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Bansal SB, Ramasubramanian V, Prasad N, Saraf N, Soman R, Makharia G, Varughese S, Sahay M, Deswal V, Jeloka T, Gang S, Sharma A, Rupali P, Shah DS, Jha V, Kotton CN. South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors. Transplantation 2023; 107:1910-1934. [PMID: 36749281 DOI: 10.1097/tp.0000000000004521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
These guidelines discuss the epidemiology, screening, diagnosis, posttransplant prophylaxis, monitoring, and management of endemic infections in solid organ transplant (SOT) candidates, recipients, and donors in South Asia. The guidelines also provide recommendations for SOT recipients traveling to this region. These guidelines are based on literature review and expert opinion by transplant physicians, surgeons, and infectious diseases specialists, mostly from South Asian countries (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) as well as transplant experts from other countries. These guidelines cover relevant endemic bacterial infections (tuberculosis, leptospirosis, melioidosis, typhoid, scrub typhus), viral infections (hepatitis A, B, C, D, and E; rabies; and the arboviruses including dengue, chikungunya, Zika, Japanese encephalitis), endemic fungal infections (mucormycosis, histoplasmosis, talaromycosis, sporotrichosis), and endemic parasitic infections (malaria, leishmaniasis, toxoplasmosis, cryptosporidiosis, strongyloidiasis, and filariasis) as well as travelers' diarrhea and vaccination for SOT candidates and recipients including travelers visiting this region. These guidelines are intended to be an overview of each topic; more detailed reviews are being published as a special supplement in the Indian Journal of Transplantation .
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Affiliation(s)
- Shyam Bihari Bansal
- Department of Nephrology and Kidney Transplantation, Medanta Institute of Kidney and Urology Medanta-Medicity, Gurgaon, India
| | | | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neeraj Saraf
- Department of Hepatology, Medanta, Medicity, Gurgaon, India
| | - Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, and Hospital, Hyderabad, India
| | - Vikas Deswal
- Department of Infectious Diseases, Medanta, Medicity, Gurgaon, India
| | - Tarun Jeloka
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujrat, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, PGIMER, Chandigarh, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dibya Singh Shah
- Department of Nephrology and Transplant Medicine, Institute of Medicine, Tribhuvan University of Teaching hospital, Kathmandu, Nepal
| | | | - Camille Nelson Kotton
- Transplant and Immunocompromised Host Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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2
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Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review. Pathogens 2022; 11:pathogens11080921. [PMID: 36015042 PMCID: PMC9415673 DOI: 10.3390/pathogens11080921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Leishmaniases are human and animal parasitic diseases transmitted by phlebotomine sand flies. Globalization is an important driver of the burden and in the current dynamics of these diseases. A systematic review of articles published between 2000 and 2021 was conducted using the PubMed search engine to identify the epidemiology and clinical management of imported human leishmaniases as a fundamental step to better manage individual cases and traveler and migrant health from a global perspective. A total of 275 articles were selected, representing 10,341 human imported cases. Identified drivers of changing patterns in epidemiology include conflict and war, as well as host factors, such as immunosuppression, natural and iatrogenic. Leishmania species diversity associated with different clinical presentations implies diagnostic and treatment strategies often complex to select and apply, especially in non-endemic settings. Thus, diagnostic and management algorithms for medical clinical decision support are proposed. Increased surveillance of non-endemic cases, whether in vulnerable populations such as refugees/migrants and immunocompromised individuals or travelers, could improve individual health and mitigate the public health risk of introducing Leishmania species into new areas.
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3
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Yaich S, Abid H, Toumi S, Fendri B, Chaker H, Agrebi I, Dammak N, Masmoudi M, Masmoudi A, Turki H, Kammoun K, Hmida MB. Leishmaniose cutanée après transplantation rénale : à propos de 7 cas et revue de la littérature. Nephrol Ther 2022; 18:506-511. [DOI: 10.1016/j.nephro.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
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4
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Lin ZN, Sun YC, Wang JP, Lai YL, Sheng LX. Next-generation sequencing technology for diagnosis and efficacy evaluation of a patient with visceral leishmaniasis: A case report. World J Clin Cases 2021; 9:9903-9910. [PMID: 34877329 PMCID: PMC8610921 DOI: 10.12998/wjcc.v9.i32.9903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a parasitic disease caused by Leishmania and transmitted by infected sand flies. VL has a low incidence in China, and its clinical presentation is complex and atypical. This disease is easily misdiagnosed and can become life-threatening within a short period of time. Therefore, early, rapid and accurate diagnosis and treatment of the disease are essential.
CASE SUMMARY A 25-year-old male patient presented with the clinical manifestations of irregular fever, hepatosplenomegaly, increased polyclonal globulin, and pancytopenia. The first bone marrow puncture biopsy did not provide a clear diagnosis. In order to relieve the pressure and discomfort of the organs caused by the enlarged spleen and to confirm the diagnosis, splenectomy was performed, and hemophagocytic syndrome was diagnosed by pathological examination of the spleen biopsy. Following bone marrow and spleen pathological re-diagnosis and metagenomic next-generation sequencing (mNGS) technology detection, the patient was finally diagnosed with VL. After treatment with liposomal amphotericin B, the body temperature quickly returned to normal and the hemocytes recovered gradually. Post-treatment re-examination of the bone marrow puncture and mNGS data showed that Leishmania was not detected.
CONCLUSION As a fast and accurate detection method, mNGS can diagnose and evaluate the efficacy of treatment in suspicious cases of leishmaniasis.
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Affiliation(s)
- Zhou-Ning Lin
- Internal Medicine, School of Medicine Ningbo University, Ningbo 315000, Zhejiang Province, China
| | - Yong-Cheng Sun
- Department of Hematology, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
| | - Jia-Ping Wang
- Department of Hematology, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
| | - Yan-Li Lai
- Department of Hematology, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
| | - Li-Xia Sheng
- Department of Hematology, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
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5
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Aissaoui N, Hamane S, Gits-Muselli M, Petit A, Benderdouche M, Denis B, Alanio A, Dellière S, Bagot M, Bretagne S. Imported leishmaniasis in travelers: a 7-year retrospective from a Parisian hospital in France. BMC Infect Dis 2021; 21:953. [PMID: 34525963 PMCID: PMC8442464 DOI: 10.1186/s12879-021-06631-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Leishmaniases are regularly seen in non-endemic areas due to the increase of international travels. They include cutaneous leishmaniases (CL) and mucocutaneous (MC) caused by different Leishmania species, and visceral leishmaniases (VL) which present with non-specific symptoms. METHODS We reviewed all consecutive leishmaniasis cases seen between September 2012 and May 2020. The diagnostic strategy included microscopy after May-Grünwald-Giemsa staining, a diagnostic quantitative PCR (qPCR) assay, and species identification based on sequencing of the cytochrome b gene. RESULTS Eighty-nine patients had a definitive leishmaniasis diagnosis. Nine patients had VL with Leishmania infantum. Eighty patients had CL. Twelve patients acquired CL after trips in Latin America (7 Leishmania guyanensis, 2 Leishmania braziliensis, 2 Leishmania mexicana, and 1 Leishmania panamensis). Species could be identified in 63 of the 68 CLs mainly after travel in North Africa (59%) with Leishmania major (65%), Leishmania tropica/killicki (24%), and L. infantum (11%), or in West Sub-Saharan Africa (32%), all due to L. major. The median day between appearance of the lesions and diagnosis was 90 [range 60-127]. CONCLUSIONS Our diagnostic strategy allows both positive diagnoses and species identifications. Travelers in West Sub-Saharan Africa and North Africa should be better aware of the risk of contracting leishmananiasis.
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Affiliation(s)
- Nesrine Aissaoui
- Laboratoire de Parasitologie et de Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75475, Paris, France
| | - Samia Hamane
- Laboratoire de Parasitologie et de Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75475, Paris, France
| | - Maud Gits-Muselli
- Laboratoire de Parasitologie et de Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75475, Paris, France.,Université de Paris, Paris, France
| | - Antoine Petit
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Mazouz Benderdouche
- Laboratoire de Parasitologie et de Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75475, Paris, France
| | - Blandine Denis
- Département de Maladies Infectieuses, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexandre Alanio
- Laboratoire de Parasitologie et de Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75475, Paris, France.,Université de Paris, Paris, France
| | - Sarah Dellière
- Laboratoire de Parasitologie et de Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75475, Paris, France.,Université de Paris, Paris, France
| | - Martine Bagot
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,INSERM U976, Paris, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie et de Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75475, Paris, France. .,Université de Paris, Paris, France.
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6
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Lack of Impact of the A1298C MTHFR on the Risk of Childhood Acute Lymphoblastic Leukemia: Evidence from a Meta-analysis. Indian J Hematol Blood Transfus 2021; 38:255-263. [PMID: 35496972 PMCID: PMC9001782 DOI: 10.1007/s12288-021-01453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022] Open
Abstract
To clarify the effect of the A1298C variant of methylenetetrahydrofolate reductase (MTHFR) gene on the risk of acute lymphoblastic leukemia (ALL), an updated meta-analysis was performed. Electronic literature search was carried out in PubMed to collect relevant articles. Pooled odds ratios (OR) and stratification analysis were achieved under different genetic comparison models, age and ethnicity. A total of 46 articles including 7020 cases and 12,114 controls were enrolled. Overall, no significant association was observed for the MTHFR A1298C variant on the risk of ALL in any genetic model test, when all the studies pooled together (OR ~ 1 0.91; p > 0.05). In subgroup analyses stratified by age and ethnicity, the MTHFR A1298C reduce the risk of ALL in adult under allele contrast (OR = 0.88; [0.72; 1.09], p = 0.23) mainly in Caucasian populations. The present meta-analysis provides evidence that the A1298C variant of MTHFR gene is unlikely to be a major risk gene for childhood ALL.
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7
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Williams E, Isles NS, Seemann T, Kilpatrick T, Grigg A, Leroi M, Howden BP, Kwong JC. Case Report: Confirmation by Metagenomic Sequencing of Visceral Leishmaniasis in an Immunosuppressed Returned Traveler. Am J Trop Med Hyg 2020; 103:1930-1933. [PMID: 32959759 DOI: 10.4269/ajtmh.19-0841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There has been increased interest in using metagenomic next-generation sequencing as an unbiased approach for diagnosing infectious diseases. We describe a 61-year-old man on fingolimod therapy for multiple sclerosis with an extensive travel history who presented with 7 months of fevers, night sweats, and weight loss. Peripheral blood tests showed pancytopenia and abnormal acute phase reactants. A bone marrow aspirate showed the presence of numerous intracellular and extracellular amastigotes consistent with visceral leishmaniasis (VL). Metagenomic sequencing of the bone marrow aspirate confirmed Leishmania infantum, a species widely reported in the Mediterranean region. This correlated with acquisition of VL infection during the patient's most recent epidemiological exposure in southern Italy 12 months prior. This case demonstrates the potential application of metagenomic sequencing for identification and speciation of Leishmania in cases of VL; however, further assessment is required using other more readily obtained clinical samples such as blood.
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Affiliation(s)
- Eloise Williams
- Department of Infectious Diseases, Austin Health, Heidelberg, Australia.,Department of Microbiology, Austin Health, Heidelberg, Australia
| | - Nicole S Isles
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Trevor Kilpatrick
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia.,Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, Australia
| | - Marcel Leroi
- Department of Microbiology, Austin Health, Heidelberg, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Jason C Kwong
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Australia
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8
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Mody RM, Lakhal-Naouar I, Sherwood JE, Koles NL, Shaw D, Bigley DP, Co EMA, Copeland NK, Jagodzinski LL, Mukbel RM, Smiley RA, Duncan RC, Kamhawi S, Jeronimo SMB, DeFraites RF, Aronson NE. Asymptomatic Visceral Leishmania infantum Infection in US Soldiers Deployed to Iraq. Clin Infect Dis 2020; 68:2036-2044. [PMID: 30239631 DOI: 10.1093/cid/ciy811] [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: 07/04/2018] [Accepted: 09/14/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL), due to Leishmania infantum, is a persistent intracellular parasitic infection transmitted by the bite of infected sand flies. Symptomatic VL has been reported in U.S. soldiers with Iraq deployment. Untreated symptomatic VL can be fatal; asymptomatic VL (AVL) may establish a lifelong risk of reactivation. We report prevalence and AVL risk factors in Operation Iraqi Freedom (OIF) deployers during 2002-11. METHODS Healthy soldiers exposed to VL endemic areas in Iraq and 50 controls who never traveled to endemic regions were recruited through military healthcare facilities (2015-17). Responses to a risk factor survey and blood samples were obtained. Leishmania research diagnostics utilized included enzyme-linked immunosorbent assay (ELISA), rk39 test strips, quantitative polymerase chain reaction (PCR), and interferon gamma release (IGRA) assays. Statistical analyses included Fisher exact test, Pearson χ2 test, Mann-Whitney U test, and logistic regression. RESULTS 200 deployed subjects were enrolled, mostly males (84.0%), of white ethnicity (79.0%), and median age 41 (range 24-61) years. 64% were seropositive for Phlebotomus alexandri saliva antibodies. Prevalence of AVL (any positive test result) was 39/200 (19.5%, 95% confidence interval 14.4%-25.8%). Two (1.0%) PCR, 10 (5%) ELISA, and 28 (14%) IGRA samples were positive. Travel to Ninewa governorate increased risk for AVL (P = .01). CONCLUSION AVL was identified in 19.5% of OIF deployers; travel to northwest Iraq correlated with infection. Further studies are needed to inform risk for reactivation VL in US veterans and to target additional blood safety and surveillance measures.
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Affiliation(s)
- Rupal M Mody
- Infectious Diseases Department, William Beaumont Army Medical Center, El Paso, Texas
| | - Ines Lakhal-Naouar
- Infectious Diseases Division, Uniformed Services University of the Health Sciences
| | - Jeffrey E Sherwood
- Infectious Diseases Department, William Beaumont Army Medical Center, El Paso, Texas
| | - Nancy L Koles
- Infectious Diseases Division, Uniformed Services University of the Health Sciences
| | - Dutchabong Shaw
- Clinical Research Unit, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Edgie-Mark A Co
- Internal Medicine Department, William Beaumont Army Medical Center, El Paso, Texas
| | | | | | - Rami M Mukbel
- Department of Basic Veterinary Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Rebecca A Smiley
- Department of Clinical Investigations, William Beaumont Army Medical Center, El Paso, Texas
| | - Robert C Duncan
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring
| | - Shaden Kamhawi
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | - Selma M B Jeronimo
- Department of Biochemistry and Institute of Tropical Medicine at Rio Grande do Norte, Natal.,National Institute of Science and Technology of Tropical Diseases, Salvador, Bahia, Brazil
| | - Robert F DeFraites
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Naomi E Aronson
- Infectious Diseases Division, Uniformed Services University of the Health Sciences
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9
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Gianchecchi E, Montomoli E. The enemy at home: leishmaniasis in the Mediterranean basin, Italy on the focus. Expert Rev Anti Infect Ther 2020; 18:563-577. [DOI: 10.1080/14787210.2020.1751611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | - Emanuele Montomoli
- VisMederi S.r.l, Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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10
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André S, Rodrigues V, Pemberton S, Laforge M, Fortier Y, Cordeiro-da-Silva A, MacDougall J, Estaquier J. Antileishmanial Drugs Modulate IL-12 Expression and Inflammasome Activation in Primary Human Cells. THE JOURNAL OF IMMUNOLOGY 2020; 204:1869-1880. [PMID: 32132181 DOI: 10.4049/jimmunol.1900590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/02/2020] [Indexed: 01/10/2023]
Abstract
Leishmaniases are neglected tropical diseases. The treatment of leishmaniasis relies exclusively on chemotherapy including amphotericin B (AmB), miltefosine (hexadecylphosphocholine), and pentamidine. Besides the fact that these molecules are harmful for patients, little is known about the impact of such antileishmanial drugs on primary human cells in relation to immune function. The present study demonstrates that all antileishmanial drugs inhibit CD4 and CD8 T cell proliferation at the doses that are not related to increased cell death. Our results highlight that antileishmanial drugs have an impact on monocytes by altering the expression of IL-12 induced by LPS, whereas only AmB induced IL-10 secretion; both cytokines are essential in regulating Th1 cell-mediated immunity. Interestingly, IL-12 and anti-IL-10 Abs improved T cell proliferation inhibited by AmB. Furthermore, our results show that in contrast to hexadecylphosphocholine and pentamidine, AmB induced gene expression of the inflammasome pathway. Thus, AmB induced IL-1β and IL-18 secretions, which are reduced by specific inhibitors of caspase activation (Q-VD) and NLRP3 activation (MCC950). Our results reveal previously underestimated effects of antileishmanial drugs on primary human cells.
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Affiliation(s)
- Sonia André
- INSERM-U1124, Paris University, 75006 Paris, France
| | | | - Sarah Pemberton
- INSERM-U1124, Paris University, 75006 Paris, France.,Photeomix, 93160 Noisy Le Grand, France
| | | | | | - Anabela Cordeiro-da-Silva
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal.,Instituto de Biologia Molecular e Celular da Universidade do Porto, 450-313 Porto, Portugal.,Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, 450-313 Porto, Portugal; and
| | | | - Jérôme Estaquier
- INSERM-U1124, Paris University, 75006 Paris, France; .,Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, Quebec G1V 4G2, Canada
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11
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Norman FF, Comeche B, Chamorro S, Pérez-Molina JA, López-Vélez R. Update on the major imported protozoan infections in travelers and migrants. Future Microbiol 2020; 15:213-225. [PMID: 32065535 DOI: 10.2217/fmb-2019-0212] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Globalization has contributed to the emergence of specific parasitic diseases in novel geographical areas, and in these regions, these infections in travelers and immigrants may cause a considerable burden of disease. Timely diagnosis and treatment of protozoan infections to decrease mortality and prevent associated complications are essential. In this respect, the increased availability of specific DNA-detection procedures has improved the diagnosis of many imported parasitic infections. Travelers and immigrants with associated comorbidities or immunosuppression may pose a special challenge regarding management. An updated review of the main protozoan infections in mobile populations (malaria, Chagas disease, leishmaniasis, enteric protozoan infections) is provided, focusing on the changing epidemiology of these diseases, recent developments in diagnosis and management and the possibility of local transmission of imported infections.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - Belén Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - Sandra Chamorro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - José-Antonio Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
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12
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Vanhinsbergh L, Mason A, Godfrey A. Visceral leishmaniasis presenting as haemophagocytic lymphohistiocytosis. BMJ Case Rep 2019; 12:12/12/e232576. [PMID: 31818895 DOI: 10.1136/bcr-2019-232576] [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: 11/04/2022] Open
Abstract
A 53-year-old man presented with a number of hospital admissions for investigation of fever of unknown origin. He became gradually weaker with significant weight loss, pancytopenia and progressive splenomegaly over a 6-month period of extensive investigation. This was undertaken at different NHS hospitals with involvement of multiple medical specialists. Clinical criteria for haemophagocytic lymphohistiocytosis were met. Following investigation, this was felt likely secondary to a low-grade lymphoma of the spleen, necessitating splenectomy for diagnostic and therapeutic purposes. Ultimately, this risky surgical procedure was avoided when positive L eishmania serology led to successful treatment with amphotericin B.
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Affiliation(s)
- Lewis Vanhinsbergh
- Haematology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Aaron Mason
- Haematology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Andrew Godfrey
- Haematology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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13
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Nardo-Marino A, Bukan K, Nielsen HV, El Fassi D. Remembering visceral leishmaniasis as a potential trigger of haemophagocytic lymphohistiocytosis in individuals treated with anti-TNF-alpha therapy. Eur J Rheumatol 2019; 6:226-227. [PMID: 31449489 DOI: 10.5152/eurjrheum.2019.18178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/24/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Amina Nardo-Marino
- Department of Haematology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Katrine Bukan
- Department of Haematology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Nephrology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Henrik Vedel Nielsen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Daniel El Fassi
- Department of Haematology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Rheumatology, Rigshospitalet, Institute for Inflammation Research, Copenhagen University Hospital, Copenhagen, Denmark
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14
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Zanoni L, Varani S, Attard L, Morigi JJ, Vanino E, Ortalli M, Fonti C, Viale P, Re MC, Fanti S, Ambrosini V. 18F-FDG PET/CT in visceral leishmaniasis: uptake patterns in the context of a multiannual outbreak in Northern Italy. Ann Nucl Med 2019; 33:716-723. [PMID: 31254270 DOI: 10.1007/s12149-019-01381-6] [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] [Received: 04/06/2019] [Accepted: 06/18/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Visceral leishmaniasis (VL) is the most severe manifestation of the infection caused by the protozoan Leishmania, recently on increase in Italy and Spain. The aim of the study was to describe FDG uptake patterns in VL patients (pts) who underwent 18F-FDG PET/CT. METHODS A retrospective monocentric study of pts who underwent FDG PET/CT between 2008 and 2017 and later diagnosed with VL was performed. Semi-quantitative parameters were calculated in FDG-positive lesions: SUVmax, SUVmax spleen/SUVmax liver ratio (SLR), SUVmax focal/diffuse spleen ratio (FDR). RESULTS Overall, 23 pts were included. PET/CT was negative in 2 immunocompromised pts, positive in 21/23 (91%) [6 spleen only, 2 spleen + nodes, 7 spleen + bone marrow (BM), 4 spleen + BM + nodes, 1 spleen + BM + lung, 1 BM only + nodes, 2 nodes only]. Splenic involvement was demonstrated in 20/23 (87%) pts. Two different splenic patterns were observed: diffuse (13/20 pts, mean spleen SUVmax = 7.3 ± 4.2 [4.0-14.1], mean SLR = 2.2 ± 1.6 [1.3-6.7]) and focal over diffuse (7/20 pts, mean SUVmax = 12.6 ± 4.5 [9.5-20.5], mean SLR = 2.8 ± 0.8 [2.1-4.4], mean FDR = 2.1 ± 0.8 [1.2-3.6]). Extra-splenic FDG-avid findings were detected in 15/21 pts (65%): bone marrow in 13/15 (mean SUVmax = 4.0 ± 1.3 [2.8-6.0]), nodes in 67/15 and lung in 1/15. CONCLUSIONS PET/CT demonstrated splenic FDG uptake in all immunocompetent VL pts; two splenic patterns (diffuse/focal over diffuse) were observed and indistinguishable from splenic involvement by other disorders. The most frequent extra-splenic FDG-positive sites were BM and lymph nodes. Considering the potential disease aggressiveness and recent outbreaks in north-eastern Italy, VL should be considered in the differential diagnosis of FDG-positive splenic findings in pts from endemic areas or reporting travels to endemic countries.
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Affiliation(s)
- Lucia Zanoni
- Nuclear Medicine, S.Orsola-Malpighi Hospital, Azienda ospedaliero-universitaria di Bologna, Policlinico S.Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, BO, Italy.
| | - Stefania Varani
- Unit of Microbiology, S.Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luciano Attard
- Unit of Infectious Diseases, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Joshua James Morigi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,PET/CT Unit, Royal Darwin Hospital, 105 Rocklands drive, Tiwi, NT, Australia
| | - Elisa Vanino
- Unit of Infectious Diseases, S.Orsola-Malpighi Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Margherita Ortalli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cristina Fonti
- Nuclear Medicine, S.Orsola-Malpighi Hospital, Azienda ospedaliero-universitaria di Bologna, Policlinico S.Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, BO, Italy
| | - Pierluigi Viale
- Unit of Infectious Diseases, S.Orsola-Malpighi Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maria Carla Re
- Unit of Microbiology, S.Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, S.Orsola-Malpighi Hospital, Azienda ospedaliero-universitaria di Bologna, Policlinico S.Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, BO, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Valentina Ambrosini
- Nuclear Medicine, S.Orsola-Malpighi Hospital, Azienda ospedaliero-universitaria di Bologna, Policlinico S.Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, BO, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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15
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Visceral and Cutaneous Leishmaniasis Recommendations for Solid Organ Transplant Recipients and Donors. Transplantation 2018; 102:S8-S15. [PMID: 29381573 DOI: 10.1097/tp.0000000000002018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Redondo-Benito A, Curran A, Villar-Gomez A, Trallero-Araguas E, Fernández-Codina A, Pinal-Fernandez I, Rodrigo-Pendás JÁ, Selva-O'Callaghan A. Opportunistic infections in patients with idiopathic inflammatory myopathies. Int J Rheum Dis 2018; 21:487-496. [PMID: 29314762 DOI: 10.1111/1756-185x.13255] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To describe the prevalence, clinical characteristics and risk factors of opportunistic infection (OI) in a cohort of patients with inflammatory myopathies, and compare mortality rates between those with and without OIs. METHODS In total, 204 patients from our myositis cohort were reviewed to identify patients who had experienced an OI during the period 1986-2014. The patients' clinical characteristics, treatments received, and outcomes were systematically recorded. Disease activity at the OI diagnosis and the cumulative doses of immunosuppressive drugs were analyzed, as well as the specific pathogens involved and affected organs. RESULTS The prevalence of OI in the total cohort was 6.4%: viruses, 44.4% (varicella-zoster virus, cytomegalovirus); bacteria, 22.2% (Salmonella sp., Mycobacterium tuberculosis, M. chelonae); fungi, 16.7% (Candida albicans, Pneumocystis jirovecii); and parasites, 16.7% (Toxoplasmosis gondii, Leishmania spp.). Lung and skin/soft tissues were the organs most commonly affected (27.8%). Overall, 55.6% of OIs developed during the first year after the myositis diagnosis and OI was significantly associated with administration of high-dose glucocorticoids (P = 0.0148). Fever at onset of myositis (P = 0.0317), biological therapy (P < 0.001) and sequential administration of four or more immunosuppressive agents during myositis evolution (P = 0.0032) were significantly associated with OI. All-cause mortality in the OI group was 3.69 deaths per 100 patients/year versus 3.40 in the remainder of the cohort (P = 0.996). CONCLUSIONS The prevalence of OI was 6.4% in our myositis cohort, higher than the rest of the inpatients of our hospital (1.7%; P < 0.01). High-dose glucocorticoids at disease onset and severe immunosuppression are the main factors implicated.
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Affiliation(s)
- Ada Redondo-Benito
- Internal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Adrian Curran
- Department of Infectious Diseases, Vall d'Hebron General Hospital, Barcelona, Spain
| | - Ana Villar-Gomez
- Department of Pneumology, Vall d'Hebron General Hospital, Barcelona, Spain
| | | | | | - Iago Pinal-Fernandez
- Internal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Jose Ángel Rodrigo-Pendás
- Department of Epidemiology and Preventive Medicine, Vall d'Hebron General Hospital, Barcelona, Spain
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17
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Schwetz V, Trummer C, Friedl C, Beham-Schmid C, Kulnik R, Wölfler A, Horvath K, Wunsch S, Prattes J, Zollner-Schwetz I, Pieber TR, Mader JK, Krause R. Visceral leishmaniasis in a patient with diabetes mellitus type 2 and discrete bicytopenia. Clin Case Rep 2017; 6:78-81. [PMID: 29375842 PMCID: PMC5771930 DOI: 10.1002/ccr3.1259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/10/2017] [Accepted: 09/30/2017] [Indexed: 01/08/2023] Open
Abstract
An Austrian patient with diabetes mellitus type 2 developed visceral leishmaniasis after trips to Spain and Crete, presenting with slight bicytopenia, later developing severe pancytopenia. Travel history taking is important due to an extended incubation period. Coexistence of diabetes mellitus can impair T lymphocyte function and cause higher relapse rates.
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Affiliation(s)
- Verena Schwetz
- Division of Endocrinology and Diabetology Department of Internal Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Christian Trummer
- Division of Endocrinology and Diabetology Department of Internal Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Claudia Friedl
- Division of Nephrology Department of Internal Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Christine Beham-Schmid
- Department of Pathology Medical University of Graz Neue Stiftingtalstraße 68010 Graz Austria
| | - Roman Kulnik
- Division of Nuclear Medicine Department of Radiology Medical University of Graz Auenbruggerplatz 98036 Graz Austria
| | - Albert Wölfler
- Division of Haematology Department of Internal Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Karl Horvath
- Division of Endocrinology and Diabetology Department of Internal Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Stefanie Wunsch
- Department of Internal Medicine Section of Infectious Diseases and Tropical Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Jürgen Prattes
- Department of Internal Medicine Section of Infectious Diseases and Tropical Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Ines Zollner-Schwetz
- Department of Internal Medicine Section of Infectious Diseases and Tropical Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology Department of Internal Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Julia K Mader
- Division of Endocrinology and Diabetology Department of Internal Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
| | - Robert Krause
- Department of Internal Medicine Section of Infectious Diseases and Tropical Medicine Medical University of Graz Auenbruggerplatz 158036 Graz Austria
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18
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Valdés Delgado T, Cordero Ruiz P, Bellido Muñoz F. Visceral Leishmaniasis Infection in a Patient with Crohn's Disease Treated with Azathioprine. J Crohns Colitis 2017; 11:1282-1283. [PMID: 28967958 DOI: 10.1093/ecco-jcc/jjx067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/07/2017] [Indexed: 12/22/2022]
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19
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Fox-Lewis A, Lockwood DNJ. Visceral leishmaniasis complicating idiopathic CD4+ T-cell lymphocytopenia: 2 case reports. PLoS Negl Trop Dis 2017; 11:e0005412. [PMID: 28493863 PMCID: PMC5426586 DOI: 10.1371/journal.pntd.0005412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Andrew Fox-Lewis
- Hospital for Tropical Diseases, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom
- * E-mail:
| | - Diana N. J. Lockwood
- Hospital for Tropical Diseases, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63:e202-e264. [PMID: 27941151 DOI: 10.1093/cid/ciw670] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
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