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1.
Am J Trop Med Hyg ; 103(5): 1927-1929, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32959758

RESUMO

Visceral leishmaniasis (VL) is a systemic infection caused by the protozoal parasite Leishmania, spread via the bloodstream to the reticuloendothelial system, through the bite of the sand fly. It is endemic in parts of Africa, South America, Asia, and Europe, including the Mediterranean. Here, we describe a case of VL that was initially diagnosed as Q fever based on positive Coxiella burnetii serology and showed a partial response to doxycycline treatment.


Assuntos
Coxiella burnetii/imunologia , Doxiciclina/uso terapêutico , Leishmania donovani/imunologia , Leishmaniose Visceral/diagnóstico por imagem , Abdome/diagnóstico por imagem , Animais , Diagnóstico Diferencial , Hepatomegalia/diagnóstico por imagem , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/parasitologia , Masculino , Febre Q/diagnóstico por imagem , Esplenomegalia/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
PLoS One ; 15(9): e0238840, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925980

RESUMO

Diagnosis of visceral leishmaniasis (VL) relies on invasive and risky aspirate procedures, and confirmation of cure after treatment is unreliable. Detection of Leishmania donovani antigens in urine has the potential to provide both a non-invasive diagnostic and a test of cure. We searched for L. donovani antigens in urine of VL patients from India and Sudan to contribute to the development of urine antigen capture immunoassays. VL urine samples were incubated with immobilised anti-L. donovani polyclonal antibodies and captured material was eluted. Sudanese eluted material and concentrated VL urine were analysed by western blot. Immunocaptured and immunoreactive material from Indian and Sudanese urine was submitted to mass spectrometry for protein identification. We identified six L. donovani proteins from VL urine. Named proteins were 40S ribosomal protein S9, kinases, and others were hypothetical. Thirty-three epitope regions were predicted with high specificity in the 6 proteins. Of these, 20 were highly specific to Leishmania spp. and are highly suitable for raising antibodies for the subsequent development of an antigen capture assay. We present all the identified proteins and analysed epitope regions in full so that they may contribute to the development of non-invasive immunoassays for this deadly disease.


Assuntos
Anticorpos Antiprotozoários/urina , Antígenos de Protozoários/urina , Leishmania donovani/imunologia , Leishmaniose Visceral/diagnóstico , Proteínas de Protozoários/urina , Adulto , Anticorpos Antiprotozoários/imunologia , Anticorpos Antiprotozoários/isolamento & purificação , Antígenos de Protozoários/imunologia , Antígenos de Protozoários/isolamento & purificação , Estudos de Casos e Controles , Humanos , Índia/epidemiologia , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/urina , Proteínas de Protozoários/imunologia , Proteínas de Protozoários/isolamento & purificação
3.
PLoS One ; 15(7): e0236127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32692783

RESUMO

Visceral leishmaniasis (VL) is an important zoonosis in Brazil. Dogs are considered the main domestic reservoirs of the disease in the country; hence, control measures are focused on these reservoirs. Despite efforts to prevent and control VL, important reductions in disease prevalence and incidence have not been identified, stimulating the development and application of new strategies. The choice and implementation of new control strategies can benefit from the application of mathematical models that allow the simulation of different strategies in different scenarios. Selecting the best strategy to be implemented is also supported by cost-effectiveness studies. Here we used the results of a mathematical model in which scenarios, including isolated use of the vaccine and insecticide-impregnated collar (IIC), both at different coverage rates, were simulated to conduct a cost-effectiveness study. The costs were calculated for each scenario considering a simulation period of four years. Collar application in both infected and non-infected animals was the most cost-effective strategy. For example, to reduce the prevalence in humans and dogs by approximately 70%, the costs ranged from $250,000 and $550,000 for the IICs and vaccination, respectively. Even in the scenario with 40% loss/replacement of IICs, this measure was more advantageous in terms of cost-effectiveness than vaccination. If the vaccine were applied with culling of seropositive tested dogs, then the measure became more effective with a reduced cost compared with the vaccine alone. The use of the three first consecutive vaccine doses had the greatest impact on the cost of the vaccination strategy. The advantage of using IICs is that there is no need for a prior diagnosis, unlike vaccination, reducing costs and facilitating implementation. The present study aims to contribute to strategies to reduce hosts infected with VL by reducing public expenditure.


Assuntos
Doenças do Cão/economia , Doenças do Cão/prevenção & controle , Leishmania donovani/efeitos dos fármacos , Leishmaniose Visceral/economia , Leishmaniose Visceral/prevenção & controle , Vacinação/economia , Vacinação/veterinária , Animais , Brasil/epidemiologia , Doenças do Cão/parasitologia , Doenças do Cão/transmissão , Cães , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/veterinária , Prevalência
5.
PLoS Negl Trop Dis ; 14(3): e0008052, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32203500

RESUMO

Post-kala-azar dermal leishmaniasis (PKDL) is clinical outcome of visceral leishmaniasis (VL) and is thought to be the potential reservoir of parasite. Miltefosine (MF) is the only oral drug existing for treatment of post-kala-azar dermal leishmaniasis (PKDL). Increased miltefosine tolerance in clinical isolates of Leishmania donovani has been reported and is one of the major concerns in the treatment of PKDL. Here, we report a highly ulcerated PKDL case that was successfully cured after miltefosine treatment.


Assuntos
Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/etiologia , Leishmaniose Visceral/complicações , Leishmaniose Visceral/tratamento farmacológico , Antiprotozoários/uso terapêutico , Humanos , Índia , Leishmania donovani/isolamento & purificação , Leishmaniose Cutânea/parasitologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/parasitologia , Masculino , Pessoa de Meia-Idade , Fosforilcolina/análogos & derivados , Fosforilcolina/uso terapêutico , Pele/diagnóstico por imagem , Pele/patologia
6.
Parasitol Int ; 74: 101991, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31520692

RESUMO

A case of cutaneous leishmaniasis was discovered in a 32-year old man with a persistent erythematous plaque. The patient resides in a high altitude (~2000 m above sea level) area that is not endemic for cutaneous leishmaniasis in the Dunai village of Dolpa, Nepal. The patient's lesion was initially misdiagnosed as lupus vulgaris. After response failure to initial treatment, additional testing by histological microscopy revealed the presence of Leishmania amastigotes in tissue from the lesion, and the diagnosis of cutaneous leishmaniasis was confirmed by nested PCR DNA assay of tissue from the lesion, and by a positive rK39 test in blood. Sequencing of the kinetoplast region confirmed the presence of Leishmania donovani complex. The patient responded well to treatments for cutaneous leishmaniasis and the skin lesions regressed after 6 months. This is the first known case of cutaneous leishmaniasis in a patient in Nepal who resides at high altitude in a non-endemic region. Increasing temperatures in this region of Nepal may be expanding the range of vectors that transmit cutaneous leishmaniasis.


Assuntos
Altitude , Leishmaniose Cutânea/diagnóstico , Adulto , Antiprotozoários/uso terapêutico , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Nepal , Pele/parasitologia , Pele/patologia , Resultado do Tratamento
7.
Transbound Emerg Dis ; 67(2): 476-480, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31536676

RESUMO

Visceral leishmaniasis is an endemic zoonotic disease identified especially in developing territories. Brazil's northeast, southeast and midwest have been endemic for several years; currently, the infection is spreading to the south. Dogs are the main reservoirs; however, other mammal species have also been infected. Herein, we have identified the infecting Leishmania species in dogs and horses from the south of Brazil, a new outbreak of the infection. Blood samples were collected in the urban area of Uruguaiana city. DNA was extracted from peripheral blood, kinetoplast DNA (kDNA) and ribosomal DNA (rDNA) fragments were obtained by polymerase chain reaction (PCR) and sequenced. Out of 123 samples, 25 of them (14 dogs and 11 horses) were positive for Leishmania spp. Sequence alignment and phylogenetic analysis revealed that the kDNA in positive samples was similar to four species previously reported: L. infantum/L. chagasi, L. donovani, L. major. Despite kDNA minicircles regions are very useful due to high sensitivity to Leishmania spp. DNA detection, the sequence polymorphism among minicircles can be an obstacle to interspecific differentiation. Our results suggest that these strains are circulating in Brazil south region cross-border and indicate the susceptibility of new outbreak for visceral leishmaniasis infection in horses domiciled in endemic region for canine and human visceral leishmaniasis.


Assuntos
Reservatórios de Doenças/parasitologia , Doenças do Cão/epidemiologia , Doenças dos Cavalos/epidemiologia , Leishmania donovani/genética , Leishmaniose Visceral/veterinária , Zoonoses/epidemiologia , Animais , Brasil/epidemiologia , DNA de Cinetoplasto/genética , Doenças do Cão/parasitologia , Cães , Feminino , Doenças dos Cavalos/parasitologia , Cavalos , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/parasitologia , Masculino , Mamíferos , Filogenia , Reação em Cadeia da Polimerase/veterinária , Alinhamento de Sequência/veterinária , Zoonoses/parasitologia
8.
J Ethnopharmacol ; 247: 112270, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31589965

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Primates forage on a variety of plant parts to balance their dietary intake to meet requirements of energy, nutrition and maintenance, however the reason(s) leading them to ingest some plants which have no nutritional value and/or contain bioactive or even toxic secondary metabolites is recently gaining closer attention. The growing literature suggests that primates consume plants for medicinal purposes (self-medication) as well, particularly when infected with parasites and pathogens (bacteria, viruses, microbes). Interestingly, some of the plants they consume are also used by humans for similar purposes or may have potential uses for humans. MATERIALS AND METHODS: As part of a 16-month study of the parasite ecology of a sub-species of Japanese macaques (Macaca fuscata yakui) on the island of Yakushima, we surveyed their feeding habits and collected a subset of plants and plant parts observed being ingested by macaques. The ethnomedicinal value of these plants was surveyed and methanolic extracts of 45 plant parts were tested in vitro against important parasites of humans, including four protozoan parasites Plasmodium falciparum, Trypanosoma brucei rhodesiense, T. cruzi and Leishmania donovani, and the trematode flatworm Schistosoma mansoni. Potential toxicity of the extracts was also assessed on mammalian cells. RESULTS: A wide range of ethnomedicinal uses in Asia for these plants is noted, with 37% associated with the treatment of parasites, pathogens and related symptoms. Additionally, the 45 extracts tested showed broad and significant activity against our test organisms. All extracts were active against T. b. rhodesiense. The majority (over 80%) inhibited the growth of P. falciparum and L. donovani. Half of the extracts also displayed antiprotozoal potential against T. cruzi while only several extracts were active against both larval and adult stages of S. mansoni. Cytotoxicity was generally low, although several extracts lacked specific toxicity to test parasites. CONCLUSIONS: Our results indicated a number of plants and their parts to have antiparasitic activity not previously reported in the ethnopharmacological literature. Enhanced understanding of the primate diets, particularly during periods of intensified parasite infection risk may help to further narrow down plants of interest for lead compound development. The study of animal self-medication is a complementary approach, with precedence, to drug discovery of new lead drug compounds against human parasitic diseases.


Assuntos
Anti-Helmínticos/farmacologia , Antiprotozoários/farmacologia , Macaca fuscata/parasitologia , Extratos Vegetais/farmacologia , Plantas Medicinais/química , Infecções Protozoárias em Animais/tratamento farmacológico , Esquistossomose mansoni/tratamento farmacológico , Animais , Anti-Helmínticos/uso terapêutico , Antiprotozoários/uso terapêutico , Etnofarmacologia , Comportamento Alimentar , Feminino , Ilhas , Japão , Leishmania donovani/efeitos dos fármacos , Leishmania donovani/isolamento & purificação , Masculino , Medicina Tradicional/métodos , Testes de Sensibilidade Parasitária , Extratos Vegetais/uso terapêutico , Plasmodium falciparum/efeitos dos fármacos , Plasmodium falciparum/isolamento & purificação , Infecções Protozoárias em Animais/parasitologia , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/parasitologia , Esquistossomose mansoni/veterinária , Automedicação/veterinária , Testes de Toxicidade , Trypanosoma brucei rhodesiense/isolamento & purificação , Trypanosoma cruzi/efeitos dos fármacos , Trypanosoma cruzi/isolamento & purificação
9.
Parasitol Res ; 119(1): 345-349, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31776667

RESUMO

Leishmaniasis is a parasitic disease of medical importance widely distributed around the world. Several methods are available for diagnosis but molecular approaches are highly recommended. To improve the sensitivity of an existing hsp20 gene based-PCR protocol to detect Leishmania parasites, primers were redesigned to amplify a shorter fragment using a new PCR variant (PCR-hsp20S). In this study, we aimed at characterizing the performance of the new method on cutaneous clinical samples and compare it with the former PCR-hsp20. The analytical sensitivity of the PCR-hsp20S was evaluated using DNA dilutions (100-0.1 pg) from Leishmania donovani and resulted in the detection of 10 fg of parasitic DNA, the equivalent to 0.05 parasite genome. For the diagnostic evaluation, a panel of 127 human clinical samples was used to calculate the parameters of sensitivity, specificity, accuracy, and positive and negative predictive values of the PCR-hsp20S. Diagnostic sensitivity was 94% (CI, 89.1-99.7%) and the specificity of 100% (CI, 98.6-100%). The same panel was also evaluated with the PCR-hsp20 to calculate the agreement between both molecular assays and to compare their performances. While both hsp20-based PCRs showed a good agreement coefficient (kappa index = 0.6), the performance of the novel variant, PCR-hsp20S, was significantly higher in terms of sensitivity (P = 0.0001) allowing the accurate detection of a higher number of Leishmania-positive clinical samples. We endorse the use of the PCR-hsp20S over the former protocol for the detection of Leishmania parasites from cutaneous clinical samples. In addition, as an improved sensitivity was achieved with the new method merely through the amplification of a shorter gene fragment, this investigation constitutes an experimental proof of this concept.


Assuntos
Proteínas de Choque Térmico HSP20/genética , Leishmania donovani/isolamento & purificação , Leishmaniose/parasitologia , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase/métodos , Animais , Primers do DNA/química , DNA de Protozoário/genética , Humanos , Leishmania donovani/genética , Proteínas de Protozoários/genética , Sensibilidade e Especificidade , Pele/parasitologia
10.
Parasitol Int ; 75: 102047, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31887394

RESUMO

Leishmania donovani, a protozoan parasite of family Trypanosomatidae, causes fatal visceral leishmaniasis (VL) in the Indian subcontinent and Africa and cutaneous leishmaniasis (CL) in Sri Lanka. Another member of Trypanosomatidae, Leptomonas seymouri, resembling Leishmania was discovered recently to co-exist with L. donovani in the clinical samples from India and Sri Lanka and therefore, interfere with its investigations. We earlier described a method for selective elimination of such co-existing L. seymouri from clinical samples of VL exploiting the differential growth of the parasites at 37 °C in vitro. Here, we explored ways for a rapid discriminatory diagnosis using high resolution melting (HRM) curves to detect co-occurring L. seymouri with L. donovani in clinical samples. Initial attempt with kDNA-minicircle (mitochondrial DNA) based HRM did not display different Tm values between L. donovani and L. seymouri. Surprisingly, all of their minicircle sequences co-existed in similar clades in the dendrogram analysis, although the kDNA sequences are known for its species and strain specific variations among the Trypanosomatids. However, an HRM analysis that targets the HSP70 gene successfully recognized the presence of L. seymouri in the clinical isolates. This discovery will facilitate rapid diagnosis of L. seymouri and further investigations in to this elusive organism, including the clinico-pathological implications of its co-existence with L. donovani in patients.


Assuntos
Coinfecção/diagnóstico , Infecções por Euglenozoa/diagnóstico , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/diagnóstico , Trypanosomatina/isolamento & purificação , DNA de Cinetoplasto/análise
11.
Top Companion Anim Med ; 37: 100356, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31837752

RESUMO

We report an unusual case of leishmaniosis with the involvement of mammary glands in an old cat with what seems to be a concurrent regressive feline leukemia virus infection. Leishmania donovani complex parasites were identified for the first time in inflammatory breast fluid during a clinical recurrence manifested about 4 years after the first diagnosis of feline leishmaniosis. Combined treatment with allopurinol and meglumine antimoniate resulted in clinical cure of mammary lesion and a concurrent uveitis.


Assuntos
Doenças do Gato/parasitologia , Leishmaniose/veterinária , Glândulas Mamárias Animais/parasitologia , Alopurinol/uso terapêutico , Animais , Antiprotozoários/uso terapêutico , Doenças do Gato/tratamento farmacológico , Doenças do Gato/virologia , Gatos , Feminino , Leishmania donovani/isolamento & purificação , Leishmaniose/tratamento farmacológico , Vírus da Leucemia Felina , Leucemia Felina , Antimoniato de Meglumina/uso terapêutico , Portugal , Uveíte/tratamento farmacológico , Uveíte/veterinária
12.
PLoS One ; 14(12): e0225588, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841511

RESUMO

Macrophages can reprogram their metabolism in response to the surrounding stimuli, which affects their capacity to kill intracellular pathogens. We have investigated the metabolic and immune status of human macrophages after infection with the intracellular trypanosomatid parasites Leishmania donovani, L. amazonensis and T. cruzi and their capacity to respond to a classical polarizing stimulus (LPS and IFN-γ). We found that macrophages infected with Leishmania preferentially upregulate oxidative phosphorylation, which could be contributed by both host cell and parasite, while T. cruzi infection did not significantly increase glycolysis or oxidative phosphorylation. Leishmania and T. cruzi infect macrophages without triggering a strong inflammatory cytokine response, but infection does not prevent a potent response to LPS and IFN-γ. Infection appears to prime macrophages, since the cytokine response to activation with LPS and IFN-γ is more intense in infected macrophages compared to uninfected ones. Metabolic polarization in macrophages can influence infection and immune evasion of these parasites since preventing macrophage cytokine responses would help parasites to establish a persistent infection. However, macrophages remain responsive to classical inflammatory stimuli and could still trigger inflammatory cytokine secretion by macrophages.


Assuntos
Doença de Chagas/imunologia , Citocinas/metabolismo , Leishmaniose/imunologia , Ativação de Macrófagos , Macrófagos/imunologia , Células 3T3 , Animais , Células Cultivadas , Doença de Chagas/sangue , Doença de Chagas/parasitologia , Citocinas/imunologia , Voluntários Saudáveis , Humanos , Leishmania donovani/imunologia , Leishmania donovani/isolamento & purificação , Leishmania mexicana/imunologia , Leishmania mexicana/isolamento & purificação , Leishmaniose/sangue , Leishmaniose/parasitologia , Macrófagos/metabolismo , Metaboloma/imunologia , Camundongos , Fosforilação Oxidativa , Cultura Primária de Células , Trypanosoma cruzi/imunologia , Trypanosoma cruzi/isolamento & purificação , Regulação para Cima
13.
Parasit Vectors ; 12(1): 527, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699125

RESUMO

BACKGROUND: The main clinical forms of leishmaniasis in Bangladesh are visceral leishmaniasis and post-kala-azar dermal leishmaniasis, which are caused by Leishmania donovani. Imported cutaneous leishmaniasis (CL) is emerging globally due mainly to increased human mobility. In recent years, several imported CL cases have also been reported in Bangladesh. Sporadic atypical cases of CL can be challenging for diagnosis and clinical management, while occurrence of infection on a frequent basis can be alarming. We report of a case of a Bangladeshi temporary-migrant worker who, upon return, presented development of skin lesions that are characteristic of CL. METHODS: A serum sample was collected and tested with an rK39 immunochromatographic test. Nucleic acid from skin biopsy derived culture sample was extracted and screened with a real-time PCR assay which targets the conserved REPL repeat region of L. donovani complex. The internal transcribed spacer 2 region of the ribosomal RNA gene cluster was amplified and sequenced. RESULTS: The suspect had a history of travel in both CL and VL endemic areas and had a positive rK39 test result. Based on clinical presentation, travel history and demonstration of the parasite in the skin biopsy, CL was diagnosed and the patient underwent a combination therapy with Miltefosine and liposomal amphotericin B. While typical endemic species were not detected, we identified Leishmania major, a species that, to our knowledge, has never been reported in Bangladesh. CONCLUSIONS: Proper monitoring and reporting of imported cases should be given careful consideration for both clinical and epidemiological reasons. Molecular tests should be performed in diagnosis to avoid dilemma, and identification of causative species should be prioritized.


Assuntos
Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/patologia , Leishmania donovani/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/patologia , Adulto , Anticorpos Antiprotozoários/sangue , Bangladesh , Biópsia , Doenças Transmissíveis Importadas/parasitologia , Humanos , Imunoensaio , Masculino , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sequência de DNA , Pele/parasitologia , Pele/patologia , Viagem
14.
Infect Genet Evol ; 76: 104073, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31629887

RESUMO

Visceral leishmaniasis (VL), the most severe form of the disease, is caused by Leishmania donovani in the Indian sub-continent (ISC). Whole genome sequencing studies revealed that two parasite populations exist in the ISC: a main population named the Core Group (CG) found mostly in the lowlands, and a new, genetically different subpopulation called ISC1. Parasites belonging to the CG were shown to be responsible for the recent epidemics, while the ISC1 variant was originally identified in hilly districts of Nepal and was later on increasingly found in the lowlands. Importantly, the ISC1 and CG isolates differ in their drug susceptibility and virulence signatures, suggesting that ISC1 constitutes an emerging and functionally different variant of L. donovani. In present study we aimed to address the potential of ISC1 transmission by the natural vector of L. donovani in the lowlands, Phlebotomus argentipes. By experimental infection of sand flies with parasites of the different genotypes, we demonstrate that ISC1 and CG strains are developing similarly in P. argentipes, suggesting that P. argentipes is a fully competent vector for ISC1 parasites. Integration of previous and current findings shows thus that ISC1 is a new and different variant of L. donovani, fully adapted to spread in the ISC through the main vector. This information is directly useful for managers of the elimination program. Furthermore, integration of our successive studies (genotyping, phenotyping and vector competence) demonstrates the relevance of molecular surveillance and should be of interest for scientists working on vector borne diseases and control managers.


Assuntos
Leishmania donovani/classificação , Leishmaniose Visceral/transmissão , Phlebotomus/parasitologia , Animais , Feminino , Humanos , Índia , Insetos Vetores/parasitologia , Leishmania donovani/genética , Leishmania donovani/isolamento & purificação , Filogenia
15.
BMC Infect Dis ; 19(1): 849, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615428

RESUMO

BACKGROUND: Leishmaniasis and malaria are tropical diseases with more than half of the world population at risk of infection resulting in significant morbidity and mortality. Co-infection of Leishmaniasis and malaria pose a great challenge in the diagnosis as well as overall management. CASE PRESENTATION: In this case report, we present a rare case of a 5 years old child hailing from non-endemic region of Nepal with history of fever for a period of 3 months who was diagnosed as co-infection of malaria due to Plasmodium vivax and visceral Leishmaniasis with pancytopenia that subsequently improved after a course of treatment. CONCLUSIONS: A high index of suspicion for a possibility of co-infection with Leishmaniasis and malaria should be borne in mind when an individual hailing from or having history of travel to endemic countries presents with prolonged fever.


Assuntos
Coinfecção/diagnóstico , Leishmaniose Visceral/diagnóstico , Malária/diagnóstico , Pancitopenia/diagnóstico , Esplenomegalia/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/complicações , Malária/complicações , Malária/parasitologia , Masculino , Nepal , Pancitopenia/etiologia , Plasmodium vivax/isolamento & purificação , Esplenomegalia/etiologia
16.
Internist (Berl) ; 60(12): 1305-1310, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31549186

RESUMO

MEDICAL HISTORY AND INITIAL PRESENTATION: A 35-year-old patient with a previous history of persistent episodic fever, sore throat, myalgia, and cephalgia presented for evaluation of pancytopenia. He had no recent travel history, except for a stay in Italy 1 year prior to admission and in Spain several years in the past. DIAGNOSTIC WORKUP: Laboratory evaluation confirmed pancytopenia, agranulocytosis, and elevated infection parameters without indicative serological results en par with lymphadenitis colli. Computed tomography scanning revealed cervical lymphadenopathy, hepatosplenomegaly, and colitis with occult perforation of the sigmoid colon. Bone marrow biopsy showed an infiltration of polyclonal plasma cells. Lymph node biopsy was compatible with necrotizing lymphadenitis. DIAGNOSIS: Polymerase chain reaction analysis of a lymph node specimen confirmed the presence of Leishmania species, thereby enabling the diagnosis of visceral Leishmania. THERAPY COURSE: Treatment with liposomal amphotericin B was initiated. Both fever and lymphadenopathy quickly resolved. CONCLUSION: VL is a clinically pleiotropic, severe disease with fatal outcome if left untreated. It often presents with distinct similarities to hematologic malignancies. Exacerbation can occasionally occur as fulminant macrophage activation syndrome. Disease incidence is globally increasing and has not peaked as yet. A complex interplay between pathogen and the immune system is the key pathophysiological mechanism.


Assuntos
Febre/etiologia , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/diagnóstico , Pancitopenia/etiologia , Adulto , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antiprotozoários/administração & dosagem , Antiprotozoários/uso terapêutico , Diagnóstico Diferencial , Hepatomegalia/diagnóstico por imagem , Hepatomegalia/tratamento farmacológico , Hepatomegalia/microbiologia , Humanos , Leishmania donovani/genética , Leishmaniose Visceral/tratamento farmacológico , Lipossomos , Masculino , Pancitopenia/diagnóstico , Esplenomegalia/diagnóstico por imagem , Esplenomegalia/tratamento farmacológico , Esplenomegalia/microbiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Acute Med ; 18(3): 184-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536056

RESUMO

A 62-year old British Caucasian woman normally resident in Spain presented with fever and pancytopaenia after returning to the UK. Her symptoms persisted despite broad-spectrum antibiotics, and she gradually became confused, hypotensive and progressively more pancytopaenic. Imaging demonstrated hepatosplenomegaly, and a bone marrow aspirate confirmed a diagnosis of haemophagocytic lymphohistiocytosis (HLH). Bone marrow polymerase chain reaction (PCR) and blood serology were both positive for Leishmania donovani, consistent with visceral leishmaniasis (VL). Following treatment with dexamethasone and amphotericin, she improved clinically and biochemically, and was able to return to Spain. Fever in the returning traveller is a common acute medical presentation. Although HLH and VL are rare diagnoses, both carry a very high mortality rate if undiagnosed and untreated.


Assuntos
Leishmania donovani , Leishmaniose Visceral , Linfo-Histiocitose Hemofagocítica , Anfotericina B , Inglaterra , Feminino , Febre , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Pessoa de Meia-Idade , Espanha , Viagem
19.
Indian J Dermatol Venereol Leprol ; 85(6): 578-589, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397399

RESUMO

Background: Elimination of kala azar from India is challenging as there are potential reservoirs of Leishmania donovani in patients with post-kala-azar dermal leishmaniasis (PKDL). The vast repertoire of carbohydrate moieties on L. donovani is known to elicit specific and strong humoral responses in patients with kala azar. Aim: The present study was undertaken to evaluate the diagnostic performances of anti-gal antibodies using enzyme-linked immunosorbent assay for successful serological diagnosis of PKDL in Indian patients and to differentiate cases of past cured visceral leishmaniasis infections. Methods: We developed Gal enzyme-linked immunosorbent assay to measure specific anti-gal IgG isotype in the sera of 71 Indian patients with PKDL. The diagnostic efficacy of the newly developed assay was evaluated for precision, sensitivity and accuracy. Results: Gal2 enzyme-linked immunosorbent assay revealed three-fold increased anti-gal titers in 71 patients with active PKDL compared to controls. Subclass enzyme-linked immunosorbent assay analysis further revealed enhanced IgG2 and IgG3 anti-gal titers in patients with PKDL compared to control subjects. The rank order for specificity and sensitivity for IgG subclasses was IgG3>IgG2>IgG4>IgG1. The area under the curve values of 0.98 and 0.99 were obtained for IgG and IgG3 Gal2 enzyme-linked immunosorbent assays respectively. Overall sensitivity and specificity were 95.7% (95% CI: 88.1-99.1) and 98.1% (95% confidence interval: 90.1-99.9), and 98.5% (95% CI: 92.4-99.9) and 98.1% (95% CI: 90.1-99.9), respectively. Intra-assay coefficient of variation was 1.5% and inter-assay coefficient of variation was 11.7%. Limitations: The Gal2 enzyme-linked immunosorbent assay needs to be further investigated in mass surveys. Conclusion: Taken together, anti-gal titers detected through Gal2 enzyme-linked immunosorbent assay can serve as an effective diagnostic tool in disease elimination setting and help in better case management in endemic districts.


Assuntos
Leishmania donovani/isolamento & purificação , Leishmaniose Cutânea/sangue , Leishmaniose Cutânea/diagnóstico , Leishmaniose Visceral/sangue , Leishmaniose Visceral/diagnóstico , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Testes Diagnósticos de Rotina/métodos , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suínos , Adulto Jovem
20.
Pathog Glob Health ; 113(4): 180-190, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31429388

RESUMO

Cutaneous leishmaniasis (CL) caused by Leishmania donovani MON-37 is becoming a major public health problem in Sri Lanka, with 100 new cases per month being reported in endemic regions. Diagnosis of CL is challenging for several reasons. Due to relative specificity and rapidity we propose Fluorescence in Situ Hybridization as a diagnostic tool for CL. The objective was to evaluate the potential of Fluorescence in Situ Hybridization as a diagnostic method for Cutaneous leishmaniasis in Sri Lanka. Literature on current laboratory tests used to diagnose Cutaneous leishmaniasis in Sri Lanka and globally was reviewed. Sri Lankan data were reviewed systematically following the PRISMA guidelines. A narrative of the results is presented. There is currently no gold standard diagnostic method for Cutaneous leishmaniasis. Fluorescence in Situ Hybridization has been previously applied to detect dermal pathologies including those involving infectious agents, and its use to detect the Leishmania parasite in human cutaneous lesions reported in small number of studies, generally with limited numbers of subjects. Advantages of FISH has been specificity, cost and ease-of-use compared to the alternatives. Based on the available literature and our current work, FISH has potential for diagnosing CL and should now be evaluated in larger cohorts in endemic regions. FISH for CL diagnosis could find application in countries such as Sri Lanka, where laboratory facilities may be limited in rural areas where the disease burden is highest.


Assuntos
Hibridização in Situ Fluorescente/métodos , Leishmania donovani/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Humanos , Leishmania donovani/genética , Sensibilidade e Especificidade , Sri Lanka
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