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Touray M, Bakirci S, Ulug D, Gulsen SH, Cimen H, Yavasoglu SI, Simsek FM, Ertabaklar H, Ozbel Y, Hazir S. Arthropod vectors of disease agents: their role in public and veterinary health in Turkiye and their control measures. Acta Trop 2023; 243:106893. [PMID: 37004805 DOI: 10.1016/j.actatropica.2023.106893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023]
Abstract
Mosquitoes, sandflies, and ticks are hematophagous arthropods that pose a huge threat to public and veterinary health. They are capable of serving as vectors of disease agents that can and have caused explosive epidemics affecting millions of people and animals. Several factors like climate change, urbanization, and international travel contribute substantially to the persistence and dispersal of these vectors from their established areas to newly invaded areas. Once established in their new home, they can serve as vectors for disease transmission or increase the risk of disease emergence. Turkiye is vulnerable to climate change and has experienced upward trends in annual temperatures and rising sea levels, and greater fluctuations in precipitation rates. It is a potential hotspot for important vector species because the climate in various regions is conducive for several insect and acari species and serves as a conduit for refugees and immigrants fleeing areas troubled with armed conflicts and natural disasters, which have increased substantially in recent years. These people may serve as carriers of the vectors or be infected by disease agents that require arthropod vectors for transmission. Although it cannot be supposed that every arthropod species is a competent vector, this review aims to (1)illustrate the factors that contribute to the persistence and dispersal of arthropod vectors, (2)determine the status of the established arthropod vector species in Turkiye and their capability of serving as vectors of disease agents, and (3)assess the role of newly-introduced arthropod vectors into Turkiye and how they were introduced into the country. We also provide information on important disease incidence (if there's any) and control measures applied by public health officials from different provinces.
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Affiliation(s)
- Mustapha Touray
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey.
| | - Serkan Bakirci
- Department of Parasitology, Faculty of Veterinary Medicine, Aydin Adnan Menderes University, Turkey
| | - Derya Ulug
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey
| | - Sebnem H Gulsen
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey
| | - Harun Cimen
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey
| | | | - Fatih M Simsek
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey
| | - Hatice Ertabaklar
- Department of Parasitology, Faculty of Medicine, Aydin Adnan Menderes University, Turkey
| | - Yusuf Ozbel
- Department of Parasitology, Faculty of Medicine, Ege University, Turkey
| | - Selcuk Hazir
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey; Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai 602105, Tamil Nadu India
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Mesa LE, Manrique R, Robledo SM, Tabares J, Pineda T, Muskus C. The performance of the recombinase polymerase amplification test for detecting Leishmania deoxyribonucleic acid from skin lesions of patients with clinical or epidemiological suspicion of cutaneous leishmaniasis. Trans R Soc Trop Med Hyg 2021; 115:1427-1433. [PMID: 34037801 DOI: 10.1093/trstmh/trab073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/25/2021] [Accepted: 04/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The diagnosis of cutaneous leishmaniasis (CL) is based on demonstration of the presence of the parasite in samples obtained from the lesions by direct examination (DE), culture or polymerase chain reaction (PCR)-based molecular tests. Recombinase polymerase amplification (RPA) represents an isothermal version of the conventional PCR (cPCR) technique, being ideal for detecting Leishmania DNA, especially in field conditions. METHODS A prospective and cross-sectional study was conducted to evaluate the diagnostic performance of RPA in the health centres of rural endemic sites or the evaluation centre (EC) of 11 Colombian municipalities and in a reference centre (RC). RESULTS Samples of 128 patients with suspected CL were included and processed for analysis by RPA vs DE in the EC and RPA vs DE and cPCR in the RC. The RPA performed at the EC was more sensitive (90.4% [95% confidence interval {CI} 81.9 to 95.7]) than the DE (42-67%) and the specificity was 72.7% (95% CI 57.2 to 85.0). Both the sensitivity and specificity increased to 100% when adjusting by the imperfect reference standard analysis method. In the RC, the sensitivity of RPA vs cPCR was 72% and the specificity was 69.8%, while the sensitivity of cPCR vs the DE test was 78.8% and the specificity was 81%. CONCLUSIONS The higher sensitivity and specificity shown by RPA in the EC, but also its ease and speed of use, justify performing RPA in the health centres of rural endemic sites. In addition, RPA eliminates the subjectivity inherent in the traditional DE.
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Affiliation(s)
- Luz Estella Mesa
- PECET-Program for the Study and Control of Tropical Diseases. Faculty of Medicine, Universidad de Antioquia-UdeA, Medellín, Colombia.,Epidemiology and Biostatistic Universidad CES, Medellín, Colombia
| | - Rubén Manrique
- Epidemiology and Biostatistic Universidad CES, Medellín, Colombia
| | - Sara M Robledo
- PECET-Program for the Study and Control of Tropical Diseases. Faculty of Medicine, Universidad de Antioquia-UdeA, Medellín, Colombia
| | - Jessica Tabares
- PECET-Program for the Study and Control of Tropical Diseases. Faculty of Medicine, Universidad de Antioquia-UdeA, Medellín, Colombia
| | - Tatiana Pineda
- PECET-Program for the Study and Control of Tropical Diseases. Faculty of Medicine, Universidad de Antioquia-UdeA, Medellín, Colombia
| | - Carlos Muskus
- PECET-Program for the Study and Control of Tropical Diseases. Faculty of Medicine, Universidad de Antioquia-UdeA, Medellín, Colombia
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YILDIZ İ, MALATYALİ E. Aydın Adnan Menderes Üniversitesi Uygulama ve Araştırma Hastanesi Parazitoloji Laboratuvarında Kutanöz Leishmaniasis Tanısı Almış Olguların Retrospektif Olarak Değerlendirilmesi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.882533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Çulha G, DoĞramaci AÇ, Hakverdİ S, SeÇİntİ İE, AslantaŞ Ö, Çelİk E, Kaya T. The Investigation of the Association of Cutaneous Leishmaniasis in Biopsy Specimens of the Patients with Granulomatous Disease and Skin Cancer Using the Molecular Method. IRANIAN JOURNAL OF PARASITOLOGY 2020; 15:307-314. [PMID: 33082794 PMCID: PMC7548460 DOI: 10.18502/ijpa.v15i3.4194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Clinically, cutaneous leishmaniasis (CL) can be confused with granulomatous diseases and skin cancers, and it may lead to erroneous diagnosis and treatment. Diagnosis based and histopathology can have some difficulties due to low number of parasites, especially in chronic CL cases. We aimed to emphasize the necessity of considering CL in the differential diagnosis for cases of granulomatous diseases and basal cell carcinoma, particularly in areas where CL is endemic. Methods One hundred and seven paraffin-embedded tissue biopsy specimens were selected from the archive, as of 2002, of Pathology Department, School of Medicine, University of Hatay Mustafa Kemal in Hatay, Turkey. After DNA isolation, performed with the samples were used for PCR analysis with specific 13A, 13B primers targeting kinetoplastid DNA (kDNA) found in all Leishmania species. Another PCR was performed with LITSR and L5.8S primers targeting ITS-1 internal-transcribed-spacer-1 (ITS-1) region to subtype positive samples. Then these samples were further analyzed for subtyping with PCR-RFLP using HaeIII enzyme (BsuRI). Results Ten out of 107 tissue specimens were positive via kDNA-PCR. Lupus vulgaris, sarcoidosis, skin lymphoma and Leishmania cutis appeared in 9 out of 10 positive specimens. One of the cases presented with a mass on the cheek and was pre-diagnosed with hemangioma, but leishmaniasis did not appear. All of 10 specimens were diagnosed as granulomatous dermatitis. Two out of 10 samples, found positive with kDNA-PCR, were analyzed with ITS-1-PCR and identified as L. infantum/donovani after RFLP. Conclusion Molecular methods should be utilized in the differential diagnosis of CL to eliminate false diagnoses of granulomatous diseases and skin cancers.
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Affiliation(s)
- Gülnaz Çulha
- Department of Parasitology, School of Medicine, University of Hatay Mustafa Kemal, Hatay, Turkey
| | - Asena Çiğdem DoĞramaci
- Department of Dermatology, School of Medicine, University of Hatay Mustafa Kemal, Hatay, Turkey
| | - Sibel Hakverdİ
- Department of Medical Pathology, School of Medicine, University of Hatay Mustafa Kemal, Hatay, Turkey
| | - İlke Evrim SeÇİntİ
- Department of Medical Pathology, School of Medicine, University of Hatay Mustafa Kemal, Hatay, Turkey
| | - Özkan AslantaŞ
- Department of Microbiology, School of Veterinary Science, University of Hatay Mustafa Kemal, Hatay, Turkey
| | - Ebru Çelİk
- Department of Dermatology, School of Medicine, University of Hatay Mustafa Kemal, Hatay, Turkey
| | - Tuğba Kaya
- Department of Parasitology, School of Medicine, University of Hatay Mustafa Kemal, Hatay, Turkey
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Mesa LE, Manrique R, Muskus C, Robledo SM. Test accuracy of polymerase chain reaction methods against conventional diagnostic techniques for Cutaneous Leishmaniasis (CL) in patients with clinical or epidemiological suspicion of CL: Systematic review and meta-analysis. PLoS Negl Trop Dis 2020; 14:e0007981. [PMID: 31961871 PMCID: PMC6994169 DOI: 10.1371/journal.pntd.0007981] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 01/31/2020] [Accepted: 12/09/2019] [Indexed: 12/03/2022] Open
Abstract
Background Molecular diagnostic tests, notably polymerase chain reaction (PCR), are highly sensitive test for Leishmania detection, which is especially relevant in chronic cutaneous lesion with lower parasite load. An accurate diagnosis is essential because of the high toxicity of the medications for the disease. Nevertheless, diagnosis of cutaneous leishmaniasis (CL) is hampered by the absence of a reference standard. Assuming that the PCR-based molecular tools are the most accurate diagnostic method, the objective of this systematic review was to assess the diagnostic accuracy of PCR-based molecular tools in a meta-analysis of the published literature. Methodology/Principal findings A search of the published literature found 142 papers of which only 13 studies met the selection criteria, including conventional PCR, real-time PCR, Loop-mediated isothermal amplification (LAMP), recombinase polymerase amplification (RPA), polymorphism-specific PCR (PS-PCR). The sensitivities of the individual studies ranged from 61% to 100%, and specificities ranged from 11% to 100%. The pooled sensitivities of PCR in smears were 0.95 (95% CI, 0.90 to 0.98), and the specificity was 0.91(95% CI, 0.70 to 0.98). In general population, estimates were lower in aspirates, skin biopsies and swab samples with 0.90 (95% CI, 0.80 to 0.95) and 0.87 (95% CI, 0.76 to 0.94) for sensitivity and specificity, respectively. The specificity was lower in consecutive studies, at 0.88 (95% CI, 0.59 to 0.98) and its CI were wider. Conclusions/Significance No statistically significant differences between the accuracy in smears, aspirate, skin biopsies or swabs samples were observed. Therefore, a simple smear sample run by PCR, instead more invasive samples, may be enough to obtain a positive diagnosis of CL. The results for PCR in all samples type confirm previous reports that consider PCR as the most accurate method for the diagnosis of CL. This systematic review and meta-analysis confirmed that PCR is the most accurate methods for the diagnosis of CL. The summary of the estimates for sensitivity and specificity in all readout methods of the index test were high. No statistically differences between the accuracy in smears, aspirate, skin biopsies or swabs samples suggesting that a simple smears sample run by PCR instead more invasive samples is enough to obtain a positive diagnosis of CL.
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Affiliation(s)
- Luz Estella Mesa
- PECET- Medical Research Institute, School of Medicine, University of Antioquia-UdeA, Calle, Medellín-Colombia
- Epidemiology and Biostatistic, Universidad CES Calle, Medellín-Colombia
| | - Rubén Manrique
- Epidemiology and Biostatistic, Universidad CES Calle, Medellín-Colombia
| | - Carlos Muskus
- PECET- Medical Research Institute, School of Medicine, University of Antioquia-UdeA, Calle, Medellín-Colombia
| | - Sara M. Robledo
- PECET- Medical Research Institute, School of Medicine, University of Antioquia-UdeA, Calle, Medellín-Colombia
- * E-mail:
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Rasheed Z, Ahmed AA, Salem T, Al-Dhubaibi MS, Al Robaee AA, Alzolibani AA. Prevalence of Leishmania species among patients with cutaneous leishmaniasis in Qassim province of Saudi Arabia. BMC Public Health 2019; 19:384. [PMID: 30953481 PMCID: PMC6451202 DOI: 10.1186/s12889-019-6710-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background Leishmaniasis is a parasitic infection endemic in more than ninety countries of the world. The cutaneous leishmaniasis (CL) is a most common form of leishmaniasis and it remains to be a major public health issue in Saudi Arabia. This study was undertaken to investigate the Leishmania species responsible for CL infection in different provinces of Qassim, Saudi Arabia. Methods Skin biopsies were obtained from CL patients and DNA was extracted using the Magna pure system. Leishmania species were identified by highly specific/sensitive quantitative and qualitative PCR. Results Out of total 206 CL biopsies, 49.5% biopsies were found to be positive for Leishmania major (L. major), 28.6% biopsies were positive for Leishmania tropica (L. tropica), 3.9% were found to be positive for Leishmania infantum/donovani (L. infantum/donovani). Not only have these, all tested CL biopsies showed negative test for Leishmania mexicana (L. mexicana) and Leishmania viannia (L. viannia). Conclusions This is the first comprehensive study that shows the majority of CL in Qassim was caused by L. major and L. tropica. To the best of our knowledge, this is the very first report that shows the occurrence of L. infantum/donovani in Saudi Arabia. This requires higher alert to the Ministry of Health of Saudi Arabia to take proactive actions in preventing the onset of L. major, L. tropica, L. infantum and L. donovani infections.
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Affiliation(s)
- Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, P.O. Box 6655, Buraidah, 51452, Saudi Arabia.
| | - Ahmed A Ahmed
- Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Tarek Salem
- Department of Medical Biochemistry, College of Medicine, Qassim University, P.O. Box 6655, Buraidah, 51452, Saudi Arabia
| | - Mohammed S Al-Dhubaibi
- Department of Dermatology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ahmad A Al Robaee
- Department of Dermatology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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Lamm R, Alves C, Perrotta G, Murphy M, Messina C, Sanchez JF, Perez E, Rosales LA, Lescano AG, Smith E, Valdivia H, Fuhrer J, Ballard SB. Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru. Am J Trop Med Hyg 2018; 99:331-337. [PMID: 29869605 DOI: 10.4269/ajtmh.17-0909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ2 test, t-test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted odds ration [OR] = 1.93 [1.06-3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.
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Affiliation(s)
- Ryan Lamm
- Stony Brook University School of Medicine, Stony Brook, New York.,Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.,US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Grace Perrotta
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Meagan Murphy
- Stony Brook University School of Medicine, Stony Brook, New York
| | | | - Juan F Sanchez
- Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru.,US Naval Medical Research Unit No. 6, Lima, Peru
| | - Erika Perez
- US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Andres G Lescano
- Universidad Peruana Cayetano Heredia, Lima, Peru.,US Naval Medical Research Unit No. 6, Lima, Peru
| | - Edward Smith
- US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Jack Fuhrer
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Sarah-Blythe Ballard
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,US Naval Medical Research Unit No. 6, Lima, Peru
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Eid D, Guzman-Rivero M, Rojas E, Goicolea I, Hurtig AK, Illanes D, San Sebastian M. Risk factors for cutaneous leishmaniasis in the rainforest of Bolivia: a cross-sectional study. Trop Med Health 2018; 46:9. [PMID: 29692654 PMCID: PMC5902850 DOI: 10.1186/s41182-018-0089-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) is an endemic disease in Bolivia, particularly in the rainforest of Cochabamba, in the municipality of Villa Tunari. The precarious, dispersed, and poorly accessible settlements in these farming communities make it difficult to study them, and there are no epidemiological studies in the area. The aim of the present study was to identify the risk factors associated with cutaneous leishmaniasis. Methods A cross-sectional study was conducted in August 2015 and August 2016 in two communities of Villa Tunari, Cochabamba. The cases were diagnosed through clinical examinations, identification of the parasite by microscopic examination, and the Montenegro skin test. Risk factors were identified through logistic regression. Results A total of 274 participants (40.9% female and 59.1% male) were surveyed, of which 43% were CL positive. Sex was the only factor associated with CL with three times more risk for men than for women; this finding suggests a sylvatic mechanism of transmission in the area. Conclusions It is advisable to focus on education and prevention policies at an early age for activities related to either leisure or work. Further research is needed to assess the influence of gender-associated behavior for the risk of cutaneous leishmaniasis.
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Affiliation(s)
- Daniel Eid
- Institute of Biomedical Research, Faculty of Medicine, San Simon University, Aniceto Arce Avenue 371, Cochabamba, Bolivia.,2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University, Umea, Sweden
| | - Miguel Guzman-Rivero
- Institute of Biomedical Research, Faculty of Medicine, San Simon University, Aniceto Arce Avenue 371, Cochabamba, Bolivia
| | - Ernesto Rojas
- Institute of Biomedical Research, Faculty of Medicine, San Simon University, Aniceto Arce Avenue 371, Cochabamba, Bolivia
| | - Isabel Goicolea
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University, Umea, Sweden
| | - Anna-Karin Hurtig
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University, Umea, Sweden
| | - Daniel Illanes
- Institute of Biomedical Research, Faculty of Medicine, San Simon University, Aniceto Arce Avenue 371, Cochabamba, Bolivia
| | - Miguel San Sebastian
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University, Umea, Sweden
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Semi-quantitative measurement of asymptomatic L. infantum infection and symptomatic visceral leishmaniasis in dogs using Dual-Path Platform® CVL. Appl Microbiol Biotechnol 2016; 101:381-390. [PMID: 27796441 DOI: 10.1007/s00253-016-7925-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/24/2016] [Accepted: 10/04/2016] [Indexed: 12/21/2022]
Abstract
Infection with Leishmania causes diseases with variable presentation. The most severe form is visceral leishmaniasis (VL), caused by either L. donovani or L. infantum. Despite efforts to eliminate VL, to date, molecular detection in resource-poor settings have lacked the accuracy and rapidity that would enable widespread field use and the need for accurate, sensitive assays to detect asymptomatic Leishmania infection has become apparent. The domestic dog serves as the primary reservoir host of L. infantum. Study of this reservoir population provides an opportunity to evaluate the sensitivity and specificity of diagnostics for well-defined, symptomatic, canine visceral leishmaniasis (CVL) and asymptomatic L. infantum infection. Blood samples from an L. infantum-endemic population of US hunting dogs were evaluated with Dual-Path Platform (DPP®) CVL compared to those obtained via direct detection methods (culture- and Leishmania-specific quantitative polymerase chain reaction, qPCR) and immunofluorescence anti-Leishmania antibody test (IFAT). Statistically significant correlations were found between DPP® CVL development time and clinical status, culture status, circulating DNA levels, and IFAT titer. DPP® CVL results correlated with both clinical severity of disease and serological evidence of asymptomatic L. infantum infection. By precisely documenting the minimum time required for the development of a clear positive result in DPP® CVL, this test could be used in a rapid, semi-quantitative manner for the evaluation of asymptomatic and symptomatic CVL. Our results also indicate that a similar test could be used to improve our understanding of human VL.
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