RESUMEN
BACKGROUND: Treatment of cutaneous leishmaniasis (CL) remains challenging since the drugs currently used are quite toxic, thus contributing to lethality unrelated to the disease itself but to adverse events (AE). The main objective was to evaluate different treatment regimens with meglumine antimoniate (MA), in a reference center in Rio de Janeiro, Brazil. METHODOLOGY: A historical cohort of 592 patients that underwent physical and laboratory examination were enrolled between 2000 and 2017. The outcome measures of effectiveness were epithelialization and complete healing of cutaneous lesions. AE were graded using a standardized scale. Three groups were evaluated: Standard regimen (SR): intramuscular (IM) MA 10-20 mg Sb5+/kg/day during 20 days (n = 46); Alternative regimen (AR): IM MA 5 mg Sb5+/kg/day during 30 days (n = 456); Intralesional route (IL): MA infiltration in the lesion(s) through subcutaneous injections (n = 90). Statistical analysis was performed through Fisher exact and Pearson Chi-square tests, Kruskal-Wallis, Kaplan-Meier and log-rank tests. RESULTS: SR, AR and IL showed efficacy of 95.3%, 84.3% and 75.9%, with abandonment rate of 6.5%, 2.4% and 3.4%, respectively. IL patients had more comorbidities (58.9%; p = 0.001), were mostly over 50 years of age (55.6%), and had an evolution time longer than 2 months (65.6%; p = 0.02). Time for epithelialization and complete healing were similar in IL and IM MA groups (p = 0.9 and p = 0.5; respectively). Total AE and moderate to severe AE that frequently led to treatment interruption were more common in SR group, while AR and IL showed less toxicity. CONCLUSIONS/SIGNIFICANCE: AR and IL showed less toxicity and may be good options especially in CL cases with comorbidities, although SR treatment was more effective. IL treatment was an effective and safe strategy, and it may be used as first therapy option as well as a rescue scheme in patients initially treated with other drugs.
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Antiprotozoarios/administración & dosificación , Leishmaniasis Cutánea/tratamiento farmacológico , Antimoniato de Meglumina/administración & dosificación , Adolescente , Adulto , Anciano , Brasil , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intralesiones , Inyecciones Intramusculares , Leishmania/efectos de los fármacos , Leishmania/fisiología , Leishmaniasis Cutánea/parasitología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Skin ulcers in American cutaneous leishmaniasis (ACL) may heal spontaneously after months/years. However, few cases may present quick heal even during diagnosis procedure (early spontaneous healing- ESH). The main objective of this study was to compare ESH patients with cases requiring specific treatment [non-ESH (NESH)]. METHODS: A historical cohort study of ACL patients (n = 445) were divided into 2 groups: ESH - spontaneously healed patients (n = 13; 2.90%), and NESH- treated patients (n = 432; 97.10%). We compared clinical and laboratorial findings at diagnosis, including the lesion healing process. RESULTS: ESH patients had a higher percentage of single lesions (p = 0.027), epithelialized lesion on initial examination (p = 0.001), lesions located in the dorsal trunk (p = 0.017), besides earlier healing (p < 0.001). NESH presents higher frequency of ulcerated lesions (p = 0.002), amastigotes identified in histopathology exams (p = 0.005), positive cultures (p = 0.001), and higher positivity in ≥3 parasitological exams (p = 0.030). All ESH cases were positive in only a single exam, especially in PCR. CONCLUSIONS: ESH group apparently presented a lower parasitic load evidenced by the difficulty of parasitological confirmation and its positivity only by PCR method. The absence or deficiency of specific treatment is commonly identified as predisposing factors for recurrence and metastasis in ACL. However, due to the drugs toxicity, the treatment of cases which progress to early spontaneous healing is controversial. ESH patients were followed for up to 5 years after cure, with no evidence of recrudescence, therefore suggesting that not treating these patients is justifiable, but periodic dermatological and otorhinolaryngological examinations are advisable to detect a possible relapse.
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Leishmaniasis Cutánea/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios de Cohortes , Femenino , Humanos , Leishmania/genética , Leishmania/patogenicidad , Leishmaniasis Cutánea/diagnóstico , Leishmaniasis Cutánea/terapia , Masculino , Persona de Mediana Edad , Carga de Parásitos , Reacción en Cadena de la Polimerasa , Recurrencia , Cicatrización de Heridas , Adulto JovenRESUMEN
BACKGROUND: Atypical presentations of cutaneous leishmaniasis include sporotrichoid leishmaniasis (SL), which is clinically described as a primary ulcer combined with lymphangitis and nodules and/or ulcerated lesions along its pathway. AIMS: To assess the differences between patients with sporotrichoid leishmaniasis and typical cutaneous leishmaniasis (CL). METHODS: From January 2004 to December 2010, 23 cases of SL (4.7%) were detected among 494 CL patients diagnosed at a reference center for the disease in Rio de Janeiro State, Brazil. These 23 cases were compared with the remaining 471 patients presenting CL. RESULTS: SL predominated in female patients (60.9%, p = 0.024), with older age (p = 0.032) and with lesions in upper limbs (52.2%, p = 0.028). CL affected more men (64.5%), at younger age, and with a higher number of lesions exclusively in lower limbs (34.8%). CONCLUSIONS: Differences in clinical and epidemiological presentation were found between SL patients as compared to CL ones, in a region with a known predominance of Leishmania (Viannia) braziliensis. The results are similar to the features of most of the sporotrichosis patients as described in literature, making the differential diagnosis between ATL and sporotrichosis more important in overlapping areas for both diseases, like in Rio de Janeiro State.
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Leishmania braziliensis , Leishmaniasis Cutánea/diagnóstico , Adulto , Biopsia , Brasil/epidemiología , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Inmunohistoquímica , Leishmaniasis Cutánea/epidemiología , Leishmaniasis Cutánea/patología , MasculinoRESUMEN
BACKGROUND: Although high dose of antimony is the mainstay for treatment of American cutaneous leishmaniasis (ACL), ongoing major concerns remain over its toxicity. Whether or not low dose antimony regimens provide non-inferior effectiveness and lower toxicity has long been a question of dispute. METHODS: A single-blind, non-inferiority, randomized controlled trial was conducted comparing high dose with low dose of antimony in subjects with ACL treated at a referral center in Rio de Janeiro, an endemic area of Leishmania (Viannia) braziliensis transmission. The primary outcome was clinical cure at 360 days of follow-up in the modified-intention-to-treat (mITT) and per-protocol (PP) populations. Non-inferiority margin was 15%. Secondary objectives included occurrence of epithelialization, adverse events and drug discontinuations. This study was registered in ClinicalTrials.gov: NCT01301924. RESULTS: Overall, 72 patients were randomly assigned to one of the two treatment arms during October 2008 to July 2014. In mITT, clinical cure was observed in 77.8% of subjects in the low dose antimony group and 94.4% in the high dose antimony group after one series of treatment (risk difference 16.7%; 90% CI, 3.7-29.7). The results were confirmed in PP analysis, with 77.8% of subjects with clinical cure in the low dose antimony group and 97.1% in the high dose antimony group (risk difference 19.4%; 90% CI, 7.1-31.7). The upper limit of the confidence interval exceeded the 15% threshold and was also above zero supporting the hypothesis that low dose is inferior to high dose of antimony after one series of treatment. Nevertheless, more major adverse events, a greater number of adverse events and major adverse events per subject, and more drug discontinuations were observed in the high dose antimony group (all p<0.05). Interestingly, of all the subjects who were originally allocated to the low dose antimony group and were followed up after clinical failure, 85.7% achieved cure after a further treatment with local therapy or low dose of antimony. CONCLUSIONS: Compared with high dose, low dose of antimony was inferior at the pre-specified margin after one series of treatment of ACL, but was associated with a significantly lower toxicity. While high dose of antimony should remain the standard treatment for ACL, low dose antimony treatment might be preferred when toxicity is a primary concern.
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Leishmaniasis Cutánea/tratamiento farmacológico , Meglumina/uso terapéutico , Compuestos Organometálicos/uso terapéutico , Brasil , Relación Dosis-Respuesta a Droga , Humanos , Meglumina/administración & dosificación , Antimoniato de Meglumina , Compuestos Organometálicos/administración & dosificaciónRESUMEN
ABSTRACT Background Atypical presentations of cutaneous leishmaniasis include sporotrichoid leishmaniasis (SL), which is clinically described as a primary ulcer combined with lymphangitis and nodules and/or ulcerated lesions along its pathway. Aims To assess the differences between patients with sporotrichoid leishmaniasis and typical cutaneous leishmaniasis (CL). Methods From January 2004 to December 2010, 23 cases of SL (4.7%) were detected among 494 CL patients diagnosed at a reference center for the disease in Rio de Janeiro State, Brazil. These 23 cases were compared with the remaining 471 patients presenting CL. Results SL predominated in female patients (60.9%, p = 0.024), with older age (p = 0.032) and with lesions in upper limbs (52.2%, p = 0.028). CL affected more men (64.5%), at younger age, and with a higher number of lesions exclusively in lower limbs (34.8%). Conclusions Differences in clinical and epidemiological presentation were found between SL patients as compared to CL ones, in a region with a known predominance of Leishmania (Viannia) braziliensis. The results are similar to the features of most of the sporotrichosis patients as described in literature, making the differential diagnosis between ATL and sporotrichosis more important in overlapping areas for both diseases, like in Rio de Janeiro State.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Leishmania braziliensis , Leishmaniasis Cutánea/diagnóstico , Biopsia , Brasil/epidemiología , Ensayo de Inmunoadsorción Enzimática , Inmunohistoquímica , Estudios Transversales , Leishmaniasis Cutánea/patología , Leishmaniasis Cutánea/epidemiología , Técnica del Anticuerpo Fluorescente IndirectaRESUMEN
Indirect immunofluorescence is the method recommended for the diagnosis of visceral leishmanisis in dogs, however, the accuracy of this technique is low and its use on a large scale is limited. Since ELISA does not present these limitations, this technique might be an option for the detection of IgG or specific IgG1 and IgG2 subclasses. Canine ehrlichiosis is an important differential diagnosis of American Visceral Leishmaniasis (AVL). The present study compared ELISA using Leishmania chagasi and Leishmania braziliensis antigen for the detection of anti-Leishmania IgG and subclasses in serum samples from 37 dogs naturally infected with L. chagasi (AVL) and in samples from four dogs co-infected with L. braziliensis and L. chagasi (CI). The occurrence of cross-reactivity was investigated in control serum samples of 17 healthy dogs (HC) and 35 infected with Ehrlichia canis (EC). The mean optical density obtained for the detection of IgG was significantly higher when L. chagasi antigen was used, and was also higher in subgroup VLs (symptomatic) compared to subgroup Vla (asymptomatic). The correlation between IgG and IgG1 was low. The present results suggest that IgG ELISA using homologous antigen yields the best results, permitting the diagnosis of asymptomatic L. chagasi infection and the discrimination between cases of AVL and ehrlichiosis in dogs.
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Anticuerpos Antiprotozoarios/sangre , Antígenos de Protozoos/inmunología , Enfermedades de los Perros/diagnóstico , Inmunoglobulina G/inmunología , Leishmaniasis Visceral/veterinaria , Animales , Anticuerpos Antiprotozoarios/inmunología , Estudios de Casos y Controles , Enfermedades de los Perros/inmunología , Perros , Ensayo de Inmunoadsorción Enzimática , Técnica del Anticuerpo Fluorescente Indirecta , Inmunoglobulina G/sangre , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/inmunología , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
Indirect immunofluorescence is the method recommended for the diagnosis of visceral leishmanisis in dogs, however, the accuracy of this technique is low and its use on a large scale is limited. Since ELISA does not present these limitations, this technique might be an option for the detection of IgG or specific IgG1 and IgG2 subclasses. Canine ehrlichiosis is an important differential diagnosis of American Visceral Leishmaniasis (AVL). The present study compared ELISA using Leishmania chagasi and Leishmania braziliensis antigen for the detection of anti-Leishmania IgG and subclasses in serum samples from 37 dogs naturally infected with L. chagasi (AVL) and in samples from four dogs co-infected with L. braziliensis and L. chagasi (CI). The occurrence of cross-reactivity was investigated in control serum samples of 17 healthy dogs (HC) and 35 infected with Ehrlichia canis (EC). The mean optical density obtained for the detection of IgG was significantly higher when L. chagasi antigen was used, and was also higher in subgroup VLs (symptomatic) compared to subgroup Vla (asymptomatic). The correlation between IgG and IgG1 was low. The present results suggest that IgG ELISA using homologous antigen yields the best results, permitting the diagnosis of asymptomatic L. chagasi infection and the discrimination between cases of AVL and ehrlichiosis in dogs.
A imunofluorescência indireta é o método recomendado para o diagnóstico de leishmaniose visceral em cães, entretanto, a acurácia dessa técnica é baixa e seu uso em grande escala é limitado. Uma vez que o ELISA não apresenta essas limitações, essa técnica poderia ser uma opção para a detecção de IgG ou subclasses IgG1 e IgG2 específicas. A ehrlichiose canina é um importante diagnóstico diferencial de Leishmaniose Visceral Americana (LVA). O presente estudo comparou o ELISA usando antígenos de Leishmania chagasi e Leishmania braziliensis para a detecção de IgG e subclasses anti-Leishmania em amostras de soro de 37 cães naturalmente infectados com L. chagasi (LVA) e em amostras de quatro cães co-infectados (CI). A ocorrência de reatividade cruzada foi investigada em amostras de soro controle de 17 animais saudáveis (HC) e 35 de infectados por Ehrlichia canis (EC). A média de densidade óptica obtida para a detecção de IgG foi significantemente maior quando o antígeno de L. chagasi foi usado e também mais elevada no subgrupo LVs (sintomático) quando comparado ao subgrupo LVa (assintomático). A correlação entre IgG e IgG1 foi baixa. O presente resultado sugere que ELISA IgG empregando antígeno homólogo, produz os melhores resultados, permitindo o diagnóstico de infecção assintomática por L. chagasi e a discriminação entre casos de LVA e ehrlichiose em cães.
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Animales , Perros , Anticuerpos Antiprotozoarios/sangre , Antígenos de Protozoos/inmunología , Enfermedades de los Perros/diagnóstico , Inmunoglobulina G/inmunología , Leishmaniasis Visceral/veterinaria , Anticuerpos Antiprotozoarios/inmunología , Estudios de Casos y Controles , Enfermedades de los Perros/inmunología , Ensayo de Inmunoadsorción Enzimática , Técnica del Anticuerpo Fluorescente Indirecta , Inmunoglobulina G/sangre , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/inmunología , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadAsunto(s)
Carcinoma de Células Escamosas/diagnóstico , Células Epiteliales/patología , Leishmaniasis Cutánea/diagnóstico , Antiprotozoarios/uso terapéutico , Diagnóstico Diferencial , Humanos , Hiperplasia , Leishmania braziliensis/citología , Leishmania braziliensis/crecimiento & desarrollo , Leishmania braziliensis/aislamiento & purificación , Leishmaniasis Cutánea/tratamiento farmacológico , Leishmaniasis Cutánea/parasitología , Masculino , Meglumina/uso terapéutico , Antimoniato de Meglumina , Persona de Mediana Edad , Compuestos Organometálicos/uso terapéuticoRESUMEN
The diagnosis of American tegumentary leishmaniasis (ATL) is based on the visualization or isolation of the parasite, which is a time-consuming and poorly sensitive method. In this study, we evaluated the accuracy and reliability of ELISA for the diagnosis of ATL using soluble (SF) and membrane-enriched (MF) antigen fractions obtained from an infectious strain of Leishmania (Viannia) braziliensis. A total of 152 serum samples investigated at a referral center in Rio de Janeiro, Brazil, between 2005 and 2007 were studied. Each sample was tested twice with each fraction for the calculation of reliability (intraclass coefficient (ICC)). Cut-off values of 0.22 (SF) and 0.33 (MF) were defined. The use of the fractions resulted in good discrimination between patients, with a large area under the curve (P<0.0001), but no difference was observed between the two fractions (P=0.45). Sensitivity was 89.5% for each fraction, specificity was 89.5% for SF and 93.4% for MF, and the positive likelihood ratio was 8.5 for SF and 13.6 for MF. The ICCs were excellent (SF: 0.96 and MF: 0.90). The antigens tested provided precision and accuracy for the diagnosis of ATL, with SF being recommended due to its lower cost and greater practicality.
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Anticuerpos Antiprotozoarios/sangre , Antígenos de Protozoos/inmunología , Membrana Celular/inmunología , Citosol/inmunología , Leishmania braziliensis/inmunología , Leishmaniasis Cutánea/diagnóstico , Adulto , Brasil , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Leishmaniasis Cutánea/inmunología , Leishmaniasis Cutánea/parasitología , Masculino , Pronóstico , Curva ROC , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Visceral leishmaniasis (VL) is an important zoonosis in relation to public health systems. Dogs are the main domestic reservoir. This study aimed to investigate occurrences of canine VL in Dias D'Avila, State of Bahia, Brazil. METHODS: The prevalence was evaluated by means of clinical and laboratory tests on a population of 312 domestic dogs from 23 localities in this municipality, using indirect immunofluorescence and immunoenzymatic assays. RESULTS: Among the animals examined, 3.2% and 6.7% showed signs of VL, confirmed by indirect immunofluorescence and immunoenzymatic assays, respectively, with a distribution of 29.9% (24 dogs) in the rural zone and 4.9% (288 dogs) in the urban zone (p = 0.001). The clinical evaluation on seropositive dogs showed both asymptomatic animals (2.4%) and symptomatic animals (47.6%), along with other abnormalities (e.g. normocytic and normochromic anemia, with leukocytosis and thrombocytopenia). Observations relating to phenotypic characteristics (e.g. sex, age, breed and hair) did not present statistical significance, although high seropositivity among male, short-haired and mixed-breed dogs was observed. CONCLUSIONS: The findings showed that VL was a predominantly rural zoonosis and that close contact between poultry and domestic dogs significantly increased the risk of canine infection in this region.
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Anticuerpos Antiprotozoarios/sangre , Enfermedades de los Perros/epidemiología , Enfermedades Endémicas , Leishmaniasis Visceral/veterinaria , Animales , Brasil/epidemiología , Enfermedades de los Perros/diagnóstico , Perros , Ensayo de Inmunoadsorción Enzimática/veterinaria , Métodos Epidemiológicos , Femenino , Técnica del Anticuerpo Fluorescente Indirecta/veterinaria , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/epidemiología , Masculino , Población Rural , Población UrbanaRESUMEN
INTRODUCTION: Visceral leishmaniasis (VL) is an important zoonosis in relation to public health systems. Dogs are the main domestic reservoir. This study aimed to investigate occurrences of canine VL in Dias D'Ávila, State of Bahia, Brazil. METHODS: The prevalence was evaluated by means of clinical and laboratory tests on a population of 312 domestic dogs from 23 localities in this municipality, using indirect immunofluorescence and immunoenzymatic assays. RESULTS: Among the animals examined, 3.2 percent and 6.7 percent showed signs of VL, confirmed by indirect immunofluorescence and immunoenzymatic assays, respectively, with a distribution of 29.9 percent (24 dogs) in the rural zone and 4.9 percent (288 dogs) in the urban zone (p = 0.001). The clinical evaluation on seropositive dogs showed both asymptomatic animals (2.4 percent) and symptomatic animals (47.6 percent), along with other abnormalities (e.g. normocytic and normochromic anemia, with leukocytosis and thrombocytopenia). Observations relating to phenotypic characteristics (e.g. sex, age, breed and hair) did not present statistical significance, although high seropositivity among male, short-haired and mixed-breed dogs was observed. CONCLUSIONS: The findings showed that VL was a predominantly rural zoonosis and that close contact between poultry and domestic dogs significantly increased the risk of canine infection in this region.
INTRODUÇÃO: A leishmaniose visceral (LV) é uma importante zoonose para os sistemas de saúde pública, sendo os cães o principal reservatório doméstico. Este estudo teve como objetivo investigar a ocorrência de LV canina (LVC) em Dias D'Ávila, Estado da Bahia, Brasil. MÉTODOS: A prevalência foi avaliada através de exames clínicos e laboratoriais em uma população de 312 cães domésticos de 23 localidades da cidade, utilizando-se imunofluorescência indireta e ensaio imunoenzimático. RESULTADOS: Dentre os animais examinados, 3.2 por cento e 6.7 por cento apresentaram sinais de LV, confirmados por imunofluorescência indireta e ensaio imunoenzimático, respectivamente, com distribuição de 29.9 por cento (24 cães) na zona rural e 4.9 por cento (288 cães) na área urbana (p=0,001). A avaliação clínica de cães soropositivos apresentou animais assintomáticos (2,4 por cento) e sintomáticos (47,6 por cento), além de outras alterações (e.g., anemia normocítica e normocrômica, com leucocitose e trombocitopenia). Observações relativas a características fenotípicas (e.g. sexo, idade, raça e pelo) não apresentaram significância estatística, embora uma soropositividade alta entre machos, animais de pelo curto e de raça indefinida tenha sido observada. CONCLUSÕES: Os achados indicam que a LV é uma zoonose predominantemente rural e que o convívio de aves e cães domésticos aumenta significativamente o risco da infecção canina na região.
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Animales , Perros , Femenino , Masculino , Anticuerpos Antiprotozoarios/sangre , Enfermedades de los Perros/epidemiología , Enfermedades Endémicas , Leishmaniasis Visceral/veterinaria , Brasil/epidemiología , Enfermedades de los Perros/diagnóstico , Métodos Epidemiológicos , Ensayo de Inmunoadsorción Enzimática/veterinaria , Técnica del Anticuerpo Fluorescente Indirecta/veterinaria , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/epidemiología , Población Rural , Población UrbanaRESUMEN
The Brazilian Ministry of Health recommends the culling and euthanasia of dogs with a positive serological test for canine visceral leishmaniasis (CVL). In the Municipality of Rio de Janeiro, the technique used for the diagnosis of CVL is the indirect fluorescent antibody test (IFAT), using blood samples eluted on filter paper (eluate). A dog survey was conducted over a period of one year in the region of Carapiá, in order to evaluate the diagnosis of CVL in this region. All animals underwent clinical examination, and blood samples (serum and eluate) were collected for analysis by enzyme immunoassay (ELISA) and IFAT. A skin biopsy was obtained for parasitological examination (culture). A total of 305 animals were studied and Leishmania chagasi was isolated from nine animals. Sensitivity and specificity were 100 percent and 96.6 percent for ELISA, respectively, 100 percent and 65.5 percent for IFAT (cut-off at a 1:40 dilution), 100 percent and 83.4 percent for IFAT (cut-off at a 1:80 dilution), and 22.2 percent and 97.0 percent for eluate IFAT. In conclusion, ELISA was the best tool for the diagnosis of CVL among the serological techniques tested. The present results suggest the need for a better evaluation of filter paper IFAT as the only diagnostic method for CVL in the Municipality of Rio de Janeiro.
O Ministério da Saúde recomenda a eutanásia de cães sororreatores como controle da leishmaniose visceral canina (LVC). No Município do Rio de Janeiro, a técnica utilizada para o diagnóstico da LVC é o teste de imunofluorescência indireta (IFI), utilizando amostras de sangue eluídas em papel de filtro (eluato). Um levantamento, durante um ano, foi conduzido na região de Carapiá, a fim de avaliar o diagnóstico da LVC nesta região. Todos os animais foram submetidos a exame clínico e coleta de sangue (soro e eluato) para realização do ensaio imunoenzimático (ELISA) e imunofluorescência indireta (IFI). Biópsia de pele foi obtida para o exame parasitológico (cultura). Foram avaliados 305 (89,4 por cento) animais de uma população de 341 cães e Leishmania chagasi foi isolada de nove animais. A sensibilidade e especificidade do ELISA foram de 100 por cento e 96,6 por cento, na IFI (ponto de corte 1:40) de 100 por cento e 65,5 por cento, na IFI (ponto de corte 1:80) de 100 por cento e 83,4 por cento e na IFI (eluato) de 22,2 por cento e 97,0 por cento, respectivamente. A partir dos resultados obtidos podemos concluir que entre as técnicas sorológicas empregadas, o teste de ELISA apresentou-se como a melhor ferramenta para o diagnóstico da LVC. Os resultados sugerem a necessidade de uma melhor avaliação do teste de IFI realizada com eluato, como único método de diagnóstico para LVC no município do Rio de Janeiro.
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Animales , Perros , Anticuerpos Antiprotozoarios/análisis , Enfermedades de los Perros/diagnóstico , Leishmaniasis Visceral/veterinaria , Brasil , Ensayo de Inmunoadsorción Enzimática/veterinaria , Técnica del Anticuerpo Fluorescente Indirecta/veterinaria , Inmunoglobulina G/análisis , Leishmaniasis Visceral/diagnóstico , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
The Brazilian Ministry of Health recommends the culling and euthanasia of dogs with a positive serological test for canine visceral leishmaniasis (CVL). In the Municipality of Rio de Janeiro, the technique used for the diagnosis of CVL is the indirect fluorescent antibody test (IFAT), using blood samples eluted on filter paper (eluate). A dog survey was conducted over a period of one year in the region of Carapiá, in order to evaluate the diagnosis of CVL in this region. All animals underwent clinical examination, and blood samples (serum and eluate) were collected for analysis by enzyme immunoassay (ELISA) and IFAT. A skin biopsy was obtained for parasitological examination (culture). A total of 305 animals were studied and Leishmania chagasi was isolated from nine animals. Sensitivity and specificity were 100% and 96.6% for ELISA, respectively, 100% and 65.5% for IFAT (cut-off at a 1:40 dilution), 100% and 83.4% for IFAT (cut-off at a 1:80 dilution), and 22.2% and 97.0% for eluate IFAT. In conclusion, ELISA was the best tool for the diagnosis of CVL among the serological techniques tested. The present results suggest the need for a better evaluation of filter paper IFAT as the only diagnostic method for CVL in the Municipality of Rio de Janeiro.
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Anticuerpos Antiprotozoarios/análisis , Enfermedades de los Perros/diagnóstico , Leishmaniasis Visceral/veterinaria , Animales , Brasil , Perros , Ensayo de Inmunoadsorción Enzimática/veterinaria , Técnica del Anticuerpo Fluorescente Indirecta/veterinaria , Inmunoglobulina G/análisis , Leishmaniasis Visceral/diagnóstico , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
From 1977 (index case) to 2006, 87 cases of visceral leishmaniasis were confirmed in the municipality of Rio de Janeiro, Brazil, in periurban areas on the continental and coastal slopes of the Pedra Branca massif and the continental slopes of the Gericinó massif. The majority (65.5%) of the patients were more than five years old, predominantly males (61.5%), but without any difference between the sexes below the age of 14 years. The overall fatality rate was 10.4%. Two cases of visceral leishmaniasis/human immunodeficiency virus coinfection were detected. Leishmania chagasi was isolated from human and canine cases. The associations between the presence of phlebotomines and human and canine migrations, disorderly occupation involving degradation of environmental preservation areas and poor socioeconomic conditions may have created a favorable setting for the establishment and propagation of the disease. Close epidemiological surveillance associated with traditional control measures and others (active case researches, land clearing and health education), reduced the incidence of human cases from 2.8 per 100,000 inhabitants in 1981 to less than 0.01 per 100,000 since 1997. The canine infection rates decreased from 4.6% in 1984 to 1.6% in 2008. Lutzomyia longipalpis was not detected in some locations where human and canine cases occurred. In the years 2007 and 2008, no new human cases were reported, but there is a persistent and worrisome residual canine seroprevalence.
Asunto(s)
Insectos Vectores/clasificación , Leishmaniasis Visceral/epidemiología , Psychodidae/clasificación , Adolescente , Adulto , Animales , Brasil/epidemiología , Niño , Preescolar , Perros , Femenino , Humanos , Lactante , Recién Nacido , Control de Insectos , Leishmaniasis Visceral/prevención & control , Leishmaniasis Visceral/transmisión , Leishmaniasis Visceral/veterinaria , Masculino , Estaciones del Año , Adulto JovenRESUMEN
From 1977 (index case) to 2006, 87 cases of visceral leishmaniasis were confirmed in the municipality of Rio de Janeiro, Brazil, in periurban areas on the continental and coastal slopes of the Pedra Branca massif and the continental slopes of the Gericinó massif. The majority (65.5 percent) of the patients were more than five years old, predominantly males (61.5 percent), but without any difference between the sexes below the age of 14 years. The overall fatality rate was 10.4 percent. Two cases of visceral leishmaniasis/human immunodeficiency virus coinfection were detected. Leishmania chagasi was isolated from human and canine cases. The associations between the presence of phlebotomines and human and canine migrations, disorderly occupation involving degradation of environmental preservation areas and poor socioeconomic conditions may have created a favorable setting for the establishment and propagation of the disease. Close epidemiological surveillance associated with traditional control measures and others (active case researches, land clearing and health education), reduced the incidence of human cases from 2.8 per 100,000 inhabitants in 1981 to less than 0.01 per 100,000 since 1997. The canine infection rates decreased from 4.6 percent in 1984 to 1.6 percent in 2008. Lutzomyia longipalpis was not detected in some locations where human and canine cases occurred. In the years 2007 and 2008, no new human cases were reported, but there is a persistent and worrisome residual canine seroprevalence.
Entre 1977 (caso índice) e 2006 foram confirmados 87 casos de leishmaniose visceral no Município do Rio de Janeiro, oriundos de áreas peri-urbanas das vertentes continentais e litorâneas do Maciço da Pedra Branca e das vertentes continentais do Maciço do Gericinó. A maioria (65,5 por cento) dos pacientes tinha mais de 5 anos de idade, prevalecendo o sexo masculino (61,5 por cento), sem diferença de freqüência entre os sexos até os 14 anos. A letalidade foi de 10,4 por cento. Houve dois casos de co-infecção por leishmaniose visceral/vírus da imunodeficiência. Leishmania chagasi foi isolada de casos humanos e caninos. Presença de flebotomíneos associada a migrações humanas e caninas, ocupação desordenada degradando áreas de preservação ambiental e baixas condições socioeconômicas podem ter criado o contexto propício à instalação e à propagação da endemia. Vigilância epidemiológica estreita com as medidas tradicionais de controle e outras - busca ativa de pacientes, limpeza de terrenos e educação em saúde -, reduziram a incidência de casos humanos de 2,8 por 100 mil habitantes em 1981 para menos de 0,01 por 100 mil a partir de 1997. As taxas de infecção canina decresceram de 4,6 por cento em 1984 para 1,6 por cento em 2008. Lutzomyia longipalpis não foi detectada em algumas localidades onde ocorreram casos humanos e caninos. Em 2007 e 2008, nenhum novo caso da doença humana foi notificado, mas permanece uma preocupante prevalência sorológica residual canina.
Asunto(s)
Adolescente , Adulto , Animales , Niño , Preescolar , Perros , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Adulto Joven , Insectos Vectores/clasificación , Leishmaniasis Visceral/epidemiología , Psychodidae/clasificación , Brasil/epidemiología , Control de Insectos , Leishmaniasis Visceral/prevención & control , Leishmaniasis Visceral/transmisión , Leishmaniasis Visceral/veterinaria , Estaciones del Año , Adulto JovenRESUMEN
We compared the accuracy and reliability of three amplification systems for enzyme immunoassays in the detection of specific IgG antibodies for the diagnosis of cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis in patients from an endemic area in Rio de Janeiro, Brazil. Partially soluble antigens obtained from the promastigote forms of L. (V.) braziliensis were used. For development of the reaction, two chromogens, 1,2-orthophenylenediamine (OPD) and 3,3',5,5'-tetramethylbenzidine (TMB), and a fluorogen, 4-methylumbelliferylphosphate (MUP), were tested. The performance of each system was compared using the following parameters: accuracy, intraclass correlation coefficient (ICC), and area under the receiver operating characteristic (ROC) curve. Sensitivity was the same (97.4%) for all systems. The reliability was excellent (ICC = 98.6, 98.7, and 99.1%) and specificity was 93.7, 95.8, and 97.4% for OPD, MUP, and TMB, respectively, showing no statistical significance. Despite the absence of differences in the performance of the three systems, the use of TMB is suggested because of its operational advantages, such as low cost compared with fluorogens, easy manipulation, greater stability, and lower toxicity.
Asunto(s)
Técnicas para Inmunoenzimas/métodos , Leishmaniasis Cutánea/diagnóstico , Animales , Antígenos de Protozoos/inmunología , Bencidinas/química , Intervalos de Confianza , Humanos , Himecromona/análogos & derivados , Himecromona/química , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Leishmania braziliensis/inmunología , Fenilendiaminas/química , Valor Predictivo de las Pruebas , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Visceral leishmaniasis is a zoonosis of public health importance, and dogs represent one of the main problems. This paper describes the first autochthonous case of canine visceral leishmaniasis in the municipality of Maricá. It provides new facts regarding the geographical distribution of Leishmania (Leishmania) chagasi in the State of Rio de Janeiro.
Asunto(s)
Enfermedades de los Perros/diagnóstico , Leishmaniasis Visceral/veterinaria , Animales , Brasil/epidemiología , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/parasitología , Perros , Leishmania infantum/aislamiento & purificación , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/epidemiología , MasculinoRESUMEN
Leishmaniose visceral é uma zoonose de importância em Saúde Pública, onde os cães representam um dos maiores problemas. Este trabalho visa relatar o primeiro caso autóctone da leishmaniose visceral canina no município de Maricá, fornecendo elementos relacionados à distribuição geográfica de Leishmania (Leishmania) chagasi no Estado do Rio de Janeiro.
Visceral leishmaniasis is a zoonosis of public health importance, and dogs represent one of the main problems. This paper describes the first autochthonous case of canine visceral leishmaniasis in the municipality of Maricá. It provides new facts regarding the geographical distribution of Leishmania (Leishmania) chagasi in the State of Rio de Janeiro.
Asunto(s)
Animales , Perros , Masculino , Enfermedades de los Perros/diagnóstico , Leishmaniasis Visceral/veterinaria , Brasil/epidemiología , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/parasitología , Leishmania infantum/aislamiento & purificación , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/epidemiologíaRESUMEN
Flow cytometry employing Leishmania (L.) chagasi (Lc) and L. (Viannia) braziliensis (Lb) antigen was used to establish the differential diagnosis between visceral (VL) and cutaneous leishmaniasis (CL) in dogs. Flow cytometry permitted the detection of Leishmania-specific immunoglobulin G in sera from 19 dogs: nine with CL and 10 with VL. A significant difference in the percentage of positive staining was observed in sera from dogs with CL between the homologous antigen (69% for Lb) and the heterologous antigen (42% for Lc). However, this difference was not significant in sera from dogs with VL (61% for Lb and 73% for Lc). No significant staining was observed in control sera (0.6% for Lb and 0.4% for Lc) consisting of samples from healthy dogs, or in the group with sporotrichosis (1.8% for Lb and 1.5% for Lc), a differential diagnosis of CL. The results suggest that flow cytometry might be useful for the differentiation between CL and VL in dogs, with practical applications in areas where the two infections overlap.
Asunto(s)
Enfermedades de los Perros/diagnóstico , Inmunoglobulina G/sangre , Leishmania/clasificación , Leishmaniasis Cutánea/veterinaria , Leishmaniasis Visceral/veterinaria , Animales , Anticuerpos Antiprotozoarios , Antígenos de Protozoos , Enfermedades de los Perros/inmunología , Enfermedades de los Perros/parasitología , Perros , Citometría de Flujo/veterinaria , Leishmaniasis Cutánea/inmunología , Leishmaniasis Cutánea/parasitología , Leishmaniasis Visceral/inmunología , Leishmaniasis Visceral/parasitología , Especificidad de la EspecieRESUMEN
The objective of the present study was to evaluate the specificity of the Montenegro skin test (MST) in an area in Brazil, state of Grande do Sul State (RS), which was considered to be non-endemic for leishmaniasis. Sixty subjects presented a positive MST and were reevaluated by clinical examination, serology and polymerase chain reaction (PCR) of peripheral blood for the detection of subclinical Leishmania infection. None of the subjects presented clinical signs or symptoms of current leishmaniasis or a history of the disease.Leishmania (Viannia) DNA was detected in blood by PCR and hybridization in one subject. The PCR skin test-positive individual remained asymptomatic throughout the study. Clinical examination showed no scars suggestive of past cutaneous leishmaniasis. Human subclinical infection with Leishmania (Viannia) in RS was confirmed by PCR. This is the first report of subclinical infection with this parasite in the human population of this area.