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Araujo Flores GV, Sandoval Pacheco CM, Ferreira AF, Tomokane TY, Nunes JB, Colombo FA, Sosa-Ochoa WH, Zúniga C, Silveira FT, Corbett CEP, Laurenti MD. Leishmania (L.) infantum chagasi isolated from skin lesions of patients affected by non-ulcerated cutaneous leishmaniasis lead to visceral lesion in hamsters. Parasitol Int 2023; 93:102723. [PMID: 36566911 DOI: 10.1016/j.parint.2022.102723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
In Central America, Leishmania (L.) infantum chagasi infection causes visceral leishmaniasis (VL) and non-ulcerated cutaneous leishmaniasis (NUCL). The aim of the present study was to evaluate the course of an experimental infection in hamsters caused by L. (L.) infantum chagasi isolated from patients affected by NUCL compared with a strain isolated from a patient with VL. Stationary phase parasites in culture were inoculated through subcutaneous and intraperitoneal routes in hamsters. Following the post-infection times, a histopathological study, parasite load and cytokine determination in skin from the cutaneous inoculation site and viscera were performed. Animals subcutaneously infected with the different strains did not develop macroscopic lesions at the inoculation site, and the histopathological changes in the dermis were very slight. Regarding the histopathological study of the viscera, we observed the portal mononuclear inflammatory infiltrate, the presence of nodules in the hepatic parenchyma and the proliferation of macrophages in the spleen, which increased over the infection course. Overall, the parasite load in the liver and spleen and in the total IgG titres in the sera of infected hamster showed an increase with the time of infection, regardless of the route of inoculation. Regarding cellular immunity, we did not observe an increase or decrease in pro- and anti-inflammatory cytokines compared to the healthy control, except for IL-10, which was evident in the infected animals. The data showed that strains isolated from NUCL cause visceral lesions in the hamsters regardless of the route of inoculation, and they were similar to parasites isolated from VL humans.
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Affiliation(s)
- Gabriela V Araujo Flores
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carmen M Sandoval Pacheco
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aurea F Ferreira
- Laboratório de Investigação Médica, LIM50, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, HCFMUSP, SP, Brazil
| | - Thaise Yumie Tomokane
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Wilfredo H Sosa-Ochoa
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Investigaciones en Microbiologia, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Fernando T Silveira
- Instituto Evandro Chagas, Belém, PA, Brazil; Universidade Federal do Pará, Belém, PA, Brazil
| | - Carlos E P Corbett
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Márcia D Laurenti
- Laboratório de Patologia de Moléstias Infecciosas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Segura GBR, Ochoa WHS, da Matta VLR, Martínez M, Tercero CR, Gonzalez RR, Pacheco CMS, Flores GVA, Silveira FT, Henriquez MMR, Laurenti MD. Can domestic dogs be considered a good reservoir of Leishmania (L.) infantum chagasi in an endemic area of nonulcerated cutaneous leishmaniasis in Southern Honduras? Rev Inst Med Trop Sao Paulo 2023; 65:e24. [PMID: 36995877 PMCID: PMC10041965 DOI: 10.1590/s1678-9946202365024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/03/2023] [Indexed: 03/30/2023] Open
Abstract
Dogs are considered to be the main domestic reservoir associated with the transmission of Leishmania (L.) infantum chagasi to humans in endemic areas of visceral leishmaniasis in America. However, little is known about the role of canines as a source of infection in endemic areas of nonulcerated cutaneous leishmaniasis (NUCL). Therefore, the objective of the present study was to investigate the role of dogs as a possible reservoir of the parasite in Southern Honduras. Dogs (n = 107) living with individuals affected by NUCL were clinically examined and biological material was collected for parasitological and immunological diagnosis. Most animals showed a healthy appearance and a few presented slight weight loss (64%), alopecia (7%), onychogryphosis (5%) and skin lesions (1%). The overall seroprevalence of Leishmania infection based on the DDP ® quick test and/or in-house ELISA serological test was 41%. The presence of the parasite’s DNA was confirmed in 94% of the dogs; however, the average parasite load in the buffy coat was low at 6.09 parasites/µL, ranging between 0.221 and 50.2. The skin of seropositive dogs examined by histopathology using paraffin sections stained by hematoxylin and immunohistochemistry did not show cutaneous lesions or parasite amastigotes. Based on the absence of parasites in the skin and the low parasite load detected in the buffy coat, it seems that the dog does not represent a good source of infection for the vector in the endemic area of NUCL transmission in Southern Honduras. Other domestic and/or wild animals should be investigated.
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Affiliation(s)
- Gabriela Beatriz Rodriguez Segura
- Universidad Nacional Autónoma de Honduras , Instituto de Investigaciones en Microbiologia , Tegucigalpa , Honduras
- Universidad Nacional Autónoma de Honduras , Posgrado en Salud Pública , Tegucigalpa , Honduras
| | - Wilfredo Humberto Sosa Ochoa
- Universidad Nacional Autónoma de Honduras , Instituto de Investigaciones en Microbiologia , Tegucigalpa , Honduras
| | - Vânia Lúcia Ribeiro da Matta
- Universidade de São Paulo , Faculdade de Medicina , Hospital das Clínicas , Laboratório de Investigação Médica (LIM-50), São Paulo , São Paulo , Brazil
| | - Mercedes Martínez
- Universidad Nacional Autónoma de Honduras , Posgrado en Salud Pública , Tegucigalpa , Honduras
| | - Carol Rodriguez Tercero
- Universidad Nacional Autónoma de Honduras , Instituto de Investigaciones en Microbiologia , Tegucigalpa , Honduras
| | - Raquel Romero Gonzalez
- Universidad Nacional Autónoma de Honduras , Instituto de Investigaciones en Microbiologia , Tegucigalpa , Honduras
| | - Carmen M. Sandoval Pacheco
- Universidade de São Paulo , Faculdade de Medicina , Laboratório de Patologia de Moléstias Infecciosas , São Paulo , São Paulo , Brazil
| | - Gabriela V. Araujo Flores
- Universidade de São Paulo , Faculdade de Medicina , Laboratório de Patologia de Moléstias Infecciosas , São Paulo , São Paulo , Brazil
| | - Fernando Tobias Silveira
- Instituto Evandro Chagas , Laboratório de Leishmanioses , Belém , Pará , Brazil
- Universidade Federal do Pará , Núcleo de Medicina Tropical , Belém , Pará , Brazil
| | | | - Márcia Dalastra Laurenti
- Universidade de São Paulo , Faculdade de Medicina , Laboratório de Patologia de Moléstias Infecciosas , São Paulo , São Paulo , Brazil
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Comparative Genomic Analyses of New and Old World Viscerotropic Leishmanine Parasites: Further Insights into the Origins of Visceral Leishmaniasis Agents. Microorganisms 2022; 11:microorganisms11010025. [PMID: 36677318 PMCID: PMC9865424 DOI: 10.3390/microorganisms11010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Visceral leishmaniasis (VL), also known as kala-azar, is an anthropozoonotic disease affecting human populations on five continents. Aetiologic agents belong to the Leishmania (L.) donovani complex. Until the 1990s, three leishmanine parasites comprised this complex: L. (L.) donovani Laveran & Mesnil 1903, L. (L.) infantum Nicolle 1908, and L. (L.) chagasi Lainson & Shaw 1987 (=L. chagasi Cunha & Chagas 1937). The VL causal agent in the New World (NW) was previously identified as L. (L.) chagasi. After the development of molecular characterization, however, comparisons between L. (L.) chagasi and L. (L.) infantum showed high similarity, and L. (L.) chagasi was then regarded as synonymous with L. (L.) infantum. It was, therefore, suggested that L. (L.) chagasi was not native to the NW but had been introduced from the Old World by Iberian colonizers. However, in light of ecological evidence from the NW parasite’s enzootic cycle involving a wild phlebotomine vector (Lutzomyia longipalpis) and a wild mammal reservoir (the fox, Cerdocyon thous), we have recently analyzed by molecular clock comparisons of the DNA polymerase alpha subunit gene the whole-genome sequence of L. (L.) infantum chagasi of the most prevalent clinical form, atypical dermal leishmaniasis (ADL), from Honduras (Central America) with that of the same parasite from Brazil (South America), as well as those of L. (L.) donovani (India) and L. (L.) infantum (Europe), which revealed that the Honduran parasite is older ancestry (382,800 ya) than the parasite from Brazil (143,300 ya), L. (L.) donovani (33,776 ya), or L. (L.) infantum (13,000 ya). In the present work, we have now amplified the genomic comparisons among these leishmanine parasites, exploring mainly the variations in the genome for each chromosome, and the number of genomic SNPs for each chromosome. Although the results of this new analysis have confirmed a high genomic similarity (~99%) among these parasites [except L. (L.) donovani], the Honduran parasite revealed a single structural variation on chromosome 17, and the highest frequency of genomic SNPs (more than twice the number seen in the Brazilian one), which together to its extraordinary ancestry (382,800 ya) represent strong evidence that L. (L.) chagasi/L. (L.) infantum chagasi is, in fact, native to the NW, and therefore with valid taxonomic status. Furthermore, the Honduran parasite, the most ancestral viscerotropic leishmanine parasite, showed genomic and clinical taxonomic characteristics compatible with a new Leishmania species causing ADL in Central America.
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Visceral Leishmaniasis Urbanization in the Brazilian Amazon Is Supported by Significantly Higher Infection Transmission Rates Than in Rural Area. Microorganisms 2022; 10:microorganisms10112188. [PMID: 36363780 PMCID: PMC9692416 DOI: 10.3390/microorganisms10112188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
This was an open cohort prospective study (2016−2018) that analyzed the prevalence and incidence rates of human Leishmania (L.) infantum chagasi-infection and the evolution of their clinical-immunological profiles in distinct urban and rural scenarios of American visceral leishmaniasis (AVL) in Pará State, in the Brazilian Amazon. These infection profiles were based on species-specific DTH/IFAT-IgG assays and clinical evaluation of infected individuals, comprising five profiles: three asymptomatic, Asymptomatic Infection [AI], Subclinical Resistant Infection [SRI], and Indeterminate Initial Infection [III]; and two symptomatic, Subclinical Oligosymptomatic Infection [SOI] and Symptomatic Infection [SI = AVL]. The two distinct scenarios (900 km away) were the urban area of Conceição do Araguaia municipality and the rural area of Bujaru municipality in the southeast and northeast of Pará State. Human populations were chosen based on a simple convenience sampling design (5−10% in each setting), with 1723 individuals (5.3%) of the population (32,464) in the urban area and 1568 individuals (8.9%) of the population (17,596) in the rural one. A serological survey (IFAT-IgG) of canine infection was also performed in both scenarios: 195 dogs in the urban area and 381 in the rural one. Prevalence and incidence rates of human infection were higher in the urban area (20.3% and 13.6/100 person-years [py]) than in the rural setting (14.1% and 6.8/100-py). The AI profile was the most prevalent and incident in both urban (13.4% and 8.1/100-py) and rural (8.3% and 4.2/100-py) scenarios, but with higher rates in the former. An III profile case evolved to SOI profile after four weeks of incubation and another to SI (=AVL) after six. The prevalence of canine infection in an urban setting (39.2%) was also higher (p < 0.05) than that (32%) in the rural zone. AVL urbanization in Pará State, in the Brazilian Amazon, has led to infection rates significantly higher than those in rural sites, requiring more intense control measures.
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Whole-Genome Sequencing of Leishmania infantum chagasi Isolates from Honduras and Brazil. Microbiol Resour Announc 2021; 10:e0047121. [PMID: 34854707 PMCID: PMC8638571 DOI: 10.1128/mra.00471-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This work reports on the whole-genome sequencing of Leishmania infantum chagasi from Honduras (Central America) and Brazil (South America).
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Laurenti MD, Sosa-Ochoa W, Araujo Flores GV, Sandoval Pacheco CM, Tomokane TY, Oliveira LMDS, Zúniga C, Silveira FT, Corbett CEP. Evaluation of systemic immunity in atypical cutaneous leishmaniasis caused by Leishmania (L.) infantum chagasi. Parasite Immunol 2021; 44:e12896. [PMID: 34748659 DOI: 10.1111/pim.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022]
Abstract
In some central-American countries, Leishmania (L.) infantum chagasi infection can cause non-ulcerated or atypical cutaneous leishmaniasis (NUCL) in addition to the classic clinical form, visceral leishmaniasis (VL). Little is known about the host-parasite relationship that can contribute to the determination of one or another clinical form. The present study had the objective to evaluate the humoral and cellular immunity in the sera of individuals affected by NUCL to improve the comprehension of this atypical host-parasite interaction. Based on clinical and laboratory diagnosis, serum of 80 individuals was collected to evaluate the cytokines and immunoglobulins profile of NUCL (n = 47), VL patients (n = 5), and negative controls (n = 28). Cytokines were detected using Cytokine Bead Array (CBA) Human Th1/Th2/Th17 kit according to the manufacturer's instructions; class (IgG and IgM), and subclass of (IgG1 and IgG2) immunoglobulins was evaluated by ELISA using specific antigens. The concentration of TNF-α, IFN-γ, IL-2 and IL-4 cytokines in NUCL, VL and control was present below the detection threshold of CBA kit. IL-6, IL-10 and IL-17A cytokines was lower in NUCL compared to LV patients. Regarding to immunoglobulins, NUCL patients produced 4.0 times more IgG than the control, while VL patients produced 6.6 times more; and IgM level was 1.6 times higher in NUCL and 2.6 times in VL patients compared to the control. Concerning the immunoglobulins subclass, only VL patients showed positive reaction for IgG1, and IgG2 did not show positive reaction among the groups. The results showed a weak cellular and humoral systemic immune response in NUCL patients.
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Affiliation(s)
- Márcia Dalastra Laurenti
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Wilfredo Sosa-Ochoa
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.,Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Gabriela Venicia Araujo Flores
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carmen Maria Sandoval Pacheco
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Thaise Yumie Tomokane
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luanda Mara da Silva Oliveira
- Laboratório de Dermatologia e Imunodeficiências (LIM-56), Departamento de Dermatologia, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Fernando Tobias Silveira
- Laboratório de Parasitologia, Instituto Evandro Chagas (Ministério da Saúde), Belém, PA, Brasil.,Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brasil
| | - Carlos Eduardo Pereira Corbett
- Laboratório de Patologia de Moléstias Infecciosas (LIM-50), Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Sandoval C, Araujo G, Sosa W, Avalos S, Silveira F, Corbett C, Zúniga C, Laurenti M. In situ cellular immune response in non-ulcerated skin lesions due to Leishmania (L.) infantum chagasi infection. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200149. [PMID: 33708246 PMCID: PMC7909480 DOI: 10.1590/1678-9199-jvatitd-2020-0149] [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: 10/13/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background Skin lesions of patients affected by non-ulcerated cutaneous leishmaniasis
(NUCL) caused by L. (L.) infantum chagasi are characterized
by lymphohistiocytic inflammatory infiltrate associated with epithelioid
granuloma and scarce parasitism. However, the in situ
cellular immune response of these patients is unclear. Therefore, the aim of
the present study was to characterize the cellular immune response in the
skin lesions of patients affected by NUCL. Methods Twenty biopsies were processed by immunohistochemistry using primary
antibodies to T lymphocytes (CD4, CD8), NK cells, B lymphocytes,
macrophages, nitric oxide synthase and interferon-gamma. Results Immunohistochemistry revealed higher expression of all cellular types and
molecules (IFN-γ, iNOS) in the dermis of diseased skin compared to the skin
of healthy individuals (p < 0.05). Morphometric analysis performed in the
skin lesions sections showed the predominance of CD8+ T
lymphocytes in the mononuclear infiltrate, followed by macrophages, mostly
iNOS+, a response that could be mediated by IFN-γ. Conclusion Our study improves knowledge of the cellular immune response in
non-ulcerated or atypical cutaneous leishmaniasis caused by L. (L.)
infantum chagasi in Central America and pointed to the pivotal
participation of CD8+ T lymphocytes in the host defense
mechanisms against the parasite in patients with NUCL.
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Affiliation(s)
- Carmen Sandoval
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Gabriela Araujo
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Wilfredo Sosa
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil.,Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Sara Avalos
- Master Program in Infectious and Zoonotic diseases, School of Microbiology, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Fernando Silveira
- Department of Parasitology, Evandro Chagas Institute, Secretariat of Health Surveillance, Ministry of Health, Belém, PA, Brazil.,Institute of Tropical Medicine, Federal University of Pará, Belém, PA, Brazil
| | - Carlos Corbett
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Concepción Zúniga
- Department of Health Surveillance, School Hospital, Tegucigalpa, Honduras
| | - Marcia Laurenti
- Laboratory of Infectious Diseases Pathology, Department of Pathology, Medical School (FMUSP), University of São Paulo (USP), São Paulo, SP, Brazil
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Ramos PKS, Gonçalves LP, Alves ACO, Casseb SM, Lima LVDR, Campos MB, Vasconcelos Dos Santos T, Silveira FT. Urine qPCR diagnoses over the entire clinical-immunological spectrum of human Leishmania (L.) infantum chagasi-infections in the Brazilian Amazon. Parasitol Int 2020; 81:102273. [PMID: 33333246 DOI: 10.1016/j.parint.2020.102273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
The clinical-immunological spectrum of human Leishmania (L.) infantum chagasi-infections in the Brazilian Amazon has been defined using DTH/IFAT-IgG immune assays and the clinical statuses of infected individuals, revealing five profiles: three asymptomatic [Asymptomatic Infection (AI), Subclinical Resistant Infection (SRI), and Indeterminate Initial Infection (III)], and two symptomatic profiles [Subclinical Oligosymptomatic Infection (SOI) and Symptomatic Infection (SI = American visceral leishmaniasis/AVL)]. We evaluated the diagnostic potential of urine qPCR over the entire spectrum of infection. Resine Instagene Matrix® was used for DNA extraction from urinary sediment, with amplification carried out using SYBR® Green Taq with the RV1 and RV2 primers. We examined urine samples from 151 individuals from an endemic area of AVL in Pará State in the Brazilian Amazon, including: 91 (60.3%) with diagnoses of previous infections [13 (14.3%) sharing the AI profile, 13 (14.3%) with the SRI profile, 43 (47.2%) with III, 12 (13.2%) with SI (treated AVL), and 10 (11%) with SI (untreated AVL)]; sixty (39.7%) were DTH(-)/IFAT-IgG(-) (the uninfected group). The urine qPCR was positive in 61.5% of both the AI and SRI profiles, 65% of the III profile, 50% of treated AVL, 100% of untreated AVL, and 6.7% of the uninfected group. Those results confirmed the urine qPCR diagnosis in 100% of untreated AVL cases as well as in more than 60% of the cases with asymptomatic AI, SRI, and III profiles - indicating it as a promising tool for monitoring the evolution of human L. (L.) infantum chagasi-infections in endemic areas.
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Affiliation(s)
- Patrícia Karla Santos Ramos
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Ananindeua, Pará State, Brazil.
| | - Lucas Pantoja Gonçalves
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Ananindeua, Pará State, Brazil
| | - Ana Camila Oliveira Alves
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Ananindeua, Pará State, Brazil
| | - Samir Mansour Casseb
- Arbovirology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Ananindeua, Pará State, Brazil
| | - Luciana Vieira do Rêgo Lima
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Ananindeua, Pará State, Brazil
| | - Marliane Batista Campos
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Ananindeua, Pará State, Brazil
| | - Thiago Vasconcelos Dos Santos
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Ananindeua, Pará State, Brazil
| | - Fernando Tobias Silveira
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Ananindeua, Pará State, Brazil; Tropical Medicine Nucleus, Federal University of Pará, Pará State, Brazil
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