Effectiveness In Vivo and In Vitro of Polymeric Nanoparticles as a Drug Release System in the Treatment of Leishmaniasis

Leishmaniasis is a neglected disease caused by the parasite of the genus Leishmania. Current treatment regimens are obsolete and cause several side effects, promoting poor patient compliance, in addition to the vast majority already having the potential for resistance. Therefore, polymeric nanoparticles emerge as one of the viable alternatives to overcome existing limitations, through passive or active vectorization. This review aims to summarize the latest studies of polymeric nanoparticles as an alternative treatment for leishmaniasis. In the first section, the main pharmacokinetic and pharmacodynamic challenges of current drugs are reported. The second section details how nanoparticles with and without functionalization are efficient in the treatment of leishmaniasis, discussing the characteristics of the polymer in the formulation. In this way, polymeric nanoparticles can improve the physicochemical properties of leishmanicidal drugs, improving solubility and stability, as well as improve the release of these drugs, directly or indirectly reaching monocytes/macrophages. 64.28% drugs were focused on the treatment of visceral leishmaniasis, and 28.57% on cutaneous leishmaniasis. The most chosen polymers in the literature are chitosan (35.71%) and PLGA (35.71%), the others represented 14.30% drugs, with all able to manage the drug release and increase the in vitro and/or in vivo efficacy of the original molecule. However, there are several barriers for these nanoformulations to cross laboratory research and is necessary more in-depth studies about the metabolites and degradation pathways of the polymers used in the formulations and plasma proteomics studies.

Unveiling the secrets of snakes: Analysis of environmental, socioeconomic, and spatial factors associated with snakebite risk in Paraná, Southern Brazil

The state of Paraná is home to three out of the five medically significant snake genera in Brazil and lacks of snakebite epidemiology studies. This study aimed to ascertain the spatial, environmental, and socioeconomic factors associated with snakebite risk by analyzing notification data of cases in the state of Paraná. Notification and socioeconomic data were gathered from the online platforms of the National System of Notifiable Diseases (SINAN) and the Brazilian Institute of Geography and Statistics (IBGE). Land cover and land use maps were obtained from the Mapbiomas platform in raster format and subsequently converted into vectors using QGis software. The proportions of land use and land cover in square kilometers (km2) were then calculated. All acquired data were tabulated using Microsoft Excel 365 software. For spatial analysis, GeoDa software version 1.20 was utilized to calculate the Global and Local Moran indices, assessing spatial correlations. Between 2007 and 2021, 12,877 notifications were recorded, with an average incidence of 8.22/100,000 inhabitants in the state, 8166 (63.41%) caused by Bothrops, 1534 (11.91%) caused by Crotalus, 56 (0.43%) caused by Micrurus. 1703 (13.22%) caused by non-venomous snake species, and the remaining cases did not have the identified causative species. The incidents caused by Bothrops and Crotalus showed different distribution patterns. Spatial analysis revealed that key factors contributing to snakebite risk included the presence of native forests, mangroves, apicuns, and monospecific planted forests. The population group at the highest risk comprised rural residents and workers. Furthermore, the absence of basic sanitation and proper garbage collection and disposal exhibited positive correlations with snakebites. Conversely, intensive farming practices with substantial mechanization and pastures demonstrated negative spatial correlations. This study has enabled the identification of the primary factors associated with snakebite risk, facilitating more targeted efforts to prevent snakebite accidents among vulnerable populations.

Trend of pediatric leprosy in an endemic area in Northeast of Brazil, 2008-2018

BACKGROUND

The incidence of leprosy in children is an important indicator of the disease's tendency in the general population and suggests intense circulation and transmission of Mycobacterium leprae.

OBJECTIVES

To describe the clinical, epidemiological characteristics and temporal dynamics of leprosy cases in children under 15 years of age from 2008 to 2018 in an endemic municipality.

METHODS

A descriptive study with an analytical approach was carried out with data from leprosy cases registered in the Brazilian Information System on Notifiable Diseases for the municipality of Cabo de Santo Agostinho, Pernambuco, Brazil.

RESULTS

Between 2008 and 2018, 112 new cases of leprosy were registered. Most cases were classified as paucibacillary leprosy and occurred in children living in urban areas. There was no significant difference in the incidence of leprosy during the study period. Only 4.5% of the sample presented reactional episodes, but a high number of cases were not evaluated for the occurrence of reactions.

CONCLUSIONS

The findings of this study show a high incidence of paucibacillary leprosy in children and adolescents, which reveals active transmission in the community and failures in the detection of new multibacillary cases among adults. Children between 10 and 14 years old are more vulnerable to M. leprae infection and mainly develop paucibacillary leprosy.

Cranial vault reduction cranioplasty for severe macrocephaly due to holoprosencephaly and subdural hygroma: a case report

BACKGROUND

Severe macrocephaly can still be found in developing countries. This condition is usually caused by neglected hydrocephalus and can cause a lot of morbidities. Cranial vault reconstruction cranioplasty is the main treatment option for severe macrocephaly. Holoprosencephaly is often seen with features of microcephaly. Hydrocephalus should be considered as the main cause in HPE patients with features of macrocephaly. In this report, we present a rare case of cranial vault reduction cranioplasty procedure in patient with severe macrocephaly due to holoprosencephaly and subdural hygroma.

CASE DESCRIPTION

A 4-year-10-month-old Indonesian boy was admitted with head enlargement since birth. He had a history of VP shunt placement when he was 3 months old. But the condition was neglected. Preoperative head CT showed massive bilateral subdural hygroma that compressed brain parenchyma caudally. From the craniometric calculation, the occipital frontal circumference was 70.5 cm with prominent vertex expansion, the distance between nasion to inion was 11.91 cm and the vertical height was 25.59 cm. The preoperative cranial volume was 24.611 cc. The patient underwent subdural hygroma evacuation and cranial vault reduction cranioplasty. The postoperative cranial volume was 10.468 cc.

CONCLUSION

Subdural hygroma can be a rare cause of severe macrocephaly in holoprosencephaly patients. Cranial vault reduction cranioplasty and subdural hygroma evacuation is still the main treatment option. Our procedure successfully reduces significant cranial volume (57.46% volume reduction).

Emerging biomedical tools for biomarkers detection and diagnostics in schistosomiasis

Schistosomiasis is a neglected disease that strikes many people from tropical and subtropical countries where there are not satisfactory sanitation and wide access to clean water. Schistosoma spp., the causative agents of schistosomiasis, exhibit a quite complex life cycle that involves two hosts (humans and snails, respectively, the definitive and the intermediate), and five evolutive forms: cercariae (human infective form), schistosomula, adult worms, eggs, and miracidia. The techniques to diagnose schistosomiasis still have various limitations, mainly regarding low-intensity infections. Although various mechanisms associated with schistosomiasis have already been evidenced, there is still a need to fulfill the comprehension of this disease, especially to prospect for novel biomarkers to improve its diagnosis. Developing methods with more sensitivity and portability to detect the infection is valuable to reach schistosomiasis control. In this context, this review has gathered information not only on schistosomiasis biomarkers but also on emerging optical and electrochemical tools proposed in selected studies from about the last ten years. Aspects of the assays regarding the sensibility, specificity, and time needed for detecting diverse biomarkers are described. We hope this review can guide future developments in the field of schistosomiasis, contributing to improving its diagnosis and eradication.

An 11-year epidemiological analysis of schistosomiasis in Ecuador: Investigating a non-endemic, neglected, and challenging-to-identify parasitic disease

Schistosomiasis is a neglected disease caused by parasites of the genus Schistosoma and transmitted by snails of the genus Biomphalaria. At least five species have the potential to infect humans living in or visiting tropical areas worldwide. In Latin America, Schistosoma mansoni is particularly common; however, it has not been reported in Ecuador. In this study, we assess the available official data on schistosomiasis in Ecuador to describe the prevalence of this neglected disease. We conducted a nationwide study to determine the demographic and spatial distribution patterns of schistosomiasis infection in Ecuador, using hospital discharge official data as a proxy for infection incidence from 2011 to 2021. We calculated crude and age-sex-adjusted morbidity and hospital admission rates by region, province, canton, and elevation. In the last decade of available data, schistosomiasis accounted for at least 551 hospital admissions in Ecuador. Women represented 53.7% (n = 296) of cases, equivalent to 3.2 cases per 1,000,000 inhabits. The highest number of cases (61.2%, n = 337) was found in the Coastal region. However, the highest incidence rates were observed in the Amazon region's provinces of Pastaza (173.44 cases/1,000,000).

Candimine from Hippeastrum escoipense (Amaryllidaceae): Anti-Trypanosoma cruzi activity and synergistic effect with benznidazole

BACKGROUND

Chagas disease (CD), caused by Trypanosoma cruzi, represents a health threat to around 20 million people worldwide. Side effects of benznidazole (Bzn) cause 15-20% of patients to discontinue their treatment. Evidence has increased in favor of the use of drug combinations to improve the efficacy and tolerance of the treatment. Natural products are well known to provide structures that could serve as new drugs or scaffolds for CD treatment. Spp of the Amaryllidoideae sub family of Amaryllidaceae family are known by their bioactives alkaloids, which have been reported by their antiparasitic activities.

PURPOSE

To evaluate the anti-T. cruzi activity of the isolated alkaloid candimine (Cnd) from Hippeastrum escoipense Slanis & Huaylla; and to assess the combination effect between Cnd and Bzn against different life stages of T. cruzi parasites.

METHODS

The chemical profile of H. escoipense alkaloids extract (AE-H. escoipense), including quantitation of Cnd was performed through GC/MS and UPLC-MS/MS techniques. Subsequently, Cnd was isolated using Shephadex LH-20. Then, the AE-H. escoipense and Cnd were tested against T. cruzi, (epimastigotes, trypomastigotes, and amastigotes) by in vitro proliferation and viability assays. The cytotoxicity was evaluated against Vero and HepG2 mammalian cells. The ultrastructural analysis was perform by transmission electron microscopy (TEM) and mitochondrial activity was carried out by MTT assay. Drug combination assay between Cnd and Bzn was evaluated using the Chou-Talalay method.

RESULTS

The AE-H. escoipense and Cnd showed high and specific anti-T. cruzi activity, comparable to Bzn. Cnd induces ultrastructural changes in T. cruzi, such as vacuolization, membrane blebs, and increased mitochondrial activity. Regarding the interaction between Cnd and Bzn, it generates synergism in the combinations of 0.25×IC₅₀ in epimastigotes, 2×IC₅₀ in trypomastigotes+amastigotes, and 0.25, 2, and 4×IC₅₀ in amastigotes.

CONCLUSION

The synergism between Cnd and Bzn indicates that the combination at the concentration of 4×IC₅₀ could be useful as an effective new therapy against CD in the chronic stage. Thus, Cnd isolated from the leaves of H. escoipense emerges as potential candidate for the development of a new drug for the treatment of CD.

Exploring the cultural effects of gender on perceptions of cutaneous leishmaniasis: a systematic literature review

BACKGROUND

More than one million people each year become infected by parasites that cause the disease cutaneous leishmaniasis (CL). This disease manifests as one or more skin lesions or ulcers that are slow to heal with variable response rates to drug treatments. Thus far, little attention has been paid to how the cultural effects of gender shape perceptions and experiences of CL. This review aims to bring together and analyse existing studies which use qualitative data to explore these differences. These studies offered insights into our specific research questions.

METHODS

We conducted a systematic review of the literature pertaining to either CL or muco-cutaneous leishmaniasis (MCL) through EBSCO, EMBASE, Medline, Scopus and Web of Science databases. To meet inclusion criteria, articles had to be either qualitative or mixed-method with a qualitative component. They also had to include a reflection on how the gender of participants impacted the findings and addressed the lived experiences of CL. We did not exclude articles based on the language they were published in or in which country the study took place.

RESULTS

From a total of 1589 potential articles, we found that thirteen met the inclusion criteria. These articles were published in English, Spanish or Portuguese and reported on studies carried out in various countries in Africa, Asia and South America. After using the principles of a meta-ethnography to analyse these studies, we generated several key themes. We found that health-seeking behaviours, treatment choices, stigma and the impact of scarring are shaped by gender in a variety of contexts.

CONCLUSIONS

Gender impacts on an individual's experience of CL. In particular, women are more constricted in their health-seeking behaviours and experience more stigma both from the active lesions and from scarring than men. In many contexts, however, men are more at risk of becoming infected by the parasite that causes CL and may turn to more harmful or aggressive self-treatments. We recommend that future research on CL should consider the impact of gender as this can create very different experiences for individuals.

Pancreatic eurytrematosis in small ruminants: A forgotten disease or an untold history?

Trematodiosis are among the most neglected parasitic diseases worldwide. The pancreatic eurytrematosis (PE) is a chronic parasitic infection mostly reported in cattle but has been unnoticed in small ruminants for many decades. Our review showed PE has been recorded as scattered regional reports in goats and sheep, mainly in Asia and Eastern Europe. Eurytrema coelomaticum, Eurytrema cladorchis, and Eurytrema pancreaticum have been the main pathogenic species infecting pancreatic ducts of small ruminants. Climatic, environmental, and regional conditions in both hemispheres may support the survival and feasibility of intermediate hosts and parasitic forms, enabling the emergence and spread of PE in small ruminants. As a primarily asymptomatic condition, PE in goats and sheep flocks may also have a high prevalence, causing severe parasitic pancreatitis, production losses, and death. There is little information on anthelmintic therapeutics for PE in small ruminants, and most used anti-fluke drugs are ineffective. PE is likely more unnoticed than a neglected trematodiosis in goats and sheep, or both from a global perspective.

Assessment of periportal fibrosis in Schistosomiasis mansoni patients by proton nuclear magnetic resonance-based metabonomics models

BACKGROUND

The evaluation of periportal fibrosis (PPF) is essential for a prognostic assessment of patients with Schistosomiasis mansoni. The WHO Niamey Protocol defines patterns of fibrosis from abdominal ultrasonography, 1H-nuclear magnetic resonance (NMR)-based metabonomics has been employed to assess liver fibrosis in some diseases.

AIM

To build 1H-NMR-based metabonomics models (MM) to discriminate mild from significant periportal PPF and identify differences in the metabolite profiles.

METHODS

A prospective cross-sectional study was performed on schistosomiasis patients at a University Hospital in Northeastern Brazil. We evaluated 41 serum samples from 10 patients with mild PPF (C Niamey pattern) and 31 patients with significant PPF (D/E/F Niamey patterns). MM were built using partial least squares-discriminant analysis (PLS-DA) and orthogonal projections to latent structures discriminant analysis (OPLS-DA) formalisms.

RESULTS

PLS-DA and OPLS-DA resulted in discrimination between mild and significant PPF groups with R2 and Q2 values of 0.80 and 0.38 and 0.72 and 0.42 for each model, respectively. The OPLS-DA model presented accuracy, sensitivity, and specificity values of 92.7%, 90.3%, and 100% to discriminate significant PPF. The metabolites identified as responsible by discrimination were: N-acetylglucosamines, alanine, glycolaldehyde, carbohydrates, and valine.

CONCLUSION

MMs discriminated mild from significant PPF patterns in patients with Schistosomiasis mansoni through identification of differences in serum metabolites profiles.

Strongyloides Stercoralis Infection in Hispanic Veterans Living in Puerto Rico: A Tropical Issue or a Global One?

OBJECTIVE

Strongyloidiasis is a parasitic infection classified by the World Health Organization as a neglected tropical disease. Although predominantly asymptomatic, it can become a life-threatening disease in an immunocompromised host. Epidemiologic studies in the Western Hemisphere are scarce, but even more scarce are descriptions of the natural course of this disease. Our objectives were to identify the different manifestations and outcomes of Strongyloides stercoralis infection in the Hispanic veteran population in Puerto Rico. We also discuss the importance of pursuing a timely diagnosis in high-risk patients migrating from or traveling to endemic areas, regardless of their symptomatic status.

METHODS

This was a single-center, retrospective record review study involving patients diagnosed with S. stercoralis via serology, stool samples, or organ biopsies, from 2008 through 2014.

RESULTS

A total of 270 patients tested positive; 210 (77.8%) were asymptomatic. The mean age at diagnosis was 75.4 years old. Symptomatic patients had pulmonary (n = 25), gastrointestinal (n = 21), and dermatologic (n = 5) symptoms; 9 had multiple symptoms. Five had hyperinfection, mostly after treatment with systemic steroids or preexisting immunosuppression. The most common laboratory abnormality was eosinophilia. Reasons for testing were eosinophilia, asthma, diarrhea, screening for parasites, and unexplained skin rash.

CONCLUSION

Our study highlights the importance of being aware of this potentially fatal infection, especially when treating patients traveling from endemic countries. It also highlights the importance of timely screening, diagnosis, and treatment of S. stercoralis infection in order to prevent potentially fatal outcomes, especially when considering immunosuppressive drugs.

A surge in neglected shoulder dislocations and delayed surgical management due to the coronavirus disease 2019 lockdown in India

Four patients with shoulder problems that were traumatic in etiology presented to us with delays in seeking care ranging from 6 to 12 weeks due to the coronavirus disease 2019 (COVID-19) lockdown. The care of three cases (a 3-month-old neglected anterior shoulder dislocation with a greater tuberosity fracture in a 30-year old man, a 3-month-old neglected anterior shoulder dislocation in a 17-year old boy, and a 2-month-old neglected greater tuberosity fracture in a 31-year old man) was delayed due to the lockdown and the ensuing travel restrictions, while that of one case (a 6-week-old fracture–dislocation of the proximal humerus in a 55-year-old woman) was delayed because the patient was undergoing treatment for COVID-19 at the time of injury. This report intends to present the exceptional circumstances around these cases. The unique treatment challenges and their outcomes are also described to advise the surgeons of the nuances and difficulties in treating these injuries.

Chagas disease: Immunology of the disease at a glance

Chagas disease is an important neglected disease that affects 6-7 million people worldwide. The disease has two phases: acute and chronic, in which there are different clinical symptoms. Controlling the infection depends on innate and acquired immune responses, which are activated during the initial infection and are critical for host survival. Furthermore, the immune system plays an important role in the therapeutic success. Here we summarize the importance of the immune system cytokines in the pathology outcome, as well as in the treatment.

Nanotechnological interventions for treatment of trypanosomiasis in humans and animals

Trypanosomiasis is a parasitic infection caused by Trypanosoma. It is one of the major causes of deaths in underprivileged, rural areas of Africa, America and Asia. Depending on the parasite species responsible for the disease, it can take two forms namely African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas disease). The complete life-cycle stages of trypanosomes span between insect vector (tsetse fly, triatomine bug) and mammalian host (humans, animals). Only few drugs have been approved for the treatment of trypanosomiasis. Moreover, current trypanocidal therapy has major limitations of poor efficacy, serious side effects and drug resistance. Due to the lack of economic gains from tropical parasitic infection, it has always been neglected by the researchers and drug manufacturers. There is an immense need of more effective innovative strategies to decrease the deaths associated with this diseases. Nanotechnological approaches for delivery of existing drugs have shown significant improvement in efficacy with many-fold decrease in their dose. The review emphasizes on nanotechnological interventions in the treatment of trypanosomiasis in both humans and animals. Current trypanocidal therapy and their limitations have also been discussed briefly. Graphical abstract.

Neurological disease caused by Oropouche virus in northern Brazil: should it be included in the scope of clinical neurological diseases?

We describe two neurological cases of Oropouche virus infection in northern Brazil, where the virus is endemic but neglected as a pathogen. This study reiterates the necessity of developing protocols for diagnosing infections and training medical personnel to recognize the pathogenicity of Oropouche virus in neurological infections.

Serological and molecular study of Leptospira in pediatric patients at a tertiary care centre of northern India

Leptospirosis is considered as one of the most neglected zoonotic tropical diseases. Animals and humans acquire this infection through direct contact with contaminated urine or body fluids of infected animals. This prospective study was undertaken to know the proportion of leptospirosis in pediatric patients presented with acute febrile illness at the Post Graduate Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh. Blood samples were collected over a period of one year from January to December 2018 from 70 pediatric patients aged up to 0-12 years presented with febrile illness for 3-14 days. Out of the 70 samples, 7 (10%) samples were found positive by IgM ELISA, 4 (5.7%) samples were positive by MAT and 3(4.3%) were found positive by PCR. Risk factors such as contact with infected animals and contaminated environment were highly associated with seropositivity of leptospirosis. Clinical symptoms such as fever, chills, myalgia, headache, abdominal pain and cough were significantly associated (p < 0.05) with the seropositivity of leptospirosis.

Trends and associated characteristics for Chagas disease among women of reproductive age in the United States, 2002 to 2017

Background

American trypanosomiasis, commonly referred to as Chagas disease, is caused by a single cell protozoan known as Trypanosoma cruzi (T. cruzi). Although those affected are mainly in Latin America, Chagas has been detected in the United States (US), Canada and in many European countries due to migration. Few studies have explored the epidemiology of Chagas within the US or changes in disease burden over the past decade. The objective of this study was to explore the trends and associated characteristics for Chagas disease among hospitalized women of reproductive age in the US.

Methods

We analyzed admissions data including socio-demographic and hospital characteristics for inpatient hospitalization for women of reproductive age (15-49 years) in the US from 2002 through 2017. We employed Joinpoint regression analysis to determine trends in the prevalence of Chagas disease over this period.

Results

A total of 487 hospitalizations of Chagas disease were identified, corresponding to 3.7 per million hospitalizations over the study period. The rate statistically increased from 1.6 per million in 2002 to 7.6 per million hospitalizations in 2017. Chagas was most prevalent among older women, Hispanics and those in the highest zip income bracket. The in-hospital mortality rate was about 10 times greater among women with Chagas compared to those without the condition (3.1% versus 0.3%), and the condition tended to be clustered in women treated at large, urban teaching hospitals in the Northeastern region of the US.

Conclusion

Chagas disease diagnosis appears to be increasing among hospitalized women of reproductive age in the US with a 10-fold elevated risk of mortality.

Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region

Background

Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible.

Case presentation

Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn’t any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome.

Conclusion

Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.

Chagas disease vaccine design: the search for an efficient Trypanosoma cruzi immune-mediated control

Chagas disease is currently endemic to 21 Latin-American countries and has also become a global concern because of globalization and mass migration of chronically infected individuals. Prophylactic and therapeutic vaccination might contribute to control the infection and the pathology, as complement of other strategies such as vector control and chemotherapy. Ideal prophylactic vaccine would produce sterilizing immunity; however, a reduction of the parasite burden would prevent progression from Trypanosoma cruzi infection to Chagas disease. A therapeutic vaccine for Chagas disease may improve or even replace the treatment with current drugs which have several side effects and require long term treatment that frequently leads to therapeutic withdrawal. Here, we will review some aspects about sub-unit vaccines, the rationale behind the selection of the immunogen, the role of adjuvants, the advantages and limitations of DNA-based vaccines and the idea of therapeutic vaccines. One of the main limitations to advance vaccine development against Chagas disease is the high number of variables that must be considered and the lack of uniform criteria among research laboratories. To make possible comparisons, much of this review will be focused on experiments that kept many variables constant including antigen mass/doses, type of eukaryotic plasmid, DNA-delivery system, mice strain and sex, lethal and sublethal model of infection, and similar immunogenicity and efficacy assessments.

Role of microRNAs in host defense against Echinococcus granulosus infection: a preliminary assessment

Cystic echinococcosis (CE) is a neglected helminthic zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus s.l. MicroRNAs (miRNAs) are regulators of gene expression that have been linked with the pathogenesis of several human diseases, but little exists in the available literature about miRNAs in CE. Here, we investigate the expression profiles of 84 microRNAs relevant to the function of lymphocytes and other immune cells during CE infection in the peripheral blood of patients with cysts in active and inactive stages. We applied the microRNA PCR array technology to blood samples from 20 patients with a single hepatic CE cyst in either the active (CE3b) or inactive (CE4-CE5) stage. Our results show a significant upregulation of eight miRNAs (let-7g-5p, let-7a-5p, miR- 26a-5p, miR- 26b-5p, miR- 195-5p, miR- 16-5p, miR- 30c-5p, and miR- 223-3p) in patients with active cysts compared to those with inactive cysts. The high expression of these miRNAs in patients with active cysts suggests their role in a specific host immune response against the infection. Further work in this direction may help shed light on the pathogenesis of human CE.

Toxicity and Anti-promastigote Activity of Benzoxazinoid Analogs Against Leishmania (Viannia) braziliensis and Leishmania (Leishmania) infantum

Purpose: Here, we aim to evaluate the antileishmanial activity of compounds with a benzoxazinoid (BX) skeleton, previously synthesized by our group, against Leishmania (Viannia) braziliensis and Leishmania (Leishmania) infantum promastigotes.

Methods: Anti-promastigote activity, as well as cytotoxicity, were determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assays. The selectivity index (SI) for each compound was calculated using a ratio of the cytotoxicity of compounds and the geometric mean (GM) of antileishmanial concentrations to each species tested. The comparisons between groups were carried out using a t test or analysis of variance (one-way ANOVA). A P value of less than 0.05 was considered significant.

Results: All the compounds tested were active, with IC₅₀ falling between 92±6.19 µg/mL and 238±6.57 µg/mL for L. braziliensis, and 89±6.43 µg/mL and 188±3.58 µg/mL against L. infantum. Bex2, Bex3, Pyr1, Pyr2, and Pyr4 were compounds that showed activity similar to the drug Glucantime®, exhibited low cytotoxicity against splenic hamster cells (CC50 raging between >400 and 105.7±2.26 µg/mL) and had favorable selectivity indices (SI 1.12 to 3.96).

Conclusion: The analogs in question are promising prototypes for the pharmaceutical development of novel, safer and more effective leishmanicidal agents.

Building an innovative Chagas disease program for primary care units, in an urban non- endemic city

Background

On an absolute basis, Argentina is the country with the largest affected population with Chagas Disease (ChD). This constitutes a significant public health issue. As a consequence of Argentina’s migratory patterns, there has been a significant increase of affected population in urban centers. An innovative project for early diagnosis and timely treatment of ChD was designed for Municipal Primary Care Facilities of La Plata City, a non- endemic area, in line with a proposal from the Pan-American Health Organization. The project was a public –private intervention. The objectives of this study were to demonstrate the feasibility of the primary healthcare level for early diagnosis and timely treatment of ChD; to design and implement a tailor made program and to innovate in a public-private association.

Methods

The healthcare barriers for early diagnosis and timely treatment for the population with ChD of La Plata were analyzed. The four dimensions described by Peters et al. (Ann N Y Acad Sci 1136:161–71, 2008) were used. The baseline was measured during a previous pilot project and the same items were evaluated at the end of 2017. The model from Damschroder et al. (Implement Sci 4:50, 2009) was used during the implementation process.

Results

With all the information gathered during this investigation, a “patient-centered” model was designed. During the program, 17,894 people were serologically tested for ChD, 1,394 were positive and 1,035 were treated. Additionally, 3,750 children from 46 public schools were evaluated for risk factors of ChD.

Conclusions

This project showed the feasibility of the primary healthcare level for early diagnosis and timely treatment of ChD. Tailor made programs and public-private associations should be considered for vulnerable populations in emerging economies in order to enhance efforts and obtain better results. This program may be replicated in other countries of Latin America were Chagas is a main public health issue and, with the corresponding adaptations, for other neglected diseases as well.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7248-5) contains supplementary material, which is available to authorized users.

Biological evaluation of mimetic peptides as active molecules for a new and simple skin test in an animal model

A skin test is a widely used tool in diagnostic evaluations to investigate cutaneous leishmaniases (CL). The actual antigen (Montenegro skin test [MST] antigen) presents some difficulties that pertain to its manufacturing and validation. To contribute to overcoming this problem, we propose the application of new-generation molecules that are based on skin antigen tests. These antigens were obtained through biotechnology pathways by manufacturing synthetic mimetic peptides. Three peptides, which were selected by phage display, were tested as skin test antigens in an animal model (Cavia porcellus) that was immunized with Leishmania amazonensis or Leishmania braziliensis. The peptide antigens, individually (PA1, PA2, PA3) or in a mix (PAMix), promoted induration reactions at 48 and 72 h after the test was performed. The indurations varied from 0.5 to 0.7 cm. In the animals immunized with L. amazonensis, the PA3 antigen showed better results than the standard MST antigen. In animals immunized with L. braziliensis, two peptide antigens (PA2 and PAMix) promoted induration reactions for a longer period of time than the standard MST antigen. These results validate our hypothesis that peptides could be used as antigens in skin tests and may replace the current antigen for CL diagnosis.

Disulfiram as a novel inactivator of Giardia lamblia triosephosphate isomerase with antigiardial potential

Giardiasis, the infestation of the intestinal tract by Giardia lamblia, is one of the most prevalent parasitosis worldwide. Even though effective therapies exist for it, the problems associated with its use indicate that new therapeutic options are needed. It has been shown that disulfiram eradicates trophozoites in vitro and is effective in vivo in a murine model of giardiasis; disulfiram inactivation of carbamate kinase by chemical modification of an active site cysteine has been proposed as the drug mechanism of action. The triosephosphate isomerase from G. lamblia (GlTIM) has been proposed as a plausible target for the development of novel antigiardial pharmacotherapies, and chemical modification of its cysteine 222 (C222) by thiol-reactive compounds is evidenced to inactivate the enzyme. Since disulfiram is a cysteine modifying agent and GlTIM can be inactivated by modification of C222, in this work we tested the effect of disulfiram over the recombinant and trophozoite-endogenous GlTIM. The results show that disulfiram inactivates GlTIM by modification of its C222. The inactivation is species-specific since disulfiram does not affect the human homologue enzyme. Disulfiram inactivation induces only minor conformational changes in the enzyme, but substantially decreases its stability. Recombinant and endogenous GlTIM inactivates similarly, indicating that the recombinant protein resembles the natural enzyme. Disulfiram induces loss of trophozoites viability and inactivation of intracellular GlTIM at similar rates, suggesting that both processes may be related. It is plausible that the giardicidal effect of disulfiram involves the inactivation of more than a single enzyme, thus increasing its potential for repurposing it as an antigiardial drug.

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Disulfiram inactivates efficiently the triosephosphate isomerase of Giardia lamblia.

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Inactivation is species-specific; the human enzyme is insusceptible to disulfiram.

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Recombinant and GlTIM extracted from trophozoites inactivates similarly.

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Disulfiram inhibits endogenous GlTIM and trophozoite viability simultaneously.

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Disulfiram is a promissory option for drug repurposing against giardiasis.

Implementation of new tools in molecular epidemiology studies of Echinococcus granulosus sensu lato in South America

The aim of this work was to determine Echinococcus granulosus sensu lato species and genotypes in intermediate and definitive hosts and in human isolates from endemic regions of Argentina and Brazil including those where no molecular data is available by a combination of classical and alternative molecular tools. A total of 227 samples were isolated from humans, natural intermediate and definitive hosts. Amplification of cytochrome c oxidase subunit I gene fragment was performed and a combination of AluI digestion assay, High Resolution Melting analysis (HRM) assay and DNA sequencing was implemented for Echinococcus species/genotype determination. E. granulosus sensu stricto (G1) was found in sheep (n=35), cattle (n=67) and dogs (n=5); E. ortleppi (G5) in humans (n=3) and cattle (n=108); E. canadensis (G6) in humans (n=2) and E. canadensis (G7) in pigs (n=7). We reported for the first time the presence of E. ortleppi (G5) and E. canadensis (G6) in humans from San Juan and Catamarca Argentinean provinces and E. canadensis (G7) in pigs from Cordoba Argentinean province. In this work, we widened molecular epidemiology studies of E. granulosus s. l. in South America by analyzing several isolates from definitive and intermediate hosts, including humans from endemic regions were such information was scarce or unavailable. The presence of different species/genotypes in the same region and host species reinforce the need of rapid and specific techniques for accurate determination of Echinococcus species such as the ones proposed in this work.

Mining SNPs in extracellular vesicular transcriptome of Trypanosoma cruzi: a step closer to early diagnosis of neglected Chagas disease

One of the newest and strongest members of intercellular communicators, the Extracellular vesicles (EVs) and their enclosed RNAs; Extracellular RNAs (exRNAs) have been acknowledged as putative biomarkers and therapeutic targets for various diseases. Although a very deep insight has not been possible into the physiology of these vesicles, they are believed to be involved in cell-to-cell communication and host-pathogen interactions. EVs might be significantly helpful in discovering biomarkers for possible target identification as well as prognostics, diagnostics and developing vaccines. In recent studies, highly bioactive EVs have drawn attention of parasitologists for being able to communicate between different cells and having likeliness of reflecting both source and target environments. Next-generation sequencing (NGS) has eased the way to have a deeper insight into these vesicles and their roles in various diseases. This article arises from bioinformatics-based analysis and predictive data mining of transcriptomic (RNA-Seq) data of EVs, derived from different life stages of Trypanosoma cruzi; a causing agent of neglected Chagas disease. Variants (Single Nucleotide Polymorphisms (SNPs)) were mined from Extracellular vesicular transcriptomic data and functionally analyzed using different bioinformatics based approaches. Functional analysis showed the association of these variants with various important factors like Trans-Sialidase (TS), Alpha Tubulin, P-Type H+-ATPase, etc. which, in turn, are associated with disease in different ways. Some of the ‘candidate SNPs’ were found to be stage-specific, which strengthens the probability of finding stage-specific biomarkers. These results may lead to a better understanding of Chagas disease, and improved knowledge may provide further development of the biomarkers for prognosis, diagnosis and drug development for treating Chagas disease.

First meeting "Cystic echinococcosis in Chile, update in alternatives for control and diagnostics in animals and humans"

This report summarizes the outcomes of a meeting on cystic echinococcosis (CE) in animals and humans in Chile held in Santiago, Chile, between the 21st and 22nd of January 2016. The meeting participants included representatives of the Departamento de Zoonosis, Ministerio de Salud (Zoonotic Diseases Department, Ministry of Health), representatives of the Secretarias Regionales del Ministerio de Salud (Regional Department of Health, Ministry of Health), Instituto Nacional de Desarrollo Agropecuario (National Institute for the Development of Agriculture and Livestock, INDAP), Instituto de Salud Pública (National Institute for Public Health, ISP) and the Servicio Agrícola y Ganadero (Animal Health Department, SAG), academics from various universities, veterinarians and physicians. Current and future CE control activities were discussed. It was noted that the EG95 vaccine was being implemented for the first time in pilot control programmes, with the vaccine scheduled during 2016 in two different regions in the South of Chile. In relation to use of the vaccine, the need was highlighted for acquiring good quality data, based on CE findings at slaughterhouse, previous to initiation of vaccination so as to enable correct assessment of the efficacy of the vaccine in the following years. The current world’s-best-practice concerning the use of ultrasound as a diagnostic tool for the screening population in highly endemic remote and poor areas was also discussed.

Pediculosis capitis is a growing neglected infestation due to migration in southeast Turkey

Demographic, socio-economical, and environmental changes affecting prevalence of Pediculosis capitis. The aim of this study was to investigate the prevalence of P. capitis and external factors affecting the distribution of P. capitis. A total of 6004 primary-school students between 5 and 11 years were screened for P. capitis at 28 different primary-schools in Gaziantep, located in southeastern of Turkey, during different two education terms (First education term is in September 2013 to May 2014, second education term is in September 2014 and May 2015). The prevalence of P. capitis was found to be positive 1.5 % (90/6004) and 6.9 % (415/6004) in first education term and in second education term, respectively. In this study shown that the rate of P. capitis's prevalence was increased 5.4 % in Gaziantep. P. capitis is a neglected infestation and it has re-emerged in Gaziantep, located in the southeastern of Turkey. Health staff member must improve health education programs in primary-school students especially girl students.

SAR refinement of antileishmanial N(2),N(4)-disubstituted quinazoline-2,4-diamines

Visceral leishmaniasis is a neglected parasitic disease that has a high fatality rate in the absence of treatment. New drugs that are inexpensive, orally active, and effective could be useful tools in the fight against this disease. We previously showed that N(2),N(4)-disubstituted quinazoline-2,4-diamines displayed low- to sub-micromolar potency against intracellular Leishmania, and lead compound N(4)-(furan-2-ylmethyl)-N(2)-isopropyl-7-methylquinazoline-2,4-diamine (4) exhibited modest efficacy in an acute murine model of visceral leishmaniasis. In the present work, thirty-one N(2),N(4)-disubstituted quinazoline-2,4-diamines that had not previously been examined for their antileishmanial activity were evaluated for their potency and selectivity against Leishmania donovani, the causative parasite of visceral leishmaniasis. Quinazoline-2,4-diamines with aromatic substituents at both N(2) and N(4) exhibited potent in vitro antileishmanial activity but relatively low selectivity, while compounds substituted with small alkyl groups at either N(2) or N(4) generally showed lower antileishmanial potency but were less toxic to a murine macrophage cell line. Based on their in vitro antileishmanial potency, N(4)-benzyl-N(2)-(4-chlorobenzyl)quinazoline-2,4-diamine (15) and N(2)-benzyl-N(4)-isopropylquinazoline-2,4-diamine (40) were selected for in vivo evaluation of their pharmacokinetic and antileishmanial properties. While 15 displayed a longer plasma half-life and a greater area under the curve than 40, both compounds showed low efficacy in an acute murine visceral leishmaniasis model. Although the present study did not identify new quinazoline-2,4-diamines with promising in vivo efficacy, the reduced in vitro toxicity of derivatives bearing small alkyl groups at either N(2) or N(4) may provide clues for the design of safe and effective antileishmanial quinazolines.

Mother-to-child transmission of Trypanosoma cruzi infection (Chagas disease): a neglected problem

Congenital Chagas disease may be considered a global health problem and the underdiagnosis of congenital infections should be a matter of concern. Vertical transmission is an important mode of transmission of Trypanosoma cruzi infection in non-endemic areas. Treatment in the early phases of the infection can prevent progression of the disease and is curative in the majority of cases. Prevention strategies should focus on early detection and treatment of congenital cases, screening at-risk women during pregnancy and treatment of non-pregnant women of childbearing age. Management of congenital Chagas disease and T. cruzi infection during pregnancy is discussed.

Role of decompression in late presentation of cervical spinal cord disorders

STUDY DESIGN

Prospective study conducted at Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India.

PURPOSE

To show the efficacy of decompression in the late presentation of cervical spinal cord disorders.

OVERVIEW OF LITERATURE

Studies by various authors have shown that early spinal decompression results in better neurological outcomes.

METHODS

From January 2003 to January 2005, 11 of the 41 patients with cervical spinal cord compression, meeting the inclusion criteria, underwent anterior decompression; interbody graft placement and stabilization by anterior cervical locking plate. The neurologic and functional outcomes were recorded.

RESULTS

Five patients had spinal cord injury and 6 patients had compressive cervical myelopathy. Complications included 1 death and 1 plate loosening. No patient lost their preoperative neurological status. One patient had no improvement, 2 patients showed full recovery. The mean follow-up is 28.3 month. At the of rehabilitation, 6 were able to walk without support), 2 could walk with support, and 1 needed a wheelchair. The average American Spinal Injury Association motor score on admission to the hospital, 32.8 (standard deviation [SD], 30.5); admission to rehabilitation, 38.6 (SD, 32.4); discharge from rehabilitation, 46.2 (SD, 33.7). The most recent follow-up was 64.0 (SD, 35.3).

CONCLUSIONS

The anterior approach for cervical decompression allows for adequate decompression. This decompression is the best chance offered in even late reported cases, including posttraumatic cases where there is no evidence of cord transactions. The use of anterior cervical plates reduces the chances of graft loosening, extruding, or collapsing.

Improvement of leptospirosis surveillance in remote Pacific islands using serum spotted on filter paper

OBJECTIVES

Leptospirosis is a serious neglected disease in the Pacific. Because sensitive and specific laboratory tests are largely unavailable, the burden of disease and epidemiological data are often unreliable and do not allow informed disease prioritization and efficient control. We report the use of serum spotted on filter paper to improve the surveillance of leptospirosis in remote and resource-limited settings.

METHODS

A total of 172 acute-phase serum samples collected from patients with suspected dengue at Yap State Hospital, Federated States of Micronesia, were spotted on filter paper and sent by regular mail to the Institut Louis Malardé, French Polynesia. Real-time PCR protocols for dengue and leptospirosis confirmation were performed on all specimens.

RESULTS

A total of five leptospirosis infections were detected amongst the patients with suspected dengue.

CONCLUSIONS

This study confirms the use of filter paper as a convenient tool to improve leptospirosis surveillance capacity in remote areas. New surveillance strategies, notably based on the regular use of this type of tool, are essential to more adequately describe the epidemiology and burden of neglected diseases.

Chagas' cardiomyopathy: the economic burden of an expensive and neglected disease

BACKGROUND

Chagas' cardiomyopathy (CC) is a rising etiology for heart failure (HF) that previously was restricted to some countries of Latin America. The chronic CC cases cause now a profound socio-economic impact. However this issue has not been well studied if compared to other causes of HF. The objective of this study was to assess the cost burden of CC during acute decompensated HF admissions (ADHF), and compare this cost to the other etiologies of HF.

METHODS AND RESULTS

By the end of 2006 we started a five year follow-up of 577 consecutive adult patients admitted at a high complexity cardiology university hospital in the city of Sao Paulo, Brazil. This study shows the data of the first admission of each patient of this follow-up. Patients were divided in two groups: CC (58 patients) and non-chagasic (NC) (519 patients). Mortality was different among groups, 19/58 (32.8%) in CC vs 113/519 (21.8%) in NC (p=0.046). The prevalence of signs of inadequate perfusion was higher in the CC group at admission, but in a multivariated analysis chagasic etiology and presence of diabetes were independent predictors of higher costs per day of hospitalization adjusted by mortality. Median costs per day were US$ 308 (277-542) vs US$ 467 (323-815) for NC and CC respectively (p<0.001).

CONCLUSION

Treating ADHF patients with CC etiology was more expensive and mortality was higher in this population at the first admission of this follow-up. This could be explained by the severity of Chagas' cardiomyopathy disease.

Parasitological and clinico-epidemiological features of onchocerciasis in West Wellega, Ethiopia

Onchocerciasis is a disease of public health and socio-economic importance in Ethiopia. The aim of this study was to assess parasitological and clinico-epidemiological features of onchocerciasis in the Anfilo District, West Wellega, prior to implementation of Community Directed Treatment with Ivermectin (CDTI) to generate epidemiological and parasitological data for use in control program of the disease and subsequent evaluation of CDTI. A cross-sectional study was conducted in Anfilo District of West Wellega zone during a period of 1 month: from mid-August to mid-September 2006. Data on socio-demographic characteristics were collected using a standardized questionnaire prepared for this purpose. All persons were examined clinically for skin signs and symptoms of onchocerciasis. Two skin snips, one from each side of the gluteal fold were taken using blood lancet and sterilized razor blade and examined for microfilaria. All data were categorized, coded, entered in a data base and analyzed using SPSS version 15.0. for windows. A total of 1114 individuals ≥15 years were examined for microfilariae (mf) of Onchocerca volvulus and onchocercal skin disease (OSD). The prevalence of onchocercal (mf) carrier was 74.8% (833/1114). In both genders, the prevalence of onchocerciasis showed direct correlations with the age of individuals (R (2) = 0.79, P < 0.05). The infection rate varied with the occupation of the study subjects, with preponderance among farmers. Among the subjects with onchocerciasis, the mf density ranged from 1.0 to 711.0 per mg of skin snip with a mean density (SD) and median values of 32.1 (61.5) and 10.4 respectively. The overall community microfilariae load (CMFL), the most sensitive parasitological indicator of onchocerciasis was 19.6. The pervasiveness of OSD among the study subjects was 26.4%. OSD was more frequent in males (32.4%) than their female counterparts (20.8%, P < 0.05). The overall prevalence of onchocercal nodule carrier, the symptom opted for determining the community-wide prevalence of onchocerciasis was 12.1%. Leopard skin, the proxy of longstanding infection of onchocerciasis in the community, was also relatively high (19.1%). The abundance of mf in skin would definitely lead to high transmission potential in the Anfilo District. The situation in the Anfilo District should call for continued CDTI, owing to success of similar recommendations for such programmes in other parts of the country and elsewhere.