emerged as an ideal diagnostic measure for leishmaniasis, primarily due to its accuracy, speed and simplicity. However, point-of-care diagnosis is still not been tested with the LAMP assay. We have developed a portable LAMP device for the monitoring of Leishmania infection. The LAMP assay performed using our device can detect and amplify as little as 100 femtograms of L. donovani DNA. In a preliminary study, we have shown that the device can also amplify L. donovani DNA present in VL and PKDL patient samples with high sensitivity (100%), specificity (98%) and accuracy (99%), and can be used both for diagnostic and prognostic analysis. To our knowledge, this is the first report to describe the development and application of a portable LAMP device which has the potential to evolve as a point-of-care diagnostic and prognostic tool for Leishmania infections in future.
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13
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Fujisawa K, Silcott-Niles C, Simonson P, Lamattina D, Humeres CA, Bhattacharyya T, Mertens P, Thunissen C, O’Rourke V, Pańczuk M, Whitworth JA, Salomón OD, Miles MA. Emergent canine visceral leishmaniasis in Argentina: Comparative diagnostics and relevance to proliferation of human disease. PLoS Negl Trop Dis 2021; 15:e0009552. [PMID: 34280201 PMCID: PMC8289008 DOI: 10.1371/journal.pntd.0009552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a zoonotic protozoal vector-borne disease that is a major public health challenge. In Argentina, canine (CVL) and human visceral leishmaniasis (HVL) have recently emerged. There is a lack of standardised diagnostic tests for CVL, which hinders control of CVL and HVL. METHODOLOGY/PRINCIPAL FINDINGS Sampling was carried out in Puerto Iguazú, Argentina, comprising 190 asymptomatic, oligosymptomatic and polysymptomatic dogs. The following diagnostics were applied: microscopy of lymph node aspirate (LNA); three immunochromatographic rapid diagnostic tests (RDTs), prototype rK28-ICT, rK39-ICT (both Coris BioConcept), commercial rK39 (InBios); ELISA for IgG, IgG1 and IgG2, against rK28, rK39 or crude lysate antigen. DNA detection and analysis, with 30 dogs, was of the ITS1 region using skin samples, and loop-mediated isothermal amplification (LAMP; Eiken Loopamp) of buffy coat, skin scrape or LNA. 15.4% of dogs were positive by LNA microscopy. The rK28 RDT had higher seropositivity rate (61%) than either a prototype rK39 RDT (31.4%) or commercial rK39 RDT (18.8%), without cross-reactivity with six other pathogens. IgG anti-rK39 ELISA antibody titres, but not IgG2, were positively correlated with number of clinical signs. LAMP with LNA had a higher positivity rate than PCR; buffy coat sampling was more sensitive than skin scrape. ITS1 confirmed Leishmania (Leishmania) infantum as the agent of CVL. Leishmania (Viannia) spp. was detected in skin samples from two dogs, compatible with Leishmania (Viannia) braziliensis. CONCLUSIONS/SIGNIFICANCE Seroprevalence confirmed rapid increase in CVL in Puerto Iguazú. The rK28 RDT test potentially has great value for improved point-of-care diagnosis. Given cost reduction and accessibility, commercial LAMP may be applicable to buffy coat. RDT biomarkers of CVL clinical status are required to combat spread of CVL and HVL. The presence of Viannia, perhaps as an agent of human mucocutaneous leishmaniasis (MCL), highlights the need for vigilance and surveillance.
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Affiliation(s)
- Kyoko Fujisawa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charlotte Silcott-Niles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Poppy Simonson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniela Lamattina
- Instituto Nacional de Medicina Tropical (INMeT), ANLIS, Ministerio de Salud de la Nación, Puerto Iguazú, Misiones, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Puerto Iguazú, Misiones, Argentina
| | - Cristian A. Humeres
- Instituto Nacional de Medicina Tropical (INMeT), ANLIS, Ministerio de Salud de la Nación, Puerto Iguazú, Misiones, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Puerto Iguazú, Misiones, Argentina
| | - Tapan Bhattacharyya
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Victoria O’Rourke
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Magdalena Pańczuk
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James A. Whitworth
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oscar Daniel Salomón
- Instituto Nacional de Medicina Tropical (INMeT), ANLIS, Ministerio de Salud de la Nación, Puerto Iguazú, Misiones, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Puerto Iguazú, Misiones, Argentina
| | - Michael A. Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Hossain F, Picado A, Owen SI, Ghosh P, Chowdhury R, Maruf S, Khan MAA, Rashid MU, Nath R, Baker J, Ghosh D, Adams ER, Duthie MS, Hossain MS, Basher A, Nath P, Aktar F, Cruz I, Mondal D. Evaluation of Loopamp™ Leishmania Detection Kit and Leishmania Antigen ELISA for Post-Elimination Detection and Management of Visceral Leishmaniasis in Bangladesh. Front Cell Infect Microbiol 2021; 11:670759. [PMID: 33981632 PMCID: PMC8108992 DOI: 10.3389/fcimb.2021.670759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
With reduced prevalence of visceral leishmaniasis (VL) in the Indian subcontinent (ISC), direct and field deployable diagnostic tests are needed to implement an effective diagnostic and surveillance algorithm for post-elimination VL control. In this regard, here we investigated the diagnostic efficacies of a loop-mediated isothermal amplification (LAMP) assay (Loopamp™ Leishmania Detection Kit, Eiken Chemical CO., Ltd, Japan), a real-time quantitative PCR assay (qPCR) and the Leishmania antigen ELISA (CLIN-TECH, UK) with different sampling techniques and evaluated their prospect to incorporate into post-elimination VL control strategies. Eighty clinically and rK39 rapid diagnostic test confirmed VL cases and 80 endemic healthy controls were enrolled in the study. Peripheral blood and dried blood spots (DBS) were collected from all the participants at the time of diagnosis. DNA was extracted from whole blood (WB) and DBS via silica columns (QIAGEN) and boil & spin (B&S) methods and tested with qPCR and Loopamp. Urine was collected from all participants at the time of diagnosis and was directly subjected to the Leishmania antigen ELISA. 41 patients were followed up and urine samples were collected at day 30 and day 180 after treatment and ELISA was performed. The sensitivities of the Loopamp-WB(B&S) and Loopamp-WB(QIA) were 96.2% (95% CI 89·43-99·22) and 95% (95% CI 87·69-98·62) respectively. The sensitivity of Loopamp-DBS(QIA) was 85% (95% CI 75·26- 92·00). The sensitivities of the qPCR-WB(QIA) and qPCR-DBS(QIA) were 93.8% (95% CI 86·01-97·94) and 72.5% (95% CI 61·38-81·90) respectively. The specificity of all molecular assays was 100%. The sensitivity and specificity of the Leishmania antigen ELISA were 97.5% (95% CI 91·47-99·70) and 91.95% (95% CI 84·12-96·70) respectively. The Leishmania antigen ELISA depicted clinical cure at day 180 in all the followed-up cases. Efficacy and sustainability identify the Loopamp-WB(B&S) and the Leishmania antigen ELISA as promising and minimally invasive VL diagnostic tools to support VL diagnostic and surveillance activities respectively in the post-elimination era.
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Affiliation(s)
- Faria Hossain
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Albert Picado
- Neglected Tropical Diseases, Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Sophie I. Owen
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Prakash Ghosh
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rajashree Chowdhury
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shomik Maruf
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Md. Utba Rashid
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rupen Nath
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - James Baker
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Debashis Ghosh
- Emerging infections and Parasitology laboratory, Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily R. Adams
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Ariful Basher
- Department of Medicine, Infectious Disease Hospital, Dhaka, Bangladesh
| | - Proggananda Nath
- Infectious diseases and Tropical Medicine, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh
| | - Fatima Aktar
- Research, HDT Bio-Corp., Seattle, WA, United States
| | - Israel Cruz
- Neglected Tropical Diseases, Foundation for Innovative New Diagnostics, Geneva, Switzerland
- International Health Department, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Dinesh Mondal
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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15
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Dixit KK, Ramesh V, Gupta R, Negi NS, Singh R, Salotra P. Real-Time Fluorimetry Loop-Mediated Isothermal Amplification for Diagnosis of Leishmaniasis and as a Tool for Assessment of Cure for Post-Kala-Azar Dermal Leishmaniasis. Am J Trop Med Hyg 2021; 104:2097-2107. [PMID: 33872204 DOI: 10.4269/ajtmh.20-1057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
Despite the dwindling number of visceral leishmaniasis (VL) cases in India, there is an urgent need for early and unequivocal diagnostics for controlling and preventing the reemergence of VL. Post-kala-azar dermal leishmaniasis (PKDL), a dermal sequela of VL, serves as a reservoir of the parasite. Diagnosis of PKDL, especially the macular variant, is challenging and poses impediment toward attainment of VL elimination. In this study, a real-time fluorimetry loop-mediated isothermal amplification (RealAmp) assay has been established for the detection of different clinical manifestations of leishmaniasis. The study included 150 leishmaniasis patients (25 VL, 25 cutaneous leishmaniasis [CL], and 100-PKDL) along with 120 controls. The assay demonstrated sensitivity of 100% (95% CI: 86.68-100) for diagnosis of VL and PKDL (95% CI: 79.61-100) and 96% (95% CI: 86.68-100) for CL with 100% specificity. Moreover, considering the cardinal role of PKDL, diagnosis using minimally invasive slit aspirate was explored, which demonstrated remarkable sensitivity of 96% (95% CI: 87.64-98.47). As a test of cure for PKDL, RealAmp successfully detected parasite in two of posttreatment cases who later reported relapse on follow-up. Also, direct sample lysis using slit aspirate was attempted in a small group that yielded sensitivity of 89% (95% CI: 67.20-96.90). RealAmp depicted excellent diagnostic accuracy in the diagnosis of leishmaniasis in concordance with the established SYBR Green I-based visual loop-mediated isothermal amplification (LAMP) and the reference comparator real-time PCR. The study endorsed the employment of LAMP either as visual-LAMP or RealAmp for an accurate and expeditious diagnosis of PKDL and as a tool for assessment of cure.
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Affiliation(s)
- Keerti Kaumudee Dixit
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India.,2Faculty of Health and Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - V Ramesh
- 3Department of Dermatology and STD, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Ratan Gupta
- 4Department of Paediatrics, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Narendra Singh Negi
- 5Department of Medicine, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Ruchi Singh
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India
| | - Poonam Salotra
- 1ICMR-National Institute of Pathology (NIOP), Safdarjung Hospital Campus, New Delhi, India
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16
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Ibarra-Meneses AV, Chicharro C, Sánchez C, García E, Ortega S, Ndung’u JM, Moreno J, Cruz I, Carrillo E. Loop-Mediated Isothermal Amplification Allows Rapid, Simple and Accurate Molecular Diagnosis of Human Cutaneous and Visceral Leishmaniasis Caused by Leishmania infantum When Compared to PCR. Microorganisms 2021; 9:microorganisms9030610. [PMID: 33809454 PMCID: PMC7999953 DOI: 10.3390/microorganisms9030610] [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: 02/26/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Loop-mediated isothermal amplification allows the rapid, sensitive and specific amplification of DNA without complex and expensive equipment. We compared the diagnostic performance of Loopamp™ Leishmania Detection Kit (Eiken Chemical Co., Ltd., Tokyo, Japan) with conventional and real-time polymerase chain reaction (PCR) for human cutaneous and visceral leishmaniasis caused by L. infantum. A total of 230 DNA samples from cutaneous (CL) and visceral (VL) leishmaniasis cases and controls from Spain, characterized by Leishmania nested PCR (LnPCR) were tested by: (i) the Loopamp™ Leishmania Detection Kit (Loopamp), run on Genie III real-time fluorimeter (OptiGene, UK); and (ii) real-time quantitative PCR (qPCR). The Loopamp test returned 98.8% (95% confidence interval—CI: 96.0–100.00) sensitivity and specificity of 97.7% (95% CI: 92.2–100) on VL samples, and 100% (95% CI: 99.1–100) sensitivity and 100.0% (95% CI: 98.8–100.0) specificity on CL samples. The Loopamp time-to-positivity (Tp) obtained by real-time fluorimetry showed excellent concordance (C = 97.91%) and strong correlation (r = 0.799) with qPCR’s cycle threshold (Ct). The performance of Loopamp is comparable to that of LnPCR and qPCR in the diagnosis of cutaneous and visceral leishmaniasis due to L. infantum. The excellent correlation between the Tp and Ct should be further investigated to determine the accuracy of Loopamp to quantify parasite load in tissues.
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Affiliation(s)
- Ana Victoria Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Emilia García
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Sheila Ortega
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | | | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, 1202 Geneva, Switzerland;
- National School of Public Health, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Majadahonda, Spain; (A.V.I.-M.); (C.C.); (C.S.); (E.G.); (S.O.); (J.M.); (E.C.)
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17
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García-Bernalt Diego J, Fernández-Soto P, Muro A. LAMP in Neglected Tropical Diseases: A Focus on Parasites. Diagnostics (Basel) 2021; 11:diagnostics11030521. [PMID: 33804255 PMCID: PMC8000616 DOI: 10.3390/diagnostics11030521] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/01/2023] Open
Abstract
Neglected Tropical Diseases (NTDs), particularly those caused by parasites, remain a major Public Health problem in tropical and subtropical regions, with 10% of the world population being infected. Their management and control have been traditionally hampered, among other factors, by the difficulty to deploy rapid, specific, and affordable diagnostic tools in low resource settings. This is especially true for complex PCR-based methods. Isothermal nucleic acid amplification techniques, particularly loop-mediated isothermal amplification (LAMP), appeared in the early 21st century as an alternative to PCR, allowing for a much more affordable molecular diagnostic. Here, we present the status of LAMP assays development in parasite-caused NTDs. We address the progress made in different research applications of the technique: xenomonitoring, epidemiological studies, work in animal models and clinical application both for diagnosis and evaluation of treatment success. Finally, we try to shed a light on the improvements needed to achieve a true point-of-care test and the future perspectives in this field.
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18
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Moulik S, Sengupta S, Chatterjee M. Molecular Tracking of the Leishmania Parasite. Front Cell Infect Microbiol 2021; 11:623437. [PMID: 33692966 PMCID: PMC7937807 DOI: 10.3389/fcimb.2021.623437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
With the Visceral Leishmaniasis/Kala-azar Elimination Program in South Asia in its consolidation phase, the focus is mainly on case detection, vector control, and identifying potential sources of infection. Accordingly, emphasis is presently on curbing transmission, which is potentially achievable by identification and elimination of potential reservoirs. The strongest contenders for being the disease reservoir are cases of Post Kala-azar Dermal Leishmaniasis (PKDL) which occurs in a minor proportion of individuals apparently cured of Visceral Leishmaniasis (VL). The demonstration of parasites in tissue aspirates despite being a risky and invasive process is the gold standard for diagnosis of VL, but is now being replaced by serological tests e.g., rK39 strip test and direct agglutination test. However, these antibody based tests are limited in their ability to diagnose relapses, detect cases of PKDL, and monitor effectiveness of treatment. Accordingly, detection of antigen or nucleic acids by polymerase chain reaction has been successfully applied for monitoring of parasite kinetics. This review article provides updated information on recent developments regarding the available antibody or antigen/nucleic acid based biomarkers for longitudinal monitoring of patients with VL or PKDL and emphasizes the need for availability of studies pertaining to quantification of treatment response or relapse.
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Affiliation(s)
- Srija Moulik
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Shilpa Sengupta
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Mitali Chatterjee
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
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Owen SI, Hossain F, Ghosh P, Chowdhury R, Hossain MS, Jewell C, Cruz I, Picado A, Mondal D, Adams ER. Detection of asymptomatic Leishmania infection in Bangladesh by antibody and antigen diagnostic tools shows an association with post-kala-azar dermal leishmaniasis (PKDL) patients. Parasit Vectors 2021; 14:111. [PMID: 33597000 PMCID: PMC7888088 DOI: 10.1186/s13071-021-04622-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/02/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Asymptomatic Leishmania infections outnumber clinical infections on the Indian subcontinent (ISC), where disease reservoirs are anthroponotic. Diagnostics which detect active asymptomatic infection, which are suitable for monitoring and surveillance, may be of benefit to the visceral leishmaniasis (VL) elimination campaign on the ISC. METHODS Quantitative polymerase chain reaction (qPCR), loop-mediated isothermal amplification (LAMP), and the direct agglutination test (DAT) were carried out on blood samples, and the Leishmania antigen ELISA was carried out on urine samples collected from 720 household and neighbouring contacts of 276 VL and post-kala-azar dermal leishmaniasis (PKDL) index cases, with no symptoms or history of VL or PKDL, in endemic regions of Bangladesh between September 2016 and March 2018. RESULTS Of the 720 contacts of index cases, asymptomatic infection was detected in 69 (9.6%) participants by a combination of qPCR (1.0%), LAMP (2.1%), DAT (3.9%), and Leishmania antigen ELISA (3.3%). Only one (0.1%) participant was detected positive by all four diagnostic tests. Poor agreement between tests was calculated using Cohen's kappa (κ) statistics; however, the Leishmania antigen ELISA and DAT in combination captured all participants as positive by more than one test. We find evidence for a moderately strong association between the index case being a PKDL case (OR 1.94, p = 0.009), specifically macular PKDL (OR 2.12, p = 0.004), and being positive for at least one of the four tests. CONCLUSIONS Leishmania antigen ELISA on urine detects active asymptomatic infection, requires a non-invasive sample, and therefore may be of benefit for monitoring transmission and surveillance in an elimination setting in combination with serology. Development of an antigen detection test in a rapid diagnostic test (RDT) format would be of benefit to the elimination campaign.
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Affiliation(s)
- Sophie I Owen
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Faria Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Prakash Ghosh
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Rajashree Chowdhury
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Md Sakhawat Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Chris Jewell
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Isra Cruz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland.,National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Dinesh Mondal
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Emily R Adams
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK.
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Risk-free point-of-care visceral leishmaniasis diagnostics: combining buffy coat microscopy and immunoassay in tertiary rural hospitals in Sudan. Acta Trop 2020; 211:105599. [PMID: 32592684 DOI: 10.1016/j.actatropica.2020.105599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/22/2022]
Abstract
Visceral Leishmaniasis (VL), a life-threating disease in Sudan and Eastern Africa, is usually diagnosed by a painful and invasive tissue aspirate microscopy. This study assessed the diagnostic effectiveness of buffy coat (BC) microscopy and the rK39 immunoassay test separately and combined as an easy non-invasive method applied to peripheral blood sample for field diagnosis of VL. 151 VL suspected patients were recruited from tertiary rural hospitals in Bazura, Gedaref state, from 2014-2015. All patients were tested for VL using rK39 ICT and microscopy smears from LN aspirate and BC in addition to PCR from BC as a reference standard test. Both BC and LN aspirate microscopy showed perfect specificity (100%) with false negative results, while the majority of true positives (81%) had a low-parasite burden. ICT showed almost perfect agreement but limited by its poor specificity. Each of these three tests is inadequate as a consistent single diagnostic tool and should be replaced by PCR in routine practice. Combining the results of risk-free BC microscopy and rk39 ICT, using peripheral blood sample, improved VL diagnosis with almost perfect agreement and 93.4% accuracy. Our findings indicate that combined BC microscopy and ICT are accurate, simple and easy point-of-care VL diagnostic tools in community and rural hospitals that can replace or reduce the use of invasive tissue aspirates microscopy, when PCR is unavailable. This is particularly of value in endemic rural areas, decreasing the delay in final diagnosis and preventing deaths caused by VL.
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Marlais T, Bhattacharyya T, Pearson C, Gardner BL, Marhoon S, Airs S, Hayes K, Falconar AK, Singh OP, Reed SG, El-Safi S, Sundar S, Miles MA. Isolation and characterisation of Leishmania donovani protein antigens from urine of visceral leishmaniasis patients. PLoS One 2020; 15:e0238840. [PMID: 32925980 PMCID: PMC7489519 DOI: 10.1371/journal.pone.0238840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022] Open
Abstract
Diagnosis of visceral leishmaniasis (VL) relies on invasive and risky aspirate procedures, and confirmation of cure after treatment is unreliable. Detection of Leishmania donovani antigens in urine has the potential to provide both a non-invasive diagnostic and a test of cure. We searched for L. donovani antigens in urine of VL patients from India and Sudan to contribute to the development of urine antigen capture immunoassays. VL urine samples were incubated with immobilised anti-L. donovani polyclonal antibodies and captured material was eluted. Sudanese eluted material and concentrated VL urine were analysed by western blot. Immunocaptured and immunoreactive material from Indian and Sudanese urine was submitted to mass spectrometry for protein identification. We identified six L. donovani proteins from VL urine. Named proteins were 40S ribosomal protein S9, kinases, and others were hypothetical. Thirty-three epitope regions were predicted with high specificity in the 6 proteins. Of these, 20 were highly specific to Leishmania spp. and are highly suitable for raising antibodies for the subsequent development of an antigen capture assay. We present all the identified proteins and analysed epitope regions in full so that they may contribute to the development of non-invasive immunoassays for this deadly disease.
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Affiliation(s)
- Tegwen Marlais
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Tapan Bhattacharyya
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Callum Pearson
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bathsheba L. Gardner
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Safiyyah Marhoon
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephanie Airs
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kiera Hayes
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Om Prakash Singh
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Steven G. Reed
- Infectious Disease Research Institute, Seattle, Washington, United States of America
| | - Sayda El-Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Michael A. Miles
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Recent advances and new strategies in Leishmaniasis diagnosis. Appl Microbiol Biotechnol 2020; 104:8105-8116. [PMID: 32845368 DOI: 10.1007/s00253-020-10846-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
Leishmaniasis is a set of complex and multifaceted syndromes, with different clinical manifestations, caused by different species of the genus Leishmania spp. that can be characterized by at least four syndromes: visceral leishmaniasis (VL, also known as kala-azar), post-kala-azar dermal leishmaniasis (PKDL), cutaneous leishmaniasis (CL), and mucocutaneous leishmaniasis (MCL). Among the most serious clinical forms, VL stands out, which causes the death of around 59,000 people annually. Fast and accurate diagnosis in VL is essential to reduce the disease's morbidity and mortality. There are a large number of diagnostic tests for leishmaniasis, however they do cross-react with other protozoa and their sensitivity changes according to the clinical form of the disease. Thus, it is essential and necessary to provide a diagnosis that is sufficiently sensitive to detect asymptomatic infected individuals and specific to discriminate individuals with other infectious and parasitic diseases, thus enabling more accurate diagnostic tools than those currently used. In this context, the aim of this review is to summarize the conventional diagnostic tools and point out the new advances and strategies on visceral and cutaneous leishmaniasis diagnosis.
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Evaluation of Rapid Extraction Methods Coupled with a Recombinase Polymerase Amplification Assay for Point-of-Need Diagnosis of Post-Kala-Azar Dermal Leishmaniasis. Trop Med Infect Dis 2020; 5:tropicalmed5020095. [PMID: 32517156 PMCID: PMC7344569 DOI: 10.3390/tropicalmed5020095] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022] Open
Abstract
To detect Post-kala-azar leishmaniasis (PKDL) cases, several molecular methods with promising diagnostic efficacy have been developed that involve complicated and expensive DNA extraction methods, thus limiting their application in resource-poor settings. As an alternative, we evaluated two rapid DNA extraction methods and determined their impact on the detection of the parasite DNA using our newly developed recombinase polymerase amplification (RPA) assay. Skin samples were collected from suspected PKDL cases following their diagnosis through national guidelines. The extracted DNA from three skin biopsy samples using three different extraction methods was subjected to RPA and qPCR. The qPCR and RPA assays exhibited highest sensitivities when reference DNA extraction method using Qiagen (Q) kit was followed. In contrast, the sensitivity of the RPA assay dropped to 76.7% and 63.3%, respectively, when the boil & spin (B&S) and SpeedXtract (SE) rapid extraction methods were performed. Despite this compromised sensitivity, the B&S-RPA technique yielded an excellent agreement with both Q-qPCR (k = 0.828) and Q-RPA (k = 0.831) techniques. As expected, the reference DNA extraction method was found to be superior in terms of diagnostic efficacy. Finally, to apply the rapid DNA extraction methods in resource-constrained settings, further methodological refinement is warranted to improve DNA yield and purity through rigorous experiments.
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Leishmaniasis immunopathology-impact on design and use of vaccines, diagnostics and drugs. Semin Immunopathol 2020; 42:247-264. [PMID: 32152715 DOI: 10.1007/s00281-020-00788-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
Leishmaniasis is a disease complex caused by 20 species of protozoan parasites belonging to the genus Leishmania. In humans, it has two main clinical forms, visceral leishmaniasis (VL) and cutaneous or tegumentary leishmaniasis (CL), as well as several other cutaneous manifestations in a minority of cases. In the mammalian host Leishmania parasites infect different populations of macrophages where they multiply and survive in the phagolysosomal compartment. The progression of both VL and CL depends on the maintenance of a parasite-specific immunosuppressive state based around this host macrophage infection. The complexity and variation of immune responses and immunopathology in humans and the different host interactions of the different Leishmania species has an impact upon the effectiveness of vaccines, diagnostics and drugs.
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Thakur S, Joshi J, Kaur S. Leishmaniasis diagnosis: an update on the use of parasitological, immunological and molecular methods. J Parasit Dis 2020; 44:253-272. [PMID: 32419743 PMCID: PMC7223249 DOI: 10.1007/s12639-020-01212-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/07/2020] [Indexed: 12/24/2022] Open
Abstract
Diagnosis of leishmaniasis has always been a major challenge as its clinical features resemble some other commonly occurring diseases such as tuberculosis, typhoid, and malaria. Reliable laboratory methods become important for differential diagnosis. Demonstration of the parasites in stained preparations of bone marrow and splenic aspirates being risky and invasive is still the gold standard for diagnosis. Serological tests utilizing rapid immunochromatographic formats or rK39 in enzyme linked immune sorbent assay, immunoblotting, direct agglutination test have complications related to high proportions of positive asymptomatic individuals and the inability to diagnose a relapse. Among the molecular techniques, polymerase chain reaction is the most commonly used technique that is successfully implied for diagnosis. This review provides updated information on the recent developments in the field of diagnosis in leishmaniasis, various methods utilized with their advantages and limitations.
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Affiliation(s)
- Shivani Thakur
- Parasitology Laboratory, Department of Zoology, Panjab University, Chandigarh, 160014 India
| | - Jyoti Joshi
- Parasitology Laboratory, Department of Zoology, Panjab University, Chandigarh, 160014 India
| | - Sukhbir Kaur
- Parasitology Laboratory, Department of Zoology, Panjab University, Chandigarh, 160014 India
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Maurelli MP, Bosco A, Foglia Manzillo V, Vitale F, Giaquinto D, Ciuca L, Molinaro G, Cringoli G, Oliva G, Rinaldi L, Gizzarelli M. Clinical, Molecular and Serological Diagnosis of Canine Leishmaniosis: An Integrated Approach. Vet Sci 2020; 7:vetsci7020043. [PMID: 32295198 PMCID: PMC7378766 DOI: 10.3390/vetsci7020043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022] Open
Abstract
Canine leishmaniosis (CanL) is caused by protozoans of the genus Leishmania and characterized by a broad spectrum of clinical signs in dogs. Early diagnosis is of great importance in order to perform an appropriate therapy and to prevent progression towards severe disease. The aim of this study was to compare a point-of-care molecular technique, i.e., the loop-mediated isothermal amplification (LAMP), with a real-time polymerase chain reaction (Rt-PCR), and three serological techniques, i.e., immunofluorescence antibody test (IFAT), enzyme-linked immunosorbent assay (ELISA), and a rapid SNAP Leishmania test, to develop an integrated approach for the diagnosis of CanL. Sixty dogs were chosen after physical examination and collection of blood and sera samples, fine-needle aspiration of lymph nodes, and conjunctival swabs were performed. Lymphadenopathy (82.3%), as well as clinicopathological alterations of total proteins (70.6%), were the most frequent signs. Forty-one (68.3%) samples resulted positive at least to one technique. IFAT resulted in the best serological diagnostic method (specificity = 100%, sensitivity = 97.2%), detecting a higher number of positive samples than those revealed by other techniques. Among the samples used for molecular analysis, fine-needle aspiration of lymph nodes was revealed as the best sample source. LAMP showed a substantial agreement (κ = 0.80; p <0.0001) with Rt-PCR; therefore, it could be promising for the rapid diagnosis of CanL. Nevertheless, further studies should be performed to confirm these findings.
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Affiliation(s)
- Maria Paola Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
- Regional Center for Monitoring Parasitic Diseases (CREMOPAR), Campania Region, 84025 Eboli (Sa), Italy
| | - Antonio Bosco
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
- Regional Center for Monitoring Parasitic Diseases (CREMOPAR), Campania Region, 84025 Eboli (Sa), Italy
| | - Valentina Foglia Manzillo
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
- Correspondence:
| | - Fabrizio Vitale
- National Reference Center for Leishmaniosis, Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy;
| | - Daniela Giaquinto
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
| | - Lavinia Ciuca
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
- Regional Center for Monitoring Parasitic Diseases (CREMOPAR), Campania Region, 84025 Eboli (Sa), Italy
| | - Giuseppe Molinaro
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
| | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
- Regional Center for Monitoring Parasitic Diseases (CREMOPAR), Campania Region, 84025 Eboli (Sa), Italy
| | - Gaetano Oliva
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
- Regional Center for Monitoring Parasitic Diseases (CREMOPAR), Campania Region, 84025 Eboli (Sa), Italy
| | - Manuela Gizzarelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy; (M.P.M.); (A.B.); (D.G.); (L.C.); (G.M.); (G.C.); (G.O.); (L.R.); (M.G.)
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Silva Nunes Bezerra G, Barbosa Júnior WL, Virgínia Batista Vieira A, Xavier AT, Sebastião Da Costa Lima Júnior M, Maria Xavier E, Silva EDD, Cintra Leal N, Medeiros ZMD. Loop-mediated isothermal amplification methods for diagnosis of visceral leishmaniasis ( kala-azar) - a systematic review. Expert Rev Mol Diagn 2020; 20:455-465. [PMID: 32116067 DOI: 10.1080/14737159.2020.1736564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Visceral leishmaniasis (VL) is a life-threatening infection remaining as one of the most neglected tropical diseases around the world. Despite scientific advances, an accurate diagnosis of VL remains a challenge. Loop-mediated isothermal amplification (LAMP) has emerged as a promising diagnostic tool with the possibility of becoming a point-of-care test to guide VL diagnosis and treatment.Areas covered: We conducted a systematic review assessing LAMP systems for diagnosing VL from 2000 to 2019. We performed structured searches in PubMed, LILACS, Scopus, and Web of Science without language restriction. Two reviewers screened articles, completed the data extraction and assessment of the risk of bias. A qualitative summary of the included studies was performed.Expert opinion: LAMP could be used as a screening test for VL diagnosis, so tissue aspiration could be performed only for those who are LAMP negative. We recommend more studies about the performance of the Loopamp™ Leishmania Detection kit and the Brazilian LAMP assay. Thus, we expect in the future the constitution of an international consortium to share experiences, projects, and other LAMP approaches mainly among researchers and institutions located within VL endemic countries.
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Affiliation(s)
- Gilberto Silva Nunes Bezerra
- Programa De Pós-Graduação Em Ciências Da Saúde, Universidade De Pernambuco (UPE), Recife, Pernambuco, Brasil.,Departamento De Parasitologia, Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ), Recife, Pernambuco, Brasil
| | - Walter Lins Barbosa Júnior
- Departamento De Parasitologia, Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ), Recife, Pernambuco, Brasil
| | | | - Amanda Tavares Xavier
- Programa De Pós-Graduação Em Ciências Da Saúde, Universidade De Pernambuco (UPE), Recife, Pernambuco, Brasil
| | | | - Edeneide Maria Xavier
- Programa De Pós-Graduação Em Ciências Da Saúde, Universidade De Pernambuco (UPE), Recife, Pernambuco, Brasil
| | - Elis Dionísio Da Silva
- Departamento De Parasitologia, Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ), Recife, Pernambuco, Brasil
| | - Nilma Cintra Leal
- Departamento De Microbiologia, Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ), Recife, Pernambuco, Brasil
| | - Zulma Maria De Medeiros
- Programa De Pós-Graduação Em Ciências Da Saúde, Universidade De Pernambuco (UPE), Recife, Pernambuco, Brasil.,Departamento De Parasitologia, Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ), Recife, Pernambuco, Brasil
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Abass E. Leishmania donovani infection in Eastern Sudan: Comparing direct agglutination and rK39 rapid test for diagnosis-a retrospective study. ASIAN PAC J TROP MED 2020. [DOI: 10.4103/1995-7645.285831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaur A, Ruhela A, Sharma P, Khariwal H, Seth S, Kumar A, Kapil A, Elangovan R, Kalyanasundaram D. Simultaneous and high sensitive detection of Salmonella typhi and Salmonella paratyphi a in human clinical blood samples using an affordable and portable device. Biomed Microdevices 2019; 21:95. [PMID: 31707575 DOI: 10.1007/s10544-019-0441-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Enteric fever is one of the leading causes of infection and subsequent fatality (greater than 1.8 million) (WHO 2018), especially in the developing countries due to contaminated water and food inter twinned with unhygienic practices. Clinical gold standard technique of culture-based method followed by biochemical tests demand 72+ hours for diagnosis while newly developed techniques (like PCR, RT-PCR, DNA microarray etc.) suffer from high limit of detection or involve high-cost infrastructure or both. In this work, a quick and highly specific method, SMOL was established for simultaneous detection of Salmonella paratyphi A and Salmonella typhi in clinical blood samples. SMOL consists of (i) pre-concentration of S. typhi and S. paratyphi A cells using magnetic nanoparticles followed by (ii) cell lysis and DNA extraction (iii) amplification of select nucleic acids by LAMP technique and (iv) detection of amplified nucleic acids using an affordable portable device (costs less than $70). To identify the viability of target cells at lower concentrations, the samples were processed at two different time periods of t = 0 and t = 4 h. Primers specific for the SPA2539 gene in S. paratyphi A and STY2879 gene in S. typhi were used for LAMP. Within 6 h SMOL was able to detect positive and negative samples from 55 human clinical blood culture samples and detect the viability of the cells. The results were concordant with culture and biochemical tests as well as by qPCR. Statistical power analysis yielded 100%. SMOL results were concordant with culture and biochemical tests as well as by qPCR. The sensitive and affordable system SMOL will be effective for poor resource settings.
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Affiliation(s)
- Avinash Kaur
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India
| | - Ankur Ruhela
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India
| | - Priyanka Sharma
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Harshit Khariwal
- Department of Electrical Engineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Sagar Seth
- Department of Physics, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Adarsh Kumar
- Department of Electrical Engineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ravikrishnan Elangovan
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, 110016, India
| | - Dinesh Kalyanasundaram
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Ibarra-Meneses AV, Moreno J, Carrillo E. New Strategies and Biomarkers for the Control of Visceral Leishmaniasis. Trends Parasitol 2019; 36:29-38. [PMID: 31718888 DOI: 10.1016/j.pt.2019.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023]
Abstract
Effective diagnosis and treatment of visceral leishmaniasis, together with the study of vectors and reservoirs, can lead to a better understanding of the parasite transmission dynamics and the development of more efficient control measures. Recent studies have applied new methodologies and biomarkers, and these have contributed to the early and rapid diagnosis of the disease; assessment of success of pharmacological treatments; efficient monitoring of immunosuppressed individuals; and to population screening for field trials of vaccine efficacy. This opinion article proposes an update to the diagnostic tools for visceral leishmaniasis and their rational and combined use to establish the real prevalence of infection or of exposure to Leishmania in endemic areas.
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Affiliation(s)
- Ana V Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain.
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain
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Nzelu CO, Kato H, Peters NC. Loop-mediated isothermal amplification (LAMP): An advanced molecular point-of-care technique for the detection of Leishmania infection. PLoS Negl Trop Dis 2019; 13:e0007698. [PMID: 31697673 PMCID: PMC6837287 DOI: 10.1371/journal.pntd.0007698] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Leishmaniasis, caused by protozoan parasites of the Leishmania genus, represents an important health problem in many regions of the world. Lack of effective point-of-care (POC) diagnostic tests applicable in resources-limited endemic areas is a critical barrier to effective treatment and control of leishmaniasis. The development of the loop-mediated isothermal amplification (LAMP) assay has provided a new tool towards the development of a POC diagnostic test based on the amplification of pathogen DNA. LAMP does not require a thermocycler, is relatively inexpensive, and is simple to perform with high amplification sensitivity and specificity. In this review, we discuss the current technical developments, applications, diagnostic performance, challenges, and future of LAMP for molecular diagnosis and surveillance of Leishmania parasites. Studies employing the LAMP assay to diagnose human leishmaniasis have reported sensitivities of 80% to 100% and specificities of 94% to 100%. These observations suggest that LAMP offers a good molecular POC technique for the diagnosis of leishmaniasis and is also readily applicable to screening at-risk populations and vector sand flies for Leishmania infection in endemic areas.
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Affiliation(s)
- Chukwunonso O. Nzelu
- Snyder Institute for Chronic Diseases, Departments of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine and Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
- * E-mail: (CON); (NCP)
| | - Hirotomo Kato
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
| | - Nathan C. Peters
- Snyder Institute for Chronic Diseases, Departments of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine and Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
- * E-mail: (CON); (NCP)
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van Griensven J, Diro E. Visceral Leishmaniasis: Recent Advances in Diagnostics and Treatment Regimens. Infect Dis Clin North Am 2019; 33:79-99. [PMID: 30712769 DOI: 10.1016/j.idc.2018.10.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diagnostic advances in visceral leishmaniasis include the development of the rK39 and rK28 rapid diagnostic test. The direct agglutination test is also increasingly used, as well as conventional and real-time polymerase chain reaction, which also performs well on peripheral blood. The choice of treatment for visceral leishmaniasis depends on the geographic region where the infection is acquired. Liposomal amphotericin B is generally found to be safe and effective in most endemic regions of the world; antimonials still remain to be the most effective in eastern Africa despite its high toxicity. Combination therapy is increasingly explored. Immunosuppressed patients require adapted diagnostic and therapeutic strategies.
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Affiliation(s)
- Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp 2000, Belgium.
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Post Office Box 196, Gondar, Ethiopia
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Mori Y, Notomi T. Loop-mediated isothermal amplification (LAMP): Expansion of its practical application as a tool to achieve universal health coverage. J Infect Chemother 2019; 26:13-17. [PMID: 31519395 DOI: 10.1016/j.jiac.2019.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/17/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023]
Abstract
Since its invention in 2000, loop-mediated isothermal amplification (LAMP) has attracted great interest from researchers and has been used as a simple and rapid diagnostic tool for detection of infectious and non-infectious diseases. Here we review the recent circumstances and outcomes of these applications of LAMP to show the potential of LAMP as a tool for achieving universal health coverage (UHC). A future application of LAMP, such as in an automated multiplex format, is also discussed.
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Affiliation(s)
- Yasuyoshi Mori
- Eiken Chemical Co.,Ltd, Biochemical Research Laboratory II, Research and Development Division, Japan.
| | - Tsugunori Notomi
- Eiken Chemical Co.,Ltd, Research and Development Division, Japan
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Development and evaluation of a loop-mediated isothermal amplification assay for rapid detection of Leishmania amazonensis in skin samples. Exp Parasitol 2019; 203:23-29. [DOI: 10.1016/j.exppara.2019.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/15/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022]
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35
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Development and Clinical Evaluation of Loop-Mediated Isothermal Amplification (LAMP) Assay for the Diagnosis of Human Visceral Leishmaniasis in Brazil. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8240784. [PMID: 31428648 PMCID: PMC6681617 DOI: 10.1155/2019/8240784] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/26/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
Visceral leishmaniasis (VL) is considered a major public health concern in Brazil and several regions of the world. A recent advance in the diagnosis of infectious diseases was the development of loop-mediated isothermal amplification (LAMP). The aim of this study was to develop and evaluate a new LAMP assay for detection of K26 antigen-coding gene of L. donovani complex. A total of 219 blood samples of immunocompetent patients, including 114 VL cases and 105 non-VL cases, were analyzed for the diagnosis of VL in the present study. Diagnostic accuracy was calculated against a combination of parasitological and/or serological tests as a reference standard. The results were compared to those of kDNA Leishmania-PCR. The detection limit for the K26-Lamp assay was 1fg L. infantum purified DNA and 100 parasites/mL within 60 min of amplification time with visual detection for turbidity. The assay was specific for L. donovani complex. Sensitivity, specificity, and accuracy were 98.2%, 98.1%, and 98.2%, respectively, for K26-LAMP and 100%, 100%, and 100%, respectively, for kDNA Leishmania-PCR. Excellent agreement was observed between K26-LAMP and kDNA Leishmania-PCR assays (K = 0.96). A highly sensitive and specific LAMP assay targeting K26 antigen-coding gene of L. donovani complex was developed for diagnosis in peripheral blood samples of VL patients.
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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.
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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
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Marlais T, Bhattacharyya T, Singh OP, Mertens P, Gilleman Q, Thunissen C, Hinckel BCB, Pearson C, Gardner BL, Airs S, de la Roche M, Hayes K, Hafezi H, Falconar AK, Eisa O, Saad A, Khanal B, Bhattarai NR, Rijal S, Boelaert M, El-Safi S, Sundar S, Miles MA. Visceral Leishmaniasis IgG1 Rapid Monitoring of Cure vs. Relapse, and Potential for Diagnosis of Post Kala-Azar Dermal Leishmaniasis. Front Cell Infect Microbiol 2018; 8:427. [PMID: 30619774 PMCID: PMC6300496 DOI: 10.3389/fcimb.2018.00427] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/28/2018] [Indexed: 01/13/2023] Open
Abstract
Background: There is a recognized need for an improved diagnostic test to assess post-chemotherapeutic treatment outcome in visceral leishmaniasis (VL) and to diagnose post kala-azar dermal leishmaniasis (PKDL). We previously demonstrated by ELISA and a prototype novel rapid diagnostic test (RDT), that high anti-Leishmania IgG1 is associated with post-treatment relapse versus cure in VL. Methodology: Here, we further evaluate this novel, low-cost RDT, named VL Sero K-SeT, and ELISA for monitoring IgG1 levels in VL patients after treatment. IgG1 levels against L. donovani lysate were determined. We applied these assays to Indian sera from cured VL at 6 months post treatment as well as to relapse and PKDL patients. Sudanese sera from pre- and post-treatment and relapse were also tested. Results: Of 104 paired Indian sera taken before and after treatment for VL, when deemed clinically cured, 81 (77.9%) were positive by VL Sero K-SeT before treatment; by 6 months, 68 of these 81 (84.0%) had a negative or reduced RDT test line intensity. ELISAs differed in positivity rate between pre- and post-treatment (p = 0.0162). Twenty eight of 33 (84.8%) Indian samples taken at diagnosis of relapse were RDT positive. A comparison of Indian VL Sero K-SeT data from patients deemed cured and relapsed confirmed that there was a significant difference (p < 0.0001) in positivity rate for the two groups using this RDT. Ten of 17 (58.8%) Sudanese sera went from positive to negative or decreased VL Sero K-SeT at the end of 11–30 days of treatment. Forty nine of 63 (77.8%) PKDL samples from India were positive by VL Sero K-SeT. Conclusion: We have further shown the relevance of IgG1 in determining clinical status in VL patients. A positive VL Sero K-SeT may also be helpful in supporting diagnosis of PKDL. With further refinement, such as the use of specific antigens, the VL Sero K-SeT and/or IgG1 ELISA may be adjuncts to current VL control programmes.
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Affiliation(s)
- Tegwen Marlais
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Tapan Bhattacharyya
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Om Prakash Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University Varanasi, India
| | | | | | | | - Bruno C Bremer Hinckel
- Coris BioConcept Gembloux, Belgium.,Department of Biomedical Sciences, University of Antwerp Antwerp, Belgium
| | - Callum Pearson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Bathsheba L Gardner
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Stephanie Airs
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Marianne de la Roche
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Kiera Hayes
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Hannah Hafezi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Andrew K Falconar
- Departamento de Medicina, Universidad del Norte Barranquilla, Colombia
| | - Osama Eisa
- Faculty of Medicine, University of Khartoum Khartoum, Sudan
| | | | - Basudha Khanal
- Department of Microbiology, B.P. Koirala Institute of Health Sciences Dharan, Nepal
| | | | - Suman Rijal
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences Dharan, Nepal
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine Antwerp, Belgium
| | - Sayda El-Safi
- Faculty of Medicine, University of Khartoum Khartoum, Sudan
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University Varanasi, India
| | - Michael A Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
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van Henten S, Adriaensen W, Fikre H, Akuffo H, Diro E, Hailu A, Van der Auwera G, van Griensven J. Cutaneous Leishmaniasis Due to Leishmania aethiopica. EClinicalMedicine 2018; 6:69-81. [PMID: 31193672 PMCID: PMC6537575 DOI: 10.1016/j.eclinm.2018.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 01/06/2023] Open
Abstract
Leishmania aethiopica is the main causative species for cutaneous leishmaniasis (CL) in Ethiopia. Despite its considerable burden, L. aethiopica has been one of the most neglected Leishmania species. In this review, published evidence on L. aethiopica history, geography, vector, reservoir, epidemiology, parasitology, and immunology is discussed and knowledge gaps are outlined. L. aethiopica endemic regions are limited to the highland areas, although nationwide studies on CL prevalence are lacking. Phlebotomus pedifer and P. longipes are the sandfly vectors and hyraxes are considered to be the main reservoir, but the role of other sandfly species and other potential reservoirs requires further investigation. Where and how transmission occurs exactly are also still unknown. Most CL patients in Ethiopia are children and young adults. Lesions are most commonly on the face, in contrast to CL caused by other Leishmania species which may more frequently affect other body parts. CL lesions caused by L. aethiopica seem atypical and more severe in their presentation as compared to other Leishmania species. Mucocutaneous leishmaniasis and diffuse cutaneous leishmaniasis are relatively common, and healing of lesions caused by L. aethiopica seems to take longer than that of other species. A thorough documentation of the natural evolution of L. aethiopica as well as in depth studies into the immunological and parasitological characteristics that underpin the atypical and severe clinical presentation are needed. Better understanding of CL caused by this parasite species will contribute to interventions related to transmission, prevention, and treatment.
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Affiliation(s)
- Saskia van Henten
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Wim Adriaensen
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Helina Fikre
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Hannah Akuffo
- Swedish International Development Agency (Sida) and Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solna, Sweden
| | - Ermias Diro
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Asrat Hailu
- Addis Ababa University School of Medicine, Ethiopia
| | - Gert Van der Auwera
- Unit of Molecular Parasitology, Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium
| | - Johan van Griensven
- Unit of HIV and Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Dixit KK, Verma S, Singh OP, Singh D, Singh AP, Gupta R, Negi NS, Das P, Sundar S, Singh R, Salotra P. Validation of SYBR green I based closed tube loop mediated isothermal amplification (LAMP) assay and simplified direct-blood-lysis (DBL)-LAMP assay for diagnosis of visceral leishmaniasis (VL). PLoS Negl Trop Dis 2018; 12:e0006922. [PMID: 30439953 PMCID: PMC6264900 DOI: 10.1371/journal.pntd.0006922] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/29/2018] [Accepted: 10/12/2018] [Indexed: 12/24/2022] Open
Abstract
Background The World Health Organization has targeted elimination of visceral leishmaniasis (VL) in the Indian subcontinent (ISC) by 2020. Despite distinctive decline seen in the number of VL cases in ISC, there is still a quest for development of a diagnostic test which has the utility for detection of active infection and relapse cases and as a test of cure. The present study validated the sensitivity and specificity of SYBR Green I based closed tube LAMP assay reported by us for diagnosis of VL. Methodology The validation study was carried out at two endemic sites in India, located at Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna and Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), Varanasi. Standard operating protocols were provided at the two sites for applying LAMP assay on confirmed VL cases. The diagnostic accuracy of LAMP assay was evaluated by Receiver operator curve (ROC) analysis. Furthermore, a simplified LAMP assay based on direct blood lysis, DBL-LAMP, was developed and verified for its diagnostic accuracy. Principal findings A total of 267 eligible participants were included in the study which comprised of 179 VL cases and 88 controls. Sensitivity and specificity of the LAMP assay were 98.32% (95% C.I– 95.2–99.7%) and 96.59% (95% C.I.-90.4–99.3%), respectively. ROC curve analysis depicted no significant difference between area under curve (AUCROC) for LAMP assay and rK39 RDT, indicative of LAMP as an excellent diagnostic test. DBL-LAMP assay, performed on 67 VL and 100 control samples, yielded a sensitivity of 93.05% (95% C.I- 84.75–97%) and specificity of 100% (95% C.I.- 96.30–100%). Conclusions/Significance The validated closed tube LAMP for diagnosis of VL will provide impetus to the ongoing VL elimination programme in ISC. The assay based on direct blood lysis promotes its scope for application in field settings by further reducing time and cost. Definitive diagnosis of visceral leishmaniasis(VL) by demonstration of amastigotes by microscopy is invasive and risky. Serology based diagnosis using rK39 rapid diagnostic test(RDT) has excellent sensitivity of~97% when combined with clinical symptoms but is inconclusive for detection of active infection and relapses due to persistence of anti-leishmanial antibodies. The developed SYBR Green I based closed tube LAMP assay overcomes these constraints and further, direct blood lysis (DBL)-LAMP, makes it more suitable for field application. The study involved validation of LAMP assay at two endemic sites in India, on a total of 179 VL patients confirmed by rK39 RDT and/ or microscopy and 88 controls. The assay was highly sensitive (98.32%) and specific (96.59%). Further, DBL-LAMP assay yielded a sensitivity and specificity of 93.05% and 100%, respectively. In conclusion, the study has validated the field potential of LAMP assay for diagnosis of VL which will provide momentum to ongoing VL elimination in the Indian subcontinent (ISC).
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Affiliation(s)
- Keerti Kaumudee Dixit
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
- Faculty of Health and Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Sandeep Verma
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Om Prakash Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dharmendra Singh
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Akhil Pratap Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ratan Gupta
- Department of Paediatrics, Safdarjung Hospital and Vardhman Mahavir Medical college, New Delhi, India
| | - Narendra Singh Negi
- Department of Medicine, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ruchi Singh
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Poonam Salotra
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
- * E-mail:
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Vink MMT, Nahzat SM, Rahimi H, Buhler C, Ahmadi BA, Nader M, Zazai FR, Yousufzai AS, van Loenen M, Schallig HDFH, Picado A, Cruz I. Evaluation of point-of-care tests for cutaneous leishmaniasis diagnosis in Kabul, Afghanistan. EBioMedicine 2018; 37:453-460. [PMID: 30396855 PMCID: PMC6286266 DOI: 10.1016/j.ebiom.2018.10.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/01/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background Kabul (Afghanistan) is a major focus of cutaneous leishmaniasis (CL) caused by Leishmania tropica. Microscopy remains the reference test for diagnosis despite its low performance. We evaluated whether Loopamp™ Leishmania Detection Kit (Loopamp) and CL Detect™ Rapid Test (CL Detect), detecting Leishmania DNA and antigen, respectively could improve CL diagnosis. Methods A diagnostic accuracy study with prospective inclusion was conducted in a leishmaniasis reference clinic in Kabul. Slit skin samples from CL suspects were analysed by microscopy. Samples taken with a dental broach were tested with CL Detect, Loopamp, and PCR. All samples were transferred to the Academic Medical Center (AMC, the Netherlands) for PCR and Loopamp analyses. The diagnostic performance of the tests was evaluated against a reference combining microscopy and PCR. Findings 274 CL suspects were included in the study. In Kabul, CL Detect had a 65·4% sensitivity [95% Confidence Interval (CI): 59.2–71.2%] and a 100% specificity [95% CI: 80.5–100%], while these were 87.6% [95%CI: 82.9–91.3%] and 70.6% [95% CI: 44.0–89.7%] for Loopamp. At AMC the Loopamp's sensitivity (92.2% [95% CI: 88.2–95.2%]) and specificity (94.1% [95% CI: 71.3–99.8%]) were higher. An algorithm where CL Detect negative suspects would be tested by Loopamp yielded a 93.4% sensitivity [95% CI: 89.6–96.1%] and a 94.1% specificity [95% CI: 71.3–99.8%] when Loopamp's performance at AMC was used. Interpretation The high specificity of CL Detect and the performance of Loopamp allow their use in a diagnostic algorithm that would minimize the number of CL patients referred for confirmation. Fund Federal Ministry of Education and Research, Germany.
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Affiliation(s)
- Martijn M T Vink
- Health Works (Formerly HealthNet TPO), Lizzy Ansinghstraat 163, 1072 RG Amsterdam, The Netherlands
| | - Sami M Nahzat
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Habiburrahman Rahimi
- Health Protection and Research Organization, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Cyril Buhler
- ORDiagnostics SASU, 10Rue Irénée Blanc, 75020 Paris, France
| | - Bashir A Ahmadi
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Mohammad Nader
- Health Protection and Research Organization, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | - Fazal R Zazai
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Darul Aman Road, Sanatoriam Street, Kabul, Afghanistan
| | | | - Merlin van Loenen
- Amsterdam UMC, University of Amsterdam, Medical Microbiology, Parasitology Unit, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Amsterdam UMC, University of Amsterdam, Medical Microbiology, Parasitology Unit, Meibergdreef 9, Amsterdam, The Netherlands
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland.
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Picado A, Cruz I, Redard-Jacot M, Schijman AG, Torrico F, Sosa-Estani S, Katz Z, Ndung’u JM. The burden of congenital Chagas disease and implementation of molecular diagnostic tools in Latin America. BMJ Glob Health 2018; 3:e001069. [PMID: 30364393 PMCID: PMC6195131 DOI: 10.1136/bmjgh-2018-001069] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/01/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
It is estimated that between 8000 and 15 000 Trypanosoma cruzi infected babies are born every year to infected mothers in Chagas disease endemic countries. Currently, poor access to and performance of the current diagnostic algorithm, based on microscopy at birth and serology at 8–12 months after delivery, is one of the barriers to congenital Chagas disease (CCD) control. Detection of parasite DNA using molecular diagnostic tools could be an alternative or complement to current diagnostic methods, but its implementation in endemic regions remains limited. Prompt diagnosis and treatment of CCD cases would have a positive clinical and epidemiological impact. In this paper, we analysed the burden of CCD in Latin America, and the potential use of molecular tests to improve access to early diagnosis and treatment of T. cruzi infected newborns.
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Affiliation(s)
- Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Maël Redard-Jacot
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor Torres", Buenos Aires, Argentina
| | - Faustino Torrico
- Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
- Fundación CEADES, Cochabamba, Bolivia
| | - Sergio Sosa-Estani
- Centro de Investigación de Epidemiología y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
- Drugs for Neglected Diseases initiative (DNDi), Rio de Janeiro, Brazil
| | - Zachary Katz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Zhang WW, Ghosh AK, Mohamath R, Whittle J, Picone A, Lypaczewski P, Ndao M, Howard RF, Das P, Reed SG, Matlashewski G. Development of a sandwich ELISA to detect Leishmania 40S ribosomal protein S12 antigen from blood samples of visceral leishmaniasis patients. BMC Infect Dis 2018; 18:500. [PMID: 30285653 PMCID: PMC6171325 DOI: 10.1186/s12879-018-3420-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/27/2018] [Indexed: 01/12/2023] Open
Abstract
Background Visceral leishmaniasis (VL), caused by Leishmania donovani complex parasites, is a neglected parasitic disease that is generally fatal if untreated. Despite decades of research to develop a sensitive VL diagnostic test, definitive diagnosis of VL still mainly relies on the visualization of the parasite in aspirates from the spleen, liver or bone marrow, an invasive and dangerous process with variable sensitivity. A sensitive assay that can detect Leishmania antigen from blood samples will help confirm cause, cure or recurrence of VL. Methods In this study, rabbit polyclonal antibodies were raised against eight recombinant Leishmania proteins that are highly abundant in Leishmania. The antibodies were purified and labeled with biotin for developing a prototype sandwich enzyme-linked immunosorbent assay (ELISA). Results The ELISA for the Leishmania 40S ribosomal protein S12 detected target antigen with the highest sensitivity and specificity and could detect 1 pg of purified protein or as few as 60 L. donovani parasites. The 40S ribosomal protein S12 sandwich ELISA could detect the target antigen from Peripheral Blood Mononuclear Cell (PBMC) samples in 68% of VL patients and post-kala-azar dermal leishmaniasis (PKDL) patients, providing an estimation of parasitemia ranging from 15 to 80 amastigotes per ml of blood. Conclusion These results indicate that the 40S ribosomal protein S12 sandwich ELISA warrants further tests with more clinical samples of VL patients and other parasitic diseases. It is hopeful that this ELISA could become a useful tool for confirming VL diagnosis, monitoring treatment progress, disease recurrence and possibly detecting asymptomatic Leishmania infections with a high parasite load.
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Affiliation(s)
- Wen-Wei Zhang
- Department of Microbiology and Immunology, McGill University, 3775 University Street, Montreal, Quebec, H3A2B4, Canada
| | - Ayan Kumar Ghosh
- Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, Bihar, India
| | | | | | | | - Patrick Lypaczewski
- Department of Microbiology and Immunology, McGill University, 3775 University Street, Montreal, Quebec, H3A2B4, Canada
| | - Momar Ndao
- National Reference Center for Parasitology, The Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | | | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, Bihar, India
| | - Steven G Reed
- Infectious Disease Research Institute, Seattle, WA, USA
| | - Greg Matlashewski
- Department of Microbiology and Immunology, McGill University, 3775 University Street, Montreal, Quebec, H3A2B4, Canada.
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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: 127] [Impact Index Per Article: 21.2] [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.
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