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Role of asymptomatic and symptomatic humans as reservoirs of visceral leishmaniasis in a Mediterranean context.
Molina, Ricardo; Jiménez, Maribel; García-Martínez, Jesús; San Martín, Juan Víctor; Carrillo, Eugenia; Sánchez, Carmen; Moreno, Javier; Alves, Fabiana; Alvar, Jorge.
Afiliação
  • Molina R; Laboratory of Medical Entomology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
  • Jiménez M; WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
  • García-Martínez J; Laboratory of Medical Entomology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
  • San Martín JV; WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
  • Carrillo E; Clinical Laboratory Service, Blood Bank, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
  • Sánchez C; Internal Medicine Service, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
  • Moreno J; WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
  • Alves F; WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
  • Alvar J; WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
PLoS Negl Trop Dis ; 14(4): e0008253, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32324738
ABSTRACT

BACKGROUND:

In the Mediterranean basin, Leishmania infantum is the causative agent of visceral leishmaniasis (VL), a zoonosis in which the dog is the primary domestic reservoir, although wildlife may have a leading role in the sylvatic cycle of the disease in some areas. Infections without disease are very frequent. There is limited information regarding the role that VL patients and asymptomatic infected individuals could be playing in the transmission of L. infantum. Xenodiagnosis of leishmaniasis has been used in this descriptive study to explore the role of symptomatic and asymptomatic infected individuals as reservoirs in a recent focus of leishmaniasis in southwestern Madrid, Spain. METHODOLOGY AND MAIN

FINDINGS:

Asymptomatic blood donors (n = 24), immunocompetent patients who were untreated (n = 12) or treated (n = 11) for visceral leishmaniasis (VL), and immunocompromised patients with VL (n = 3) were enrolled in the study. Their infectivity to Phlebotomus perniciosus was studied by indirect xenodiagnosis on peripheral blood samples. Quantitative polymerase chain reaction of blood samples from immunocompetent patients untreated for VL and immunocompromised untreated, treated and under secondary prophylaxis for VL was performed. Antibodies against Leishmania were studied by indirect fluorescent antibody and rK39-immunochromatographic tests. A lymphoproliferative assay with a soluble Leishmania antigen was used to screen for leishmaniasis infection in the healthy population. Sixty-two xenodiagnostic tests were carried out and 5,080 sand flies were dissected. Positive xenodiagnosis was recorded in four patients, with different sand fly infection rates 1 immunosuppressed HIV / L. infantum coinfected asymptomatic patient, 1 immunosuppressed patient with multiple myeloma and symptomatic active VL, and 2 immunocompetent patients with untreated active VL. All blood donors were negative for both xenodiagnosis and conventional PCR. CONCLUSIONS /

SIGNIFICANCE:

There is no consensus amongst authors on the definition of an 'asymptomatic case' nor on the tools for screening; we, therefore, have adopted one for the sake of clarity. Immunocompetent subjects, both infected asymptomatics and those treated for VL, are limited in number and appear to have no epidemiological relevance. The impact is limited for immunocompetent patients with untreated active VL, whilst immunosuppressed individuals undergoing immunosuppressive therapy and immunosuppressed individuals HIV / L. infantum coinfected were the most infectious towards sand flies. It is noteworthy that the HIV / L. infantum coinfected patient with asymptomatic leishmaniasis was easily infectious to sand flies for a long time, despite being under continuous prophylaxis for leishmaniasis. Accordingly, screening for latent Leishmania infection in HIV-infected patients is recommended in scenarios where transmission occurs. In addition, screening for VL in HIV-infected patients who have spent time in VL-endemic areas should also be implemented in non-endemic areas. More research is needed to better understand if some asymptomatic coinfected individuals contribute to transmission as 'super-spreaders'.
Assuntos
Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Doenças Neglicenciadas Tema em saúde: Zoonoses Base de dados: MEDLINE Assunto principal: Reservatórios de Doenças / Leishmania infantum / Transmissão de Doença Infecciosa / Leishmaniose Visceral Tipo de estudo: Estudo diagnóstico Limite: Adulto / Animais / Feminino / Humanos / Masculino / Meia-Idade País/Região como assunto: Europa Idioma: Inglês Revista: PLoS Negl Trop Dis Assunto da revista: Medicina Tropical Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Espanha

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Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Doenças Neglicenciadas Tema em saúde: Zoonoses Base de dados: MEDLINE Assunto principal: Reservatórios de Doenças / Leishmania infantum / Transmissão de Doença Infecciosa / Leishmaniose Visceral Tipo de estudo: Estudo diagnóstico Limite: Adulto / Animais / Feminino / Humanos / Masculino / Meia-Idade País/Região como assunto: Europa Idioma: Inglês Revista: PLoS Negl Trop Dis Assunto da revista: Medicina Tropical Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Espanha