Abstract
Spain has one of the world’s largest pools of organ donors and is a global leader in terms of the number of transplants it performs. The current outbreak of leishmaniasis in Fuenlabrada (in the southwest of the region of Madrid, Spain) has involved 600 clinical cases since late 2009 (prevalence 0.2%). It may therefore be wise to monitor the town’s transplanted population for Leishmania infantum; its members are immunosuppressed and at greater risk of infection and relapse following treatment. The present work examines the use of cytokine release assays to determine the prevalence of Leishmania infection in this population, and to confirm recovery following treatment for visceral leishmaniasis (VL). The humoral and cellular immune responses to L. infantum were characterized in 63 solid organ transplant (SOT) recipients from Fuenlabrada, 57 of whom reported no previous episode of VL (NVL subjects), and six of whom had been cured of VL (CVL subjects). Seventeen subjects (12 NVL and 5 CVL) showed a patent lymphoproliferative response to soluble Leishmania antigen (SLA). Stimulation of peripheral blood mononuclear cell cultures and of whole blood with SLA led to the production of different combinations of cytokines that might serve to confirm Leishmania infection or recovery from VL and help prevent cured patients from relapsing into this serious condition.
Highlights
In Spain, leishmaniasis is an endemic zoonosis caused by Leishmania infantum
The in vitro cell proliferation assay with phytohaemagglutinin type M (PHAM) stimulation revealed the functional capacity of the Peripheral blood mononuclear cells (PBMCs) to mount a response in all immunosuppressed individuals
The subject who was serologically positive by Immunofluorescent antibody titre (IFAT) alone showed no lymphoproliferative response and developed visceral leishmaniasis (VL) within a few days of testing, and for that reason was excluded for further analysis (S1 Fig)
Summary
In Spain, leishmaniasis is an endemic zoonosis caused by Leishmania infantum. The national mean annual incidence is 0.45 cases/100,000 inhabitants, similar to that traditionally reported for the capital, Madrid (0.5 cases/100,000 inhabitants) [1]. A few years ago, an unusual, large outbreak of leishmaniasis was noted in the southwest of the Region of Madrid, and disease incidence in the town of Fuenlabrada is currently 21.54/100,000. The worldwide number of cases of VL in recipients of solid organ transplants (SOT) has quadrupled since the 1990s [4] (77% of those affected received a kidney transplant, the most commonly performed transplant operation). Most of these cases occurred in the Mediterranean basin, in Spain, which has one of the world’s largest pool of organ donors and is among the foremost in performing SOTs
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