Cases Of Leishmaniasis Research Articles

Epidemiological, serological, and entomological aspects of visceral leishmaniasis (VL) in suspected new VL foci in Bangladesh

The study aimed to explore epidemiological, serological, and entomological aspects of visceral leishmaniasis (VL) in suspected new VL foci and assess the knowledge, attitude, and practices of the community living in the alleged new VL foci. The study investigated new visceral leishmaniasis (VL) cases reported between 2019 and 2020 in four sub-districts (Dharmapasha, Hakimpur, Islampur and Savar) where we tested 560 members using the rK39 rapid test and conducted vector collections in six neighbouring houses of the index cases to assess sandfly density and distribution, examined sandflies' infection, and determined the spatial relationship with VL infection. Furthermore, we highlighted the importance of early detection, and community awareness in controlling the spread of the disease. The study screened 1078 people from 231 households in the four sub-districts for fever, history of visceral leishmaniasis (VL), and PKDL-like skin lesions. Among sub-districts, positivity rate for rK39 rapid test was highest (3.5 %) in Savar. Sandflies were present across all areas except in Dharmapasha, but all 21 collected female P. argentipes sandflies were negative for Leishmania parasite DNA. We found one person from Islampur with a history of VL, and one from Islampur and another one from Savar had PKDL. After the awareness intervention, more people became familiar with VL infection (91.2 %), and their knowledge concerning sandflies being the vector of the disease and the risk of having VL increased significantly (30.1 %). The study found no active case in the suspected new foci, but some asymptomatic individuals were present. As sandfly vectors exist in these areas, the National Kala-azar Elimination Programme (NKEP) should consider these areas as kala-azar endemic and initiate control activities as per national guidelines.

Comparing the Trends of Vector-Borne Diseases (VBDs) before and after the COVID-19 Pandemic and Their Spatial Distribution in Southern Iran.

We aimed to model and predict the changes in the trend of vector-borne diseases (VBDs) before and after the COVID-19 pandemic in a high-risk area of Iran. This case-series study was conducted in Fars province, south of Iran, between April 2016 and July 2021. All referred cases of VBDs were considered during the five years to investigate the effect of the lockdown on the epidemiological profile of these diseases. We used time-series autoregressive integrated moving average (ARIMA) and seasonal ARIMA (SARIMA) models. Pediculosis incidence trend was rising with a peak of 1,146 per 100,000 in 2018, followed by a dramatic decrease reached to the minimum amount of 157.8 per 100,000 in 2021. In contrast, malaria and scabies had a smooth decreasing trend ranging from 2.2 per 100,000 and 7.3 per 100,000 in 2016 to a minimum of 0.2 per 100,000 in 2021, respectively. Likewise, leishmaniasis had a falling trend, with a maximum rate of 82.9 per 100,000 in 2016 to the lowest rate of 9.4 per 100,000 in 2021. However, the difference between observed and expected values revealed that the consequences of the COVID-19 pandemic had increased the number of leishmaniasis cases. Tropical regions of Iran, including Fars province, are the favorite destinations for travelers. During COVID-19 outbreaks, some reasons, such as quarantine, movement restrictions, and social distancing, reduced human-vector contact and finally led to the reduction of VBDs in this area.

A challenging case of cutaneous leishmaniasis with thrombophlebitic complication

AbstractWe report a case of cutaneous leishmaniasis caused by Leishmania guyanensis with sporotrichoid lymphocutaneous dissemination of the parasite and thrombophlebitic complication in a 32‐year‐old man who had recently travelled to French Guiana. After initial failure of empirical treatment with amphotericin B, the patient evolved favourably on high doses of intramuscular injections of meglumine antimoniate for 2 months. This case illustrates the existence of lymphocutaneous forms and possible thrombophlebitic complications of leishmaniasis. It also highlights the challenges in the management of leishmaniasis, despite the existence of guidelines and a wide therapeutic arsenal.

Comparison of collection methods for Phlebotomus argentipes sand flies to use in a molecular xenomonitoring system for the surveillance of visceral leishmaniasis.

The kala-azar elimination programme has resulted in a significant reduction in visceral leishmaniasis (VL) cases across the Indian Subcontinent. To detect any resurgence of transmission, a sensitive cost-effective surveillance system is required. Molecular xenomonitoring (MX), detection of pathogen DNA/RNA in vectors, provides a proxy of human infection in the lymphatic filariasis elimination programme. To determine whether MX can be used for VL surveillance in a low transmission setting, large numbers of the sand fly vector Phlebotomus argentipes are required. This study will determine the best method for capturing P. argentipes females for MX. The field study was performed in two programmatic and two non-programmatic villages in Bihar, India. A total of 48 households (12/village) were recruited. Centers for Disease Control and Prevention light traps (CDC-LTs) were compared with Improved Prokopack (PKP) and mechanical vacuum aspirators (MVA) using standardised methods. Four 12x12 Latin squares, 576 collections, were attempted (12/house, 144/village,192/method). Molecular analyses of collections were conducted to confirm identification of P. argentipes and to detect human and Leishmania DNA. Operational factors, such as time burden, acceptance to householders and RNA preservation, were also considered. A total of 562 collections (97.7%) were completed with 6,809 sand flies captured. Females comprised 49.0% of captures, of which 1,934 (57.9%) were identified as P. argentipes. CDC-LTs collected 4.04 times more P. argentipes females than MVA and 3.62 times more than PKP (p<0.0001 for each). Of 21,735 mosquitoes in the same collections, no significant differences between collection methods were observed. CDC-LTs took less time to install and collect than to perform aspirations and their greater yield compensated for increased sorting time. No significant differences in Leishmania RNA detection and quantitation between methods were observed in experimentally infected sand flies maintained in conditions simulating field conditions. CDC-LTs were favoured by householders. CDC-LTs are the most useful collection tool of those tested for MX surveillance since they collected higher numbers of P. argentipes females without compromising mosquito captures or the preservation of RNA. However, capture rates are still low.

Evaluation of the Transmission Rate, the Mortality Rate, and the Level of Endemicity Due to Visceral Leishmaniasis at Marsabit County Referral Hospital

The disease Visceral leishmaniasis is a tropical infection spread by female sandflies. This leishmaniasis affects the spleen, the liver, and bone marrow. Globally, between 0.7 million and 1 million cases of visceral leishmaniasis arise yearly. In Kenya, 4000 cases are reported yearly, while 5 million individuals are at risk of infection. If untreated, the visceral leishmaniasis death rate is more than 95%. The study aims to evaluate the mortality and the transmission rate among visceral leishmaniasis patients referred to the Marsabit County referral hospital. The study adopted a retrospective cohort design. The study used secondary data obtained from the Marsabit County referral hospital. The Susceptible, Infected, and Recovered (S.I.R) Model, was incorporated to evaluate the mortality rate, the transmission rate, and the level of endemicity. The findings revealed that the mortality rate, the transmission rate, and the level of endemicity were estimated at 13.19%, 13.67%, and 0.0141, respectively. In conclusion, the mortality rate increases as the transmission rate increase and there is a need for urgent responses from health personnel to reduce the transmission rate to reduce subsequent morbidity and mortality. The study recommended adopting the following measures; the mortality rate was 13.19%, and the prevalence of the disease was higher in males than among females which subsequently increases mortality among males therefore, there is a need to put more attention to males when creating awareness. The transmission rate was 13.67%, this rate can be reduced by reducing risk factors that are responsible for the transmission of visceral leishmaniasis. Creating awareness at the community level and seeking medication on time to reduce mortality from visceral leishmaniasis in Marsabit County.

Visceral leishmaniasis–human immunodeficiency virus coinfection in a 52-year-old male in southwest Iran: a case report

BackgroundLeishmaniasis is a rare infectious disease observed in subtropical and tropical areas. This disease that demonstrates different clinical characteristics is caused by intracellular Leishmania protozoan. One of the important countries facing the incidence of this infectious disease is Iran. Recently, human immunodeficiency virus–Leishmania coinfection has been indicated in Iran.Case presentationIn the present case report, we show an atypical case of severe visceral leishmaniasis in a 52-year-old Iranian-Arab male with positive human immunodeficiency virus status. Leishmaniasis was detected by node biopsy and subsequently histopathology evaluations and confirmed by molecular methods.ConclusionsThe current study was the first report of an atypical case of a patient with Leishmania–human immunodeficiency virus coinfection in southwestern Iran, which was not responsive to the treatment. Therefore, the health authorities should be aware of these reports, which require permanent clinical follow-up of the patients as well as effective treatments.

Diagnosis of visceral leishmaniasis in Ceará state, Brazil: A flow analysis of cases between 2007 and 2021.

To analyse the flow of cases of visceral leishmaniasis (VL) in the state of Ceará, Brazil, between 2007 and 2021. An ecological study was conducted using a spatial approach of newly confirmed cases of VL recorded in the Notifiable Diseases Information System. We identified individuals whose municipality of diagnosis differed from that of their residence. Flow maps, constructed using Tabwin 32 and ArcMap 9.2, allowed for the identification of the volume of traffic between the municipality of residence and that of initial care. There were 6775 confirmed VL cases. As a flow indicator, 178 counties had at least one resident diagnosed in another municipality in Ceará, with 2491 VL cases and an average trip of 79 km. The largest hub for receiving cases for diagnosis was the capital Fortaleza (1478 patients from 129 other municipalities), followed by Sobral, located in the northwestern region of Ceará (599 from 55 municipalities), and Barbalha, in the southern region (171 from 29 municipalities). In this southern region, 25 municipalities moved 55 people for treatment to Juazeiro do Norte and 11 municipalities moved 39 patients to Crato. A total of 255 patients with VL from 11 municipalities in other Brazilian states, mainly from the Northeast and North, were observed and notified in health services in Ceará. The major centres of VL diagnosis outside residence were in the cities of Fortaleza, Sobral, Barbalha, Juazeiro do Norte and Crato. There was also an outflow of cases from other municipalities located in the northeastern and northern regions of Brazil. The flows were more intense during the first triennium of the analysis and milder from 2019 to 2021. Understanding the diagnostic flow of VL helps in decision making and the development of public policies to improve the lives of the population.

Real-time impact of COVID-19 pandemic on cutaneous leishmaniasis case finding and strategic planning, preventive interventions, control and epidemiology in a region with a high burden of cutaneous leishmaniasis and COVID-19: A cross-sectional descriptive study based on registry data in Ilam-Iran.

Cutaneous leishmaniasis (CL) is a severe parasitic disease affecting people, mostly in underdeveloped nations. As a zoonotic infection yearly incidence of CL depends on several parameters such as demographic, epidemiological, and environmental factors as well as prevention and control measures. The sudden outbreak of pandemics such as SARS-Corona-Virus-2 pandemic, can probably affect the incidence or reporting of other diseases, especially infectious diseases, in various ways such as pressure on health systems, providing sanitary services and its components, lockdowns and changes in people's living habits. This study aimed to evaluate the COVID-19 impact on the incidence and other epidemiological aspects as well as control measures of CL in Ilam Province-Iran. Required data was extracted from the CL registration system in Ilam from 2014 to 2021 to demonstrate the trend of CL incidence before and after COVID-19 pandemic. Based on our results, a declining pattern of CL incidence was observed, accompanied by the advent and intensification of the viral pandemic in Iran and Ilam province. Although, this decreasing pattern was not integral in all areas, and even increase in CL detection was emphasized in some regions. It may be inferred that the COVID-19 pandemic may disrupt treatment programs of CL cases, rodent nest destruction, and fighting vector insects.

Leishmania donovani persistence and circulation causing cutaneous leishmaniasis in unusual-foci of Nepal

Cutaneous leishmaniasis cases have increased dramatically in recent years in Nepal. The study offers molecular identification of the Leishmania species using 40 patient’s aspiration biopsy samples, targeting markers kinetoplast minicircle DNA (kDNA) and internal transcribed spacer-1 (ITS1). Among molecularly diagnosed 22 cutaneous leishmaniasis cases, L. donovani complex was identified in 13 instances and L. major in 9 cases. The ITS1 PCR was positive in 12 of the positive nested- kDNA PCR cases (12/22), confirming L. donovani complex in seven of the cases and L. major in five of the cases. In addition, the study conclude that concurrent occurrence of atypical cutaneous infections caused by L. donovani parasite in 59.1% of cases and typical cutaneous infections caused by L. major parasite in 40.9% of cases. A Phylogentic analaysis showed that the detected L. donovani species present null genetic distances from seven references of L. donovani, but slight differences between ITS1 sequences and not grouped into a significant monophyletic cluster.

A rare form of leishmaniasis, identified in the Russian Federation

Diffuse cutaneous leishmaniasis is a rare form of cutaneous leishmaniasis characterized by an inadequate immune response of the host cells to parasitic invasion (weak T-helper (Th)1 response or Th2 response with the production of interleukin IL-4 and IL-10). The characteristic features of the disease include diffuse nodular eruption, masquerading as leprosy and a frequent association with immunosuppression (HIV co-infection, for example). The Russian Federation is a non-endemic country for leishmaniasis, but this disease can be brought into the country by tourists, immigrants, refugees and military personnel. A clinical case of diffuse cutaneous leishmaniasis and HIV co-infection is presented. The patient was a citizen of Uzbekistan, a country endemic for leishmaniasis. The authors were unable to find domestic scientific publications describing cases of diffuse cutaneous leishmaniasis detected in the Russian Federation. The presented clinical case of diffuse cutaneous leishmaniasis in a patient with HIV is the first in the Russian literature.

A Visceral Leishmaniasis Case from the Black Sea region: Skin Lesions and Leishmania Donovanii Amastigotes in Bone Marrow.

A Visceral Leishmaniasis Case from the Black Sea region: Skin Lesions and Leishmania Donovanii Amastigotes in Bone Marrow.

An Expatriate from Saudi Arabia with Papulo-nodular Rash and Blisters for Two Years

Bangladesh is non endemic for Cutaneous Leishmaniasis (CL). Rarely, we come across such cases in workers returning from Middle east particularly Saudi Arabia. Recently we found and managed a case of cutaneous leishmaniasis in a 37 year old male returning from Saudi Arabia with a lesion behind his left ankle joint. Although Sodium Stibogluconate is the first choice of drug to treat CL, it is not available in Bangladesh. He was managed successfully with Liposomal Amphotericin B. High index of suspicion is needed to diagnose such case without any delay. J MEDICINE 2023; 24(2): 167-168

A Rare Case of Visceral Leishmaniasis Diagnosed by Endoscopy in an Anemic Patient With HIV/AIDS

ABSTRACT Visceral leishmaniasis (VL) is a rare protozoan parasitic disease transmitted by sandfly vectors predominantly found in Asia and Central America. Although far less common than cutaneous leishmaniasis, VL carries a higher mortality burden because of its propensity to cause emaciation and marked anemia through bone marrow infiltration. Treatment is particularly challenging in patients coinfected with HIV before both infections work synergistically to perpetuate immunosuppression, further promoting higher viral loads and disease burden. In comparison with those without HIV, these patients have poorer treatment responses and higher rates of relapse. We describe a case of VL in an anemic patient with HIV/AIDS diagnosed during esophagogastroduodenoscopy. We also present challenges to treatment, adverse drug side effects, and long-term sequelae.

Mucosal Leishmaniasis: a Rare Infection from Western Nepal

Leishmaniasis is a neglected tropical disease infecting world’s poorest population in over 90 countries throughout Asia, Africa, the Middle East, and Central and South Africa. An underestimated 700,000 to one million new cases occur annually. Leishmaniasis refers to a spectrum of diseases caused by a parasite, Leishmania, transmitted by bite of infected sandflies. Of the three major syndromes (cutaneous, mucosal and visceral) mucosal leishmaniasis is the least common. Despite being an endemic country for cutaneous and visceral forms, there are rare reports of mucosal form published in the literature from Nepal till date. Here we present a case of mucosal leishmaniasis presented masquerading malignancy from Dailekh District immediate proximal to Surkhet, one of the endemic districts of western Nepal.

Time series analysis of cutaneous leishmaniasis incidence in Shahroud based on ARIMA model

BackgroundLeishmaniasis is a zoonotic disease and Iran is one of the ten countries with has the highest estimated cases of leishmaniasis. This study aimed to determine the time trend of cutaneous leishmaniasis (CL) incidence using the ARIMA model in Shahroud County, Semnan, Iran.MethodsIn this study, 725 patients with leishmaniasis were selected in the Health Centers of Shahroud during 2009–2020. Demographic characteristics including; history of traveling, history of leishmaniasis, co-morbidity of other family members, history of treatment, underlying disease, and diagnostic measures were collected using the patients’ information listed in the Health Ministry portal. The Box-Jenkins approach was applied to fit the SARIMA model for CL incidence from 2009 to 2020. All statistical analyses were done by using Minitab software version 14.ResultsThe mean age of patients was 28.2 ± 21.3 years. The highest and lowest annual incidence of leishmaniasis were in 2018 and 2017, respectively. The average ten-year incidence was 132 per 100,000 population. The highest and lowest incidence of the disease were 592 and 195 for 100,000 population in the years 2011 and 2017, respectively. The best model was SARIMA (3,1,1) (0,1,2)4 (AIC: 324.3, BIC: 317.7 and RMSE: 0.167).ConclusionsThis study suggested that time series models would be useful tools for predicting cutaneous leishmaniasis incidence trends; therefore, the SARIMA model could be used in planning public health programs. It will predict the course of the disease in the coming years and run the solutions to reduce the cases of the disease.

Identification of molecular mechanisms causing skin lesions of cutaneous leishmaniasis using weighted gene coexpression network analysis (WGCNA)

Leishmaniasis is an infectious disease, caused by a protozoan parasite. Its most common form is cutaneous leishmaniasis, which leaves scars on exposed body parts from bites by infected female phlebotomine sandflies. Approximately 50% of cases of cutaneous leishmaniasis fail to respond to standard treatments, creating slow-healing wounds which cause permanent scars on the skin. We performed a joint bioinformatics analysis to identify differentially expressed genes (DEGs) in healthy skin biopsies and Leishmania cutaneous wounds. DEGs and WGCNA modules were analyzed based on the Gene Ontology function, and the Cytoscape software. Among almost 16,600 genes that had significant expression changes on the skin surrounding Leishmania wounds, WGCNA determined that one of the modules, with 456 genes, has the strongest correlation with the size of the wounds. Functional enrichment analysis indicated that this module includes three gene groups with significant expression changes. These produce tissue-damaging cytokines or disrupt the production and activation of collagen, fibrin proteins, and the extracellular matrix, causing skin wounds or preventing them from healing. The hub genes of these groups are OAS1, SERPINH1, and FBLN1 respectively. This information can provide new ways to deal with unwanted and harmful effects of cutaneous leishmaniasis.

Comparison of Injection Meglumine Antimoniate with a Combination of Injection Meglumine Antimoniate and Carbon Dioxide Fractional Ablative Laser in Treatment of Cutaneous Leshmaniasis

Aim: To see the efficacy of meglumine antimoniate alone in comparison with combination of meglumine antimoniate and CO2 ablative laser among patients with cutaneous leishmaniasis. Study design: Quasi-experimental study. Place and duration of study: Department of Dermatology, Pakistan Emirates Military Hospital, Rawalpindi from 9th July 2020 to 8th January 2021. Methodology: Sixty patients (30 in each group) diagnosed cases of cutaneous leishmaniasis by skin biopsy or slit skin smear were enrolled. In group A; intramuscular injection of meglumine antimoniate (dose 20 mg/kg daily) was administered for 28 days and group B was treated with intramuscular meglumine antimoniate injection along with fractional C02 ablative laser. Standard digital photography was done before start of treatment and then every 2 weeks. Results: Efficacy of meglumine antimoniate alone was observed in 60% of patients while it was 86.7% when combined with fractional CO2 ablative laser. Better outcome was observed when such patients were treated with both meglumine antimoniate and fractional CO2 laser. Efficacy was measured after 6 x weeks in all patients of both groups. Clinical Implication: Hence CO2 lasers are latest modality of treatment with minimal side effects and can be used in treatment of patients with cutaneous leishmaniasis. Conclusion: Efficacy of meglumine antimoniate plus fractional CO2 laser found to be higher as compared to meglumine antimonate alone in treating cutaneous leishmaniasis. Keywords: Cutaneous leishmaniasis, CO2 fractional ablative laser, Meglumine antimoniate, Slit skin smear

Leishmaniases in a tropical area of Brazil: a spatio-temporal analysis.

Leishmaniases are a group of tropical and neglected diseases caused by the protozoa of the genus Leishmania which are transmitted by insect sandflies. Despite of the major efforts undertaken at global level for the control of these diseases, a recent spreading to non-endemic areas been observed. In this study we analyzed the spatio-temporal distribution of Visceral Leishmaniasis (VL) and Tegumentary Leishmaniasis (TL) cases notified in a tropical region of Brazil. A retrospective evaluation was carried out using secondary data (e.g., demographics, origin, age and area of occurrence) of human patients obtained from 2009 to 2019. Choropleth maps with levels of color intensity represented the spatial distribution of VL and TL cases. Overall, 116 (10.5 ± 8.5) cases of leishmaniases were registered in the study area during the whole period. Of those, 61 (5.5 ± 5.5) and 55 (5 ± 4.3) were diagnosed as VL and TL, respectively. VL cases were recorded in 61.9% (13/21) and TL cases in 42.8% (9/21) of the municipalities. Most of the cases were predominantly notified in men from rural areas, and specifically for TL with an age range of 30-59years old. These findings will be useful to drive strategies of control (e.g., vector control, dog surveillance and notification of suspected cases) against these neglect diseases, preventing the spreading to non-endemic areas.

Molecular detection of Leishmania and blood meal analysis in sand flies from Corumbá, Mato Grosso do Sul, Brazil

In this study, we investigated the presence of Leishmania in sand flies collected from a peridomestic area in Corumbá, Mato Grosso do Sul, after an autochthonous case of cutaneous leishmaniasis was confirmed. A total of 1,542 sand flies belonging to seven species were collected, with Lu. cruzi being the most prevalent (94.3%). We detected the presence of DNA from Le. infantum (7 pools) and Le. braziliensis (3 pools) by sequencing the ITS1 amplicon in ten pools, all of which were composed of engorged (3) and non-engorged (7) females of Lu. cruzi. We collected 24 engorged females, with Homo sapiens being the most common blood meal source (91.6%), followed by Dasyprocta azarae and Canis lupus familiaris (4.2% each). To our knowledge, this is the first molecular evidence of Le. braziliensis in wild-caught Lu. cruzi in Brazil, suggesting its potential role as a vector for this parasite.

Ecological interactions of sand flies, hosts, and Leishmania panamensis in an endemic area of cutaneous leishmaniasis in Colombia.

The transmission dynamics of leishmaniasis are complex. There is also a lack of information about the ecological relationships between the vector/host/parasite at a more local and specific level. The Andean region concentrates more than 50% of Colombia's cutaneous leishmaniasis (CL) cases. The study of the ecological interactions of sand flies through the identification of blood sources has provided information on the female's opportunistic behavior, feeding on various hosts. Therefore, this study aimed to determine sand flies' ecological interactions with Leishmania parasites and their blood sources in an endemic area of CL. A total of 4,621 sand flies were collected, comprising 20 species, in which the most abundant were Nyssomyia yuilli yuilli (55.4%), Psychodopygus ayrozai (14.5%) and Ps. panamensis (13.4%). Sequences of 12S gene fragment were analyzed using the BLASTn search tool. Blood-meal source identification was successfully performed for 47 sand flies, detecting seven vertebrate species, human and armadillo being the most frequent. Leishmania DNA was amplified in four female pools, constituted by Ny. yuilli yuilli and Ps. ayrozai, and the identification through RFLP detected Leishmania (Viannia) panamensis in the positive pools. The interactions between the sand fly species, local mammalian fauna and the Leishmania parasite in this active focus of CL, provide evidence of the potential role of two different species in the maintenance of the parasite transmission, important information for the understanding of the ecoepidemiology and transmission dynamics of the disease in Andean endemic areas. However its necessary further evaluations of the vector and host competence in the transmission and maintenance of Leishmania spp, in these complex and diverse areas.