RESUMO
Leishmania infantum infection had been expanding into new areas due to changes in vector and host biology. Zoonotic visceral leishmaniasis has become endemic in previously unsuitable areas as vectors find favourable climatic conditions and an increasing number of reservoir dogs are moved between traditionally and new endemic areas. Monitoring vector and disease expansion in areas of recent colonization is needed to understand transmission mechanisms and patterns of disease establishment. Here, we studied the infection status of 815 human blood donors and of 803 sympatric dogs from five, newly endemic, areas in Northwestern Italy. In autochthonous dogs, the seroprevalence of anti-L. infantum antibodies, recorded by Western blot, reached 42.22%, while in humans, the seroprevalence was of 16.81%. No significant correlation between the infection status of dogs and that of their human owners was found, but L. infantum infection was recorded in the different study areas with significant levels of diversity. Restriction fragment length polymorphism showed a high genetic variability of the circulating strains and gave useful insights on patterns of disease establishment into a naïve area.
Assuntos
Doenças do Cão/parasitologia , Leishmania infantum , Leishmaniose Visceral/veterinária , Animais , Anticorpos Antiprotozoários/sangue , Reservatórios de Doenças , Doenças do Cão/epidemiologia , Cães , Doenças Endêmicas , Feminino , Humanos , Itália/epidemiologia , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/parasitologia , Leishmaniose Visceral/transmissão , Masculino , Psychodidae/parasitologia , Fatores de Risco , Estudos Soroepidemiológicos , ZoonosesRESUMO
Both the presentation and clinical course of visceral leishmaniasis (VL) may be atypical in immunosuppressed subjects, often resulting in delayed diagnosis and treatment. We describe a case of VL characterized by negative serologic testing, a relapsing course, and a fatal outcome 2 years after the patient had been successfully treated for non-Hodgkin's lymphoma with rituximab. Diagnosis of VL may be further delayed or even missed in patients treated with drugs that interfere with specific antibody production unless specific diagnostic methods, such as bone marrow examination and parasite DNA amplification/detection, are routinely employed.
Assuntos
Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Medula Óssea/parasitologia , Leishmania infantum/efeitos dos fármacos , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/prevenção & controle , Leucócitos Mononucleares/parasitologia , Idoso , Anticorpos Monoclonais Murinos/uso terapêutico , Antineoplásicos/uso terapêutico , Evolução Fatal , Feminino , Humanos , Hospedeiro Imunocomprometido , Itália , Leishmania infantum/isolamento & purificação , Leishmaniose Visceral/sangue , Leishmaniose Visceral/diagnóstico , Linfoma não Hodgkin/tratamento farmacológico , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Recidiva , RituximabRESUMO
Rapid and accurate diagnosis of tuberculous pericarditis is often difficult, considering the low specificity of both clinical picture and laboratory tests on pericardial fluid, as well as the low sensitivity of microbiological tests. This report documents the feasibility and clinical usefulness of an Interferon (IFN) - gamma ELISpot - TB assay on pericardial fluid cells in a case of suspected tuberculous pericarditis presenting with tamponade. As large pericardial effusions requiring pericardiocentesis are relatively frequent in tuberculous pericarditis, the physician may consider this particular application of ELISpot-TB as a rapid decision aid for starting the treatment.