Combining diagnostic procedures for the management of leishmaniasis in areas with high prevalence of Leishmania guyanensis
Ednelza de Almeida BenicioEllen Pricilla Nunes GadelhaAnette Chrusciak TalhariRoberto Moreira da SilvaLuis Carlos FerreiraMayara Cristina Cordeiro dos SantosMarcelo Távora MiraCíntia Mara Costa de OliveiraCarolina TalhariSinésio TalhariPaulo Roberto Lima MachadoAlbert Schriefer
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BACKGROUND: The Amazon region corresponds to approximately 40% of the cases of leishmaniasis in Brazil. We report a prospective study with 180 patients conducted in a health care unit that diagnoses 10% of the cases of leishmaniasis in the Brazilian Amazon. The study addresses how a combination of procedures improves diagnosis in areas with high prevalence of Leishmania guyanensis. OBJECTIVES: to evaluate diagnostic methods in areas with high prevalence of Leishmania guyanensis. METHODS: All subjects were amastigote-positive by direct microscopic examination of lesion scarifications. We conducted skin biopsy and histopathology, polymerase chain reaction and parasite cultivation. RESULTS: Polymerase chain reaction detected almost ninety percent of infections when two amplification protocols were used (mini-exon and HSP-70). HSP-70 specific polymerase chain reaction matched the sensitivity of parasite cultivation plus histopathology. CONCLUSION: The best combination was polymerase chain reaction plus histopathology, which increased diagnostic sensitivity to 94%. Species discrimination by polymerase chain reaction disclosed prevalence of human infections with Leishmania guyanensis of 94% and with Leishmania braziliensis of 6% for this regionKeywords:
Histopathology
Leishmania braziliensis
Background: Leishmaniasis is one of the most common parasitic diseases in tropical and subtropical regions of the world and is considered a threat to public health. Iran is also one of the most endemic areas of cutaneous leishmaniasis in the world. The causative species of cutaneous leishmaniasis is a protozoan from the Kinetoplastida order, which in Iran is Leishmania major (rural type) and Leishmania tropica (urban type). More than 70% of leishmaniasis in Iran is Leishmania major. The reservoir of the disease is humans in the urban type and field rodents in the rural type, and the vector is the female mosquito of the genus Phlebotomus. Methods: This study is organized as a review, in which, by searching the keywords cutaneous leishmaniasis, Leishmania major, plants effective against leishmaniasis in Iran, scientific-research articles, Google Scholar search engine information, Pubmed and Science Direct databases, the available books in this field were analyzed. Results: 5-valent antimoan compounds are used for the treatment of cutaneous leishmaniasis. Of course, not all patients need treatment because, in a large number of people, the lesion heals by itself, and due to the side effects of antimoan compounds, it is better to use fewer of these drugs. Therefore, the desire of patients and therapists to use herbal compounds has increased. Conclusion: Although cutaneous leishmaniasis is not usually associated with high Although cutaneous leishmaniasis is not usually associated with high mortality, the rate of infection is very high and causes malformed skin lesions that remain for more than a year in some cases, and even with standard treatment, scars remain. It remains forever and causes emotional pain for the patient. Therefore, domestic researchers have provided research on herbal treatments against Leishmaniasis, considering the history of traditional treatments in Iran and the scattered vegetation in the country.
Leishmania tropica
Tropical disease
Neglected Tropical Diseases
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Leishmania tropica
Sodium stibogluconate
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Diffuse cutaneous leishmaniasis (DCL) is an unusual form of cutaneous leishmaniasis mainly caused by infection with Leishmania aethiopica in the Old World. In this paper, diffuse cutaneous leishmaniasis was reported for the first time, in an Egyptian patient from Sinai Peninsula resulting from infection with L. major zymodeme LOND-1 as proved by enzymatic characterization, using seven enzymes.
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Diffuse cutaneous leishmaniasis (DCL) is characterised by multiple and progressive cutaneous lesions, resistance to chemotherapy and Leishmania-specific T-cell anergy. We report the first autochthonous DCL case and the first human infection with Leishmania amazonensis in Rio de Janeiro State, Brazil, where only L. braziliensis is considered to be the causative agent of cutaneous leishmaniasis. Leishmania amazonensis was identified by multilocus enzyme electrophoresis and PCR-RFLP. Our case was diagnosed as DCL according to clinical, parasitological, histopathological and immunological criteria. These observations indicate that L. amazonensis is increasing its geographical distribution in Brazil, accounting for unusual clinical presentations in new transmission areas.
Leishmania braziliensis
Kinetoplastida
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Treatment of leishmaniasis by chemotherapy remains a challenge because of limited efficacy, toxic side effects, and drug resistance. We previously reported that synthetic flavonoid dimers have potent antipromastigote and antiamastigote activity against Leishmania donovani, the causative agent of visceral leishmaniasis. Here, we further investigate their leishmanicidal activities against cutaneous Leishmania species. One of the flavonoid dimers (compound 39) has marked antipromastigote (50% inhibitory concentrations [IC50s], 0.19 to 0.69 μM) and antiamastigote (IC50s, 0.17 to 2.2 μM) activities toward different species of Leishmania that cause cutaneous leishmaniasis, including Leishmania amazonensis, Leishmania braziliensis, Leishmania tropica, and Leishmania major. Compound 39 is not toxic to peritoneal elicited macrophages, with IC50 values higher than 88 μM. In the mouse model of cutaneous leishmaniasis induced by subcutaneous inoculation of L. amazonensis in mouse footpads, intralesional administration of 2.5 mg/kg of body weight of compound 39.HCl can reduce footpad thickness by 36%, compared with that of controls values. The amastigote load in the lesions was reduced 20-fold. The present study suggests that flavonoid dimer 39 represents a new class of safe and effective leishmanicidal agent against visceral and cutaneous leishmaniasis.
Amastigote
Leishmania tropica
Leishmania braziliensis
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Tegumentary Leishmaniasis (TL) is endemic in Latin America, and Brazil contributes approximately 20 thousand cases per year. The pathogenesis of TL, however, is still not fully understood. Clinical manifestations vary from cutaneous leishmaniasis (CL) to more severe outcomes, such as disseminated leishmaniasis (DL), mucosal leishmaniasis (ML) and diffuse cutaneous leishmaniasis (DCL). Many factors have been associated with the severity of the disease and the development of lesions. Recent studies have reported that the presence of Leishmania RNA virus 1 infecting Leishmania (Leishmania RNA virus 1, LRV1) is an important factor associated with the severity of ML in experimental animal models. In the present study, 156 patients who attended Rondonia's Hospital of Tropical Medicine with both leishmaniasis clinical diagnoses (109 CL; 38 ML; 5 CL+ML; 3 DL and 1 DCL) and molecular diagnoses were investigated. The clinical diagnosis were confirmed by PCR by targeting hsp70 and kDNA DNA sequences and the species causing the infection were determined by HSP70 PCR-RFPL. The presence of LVR1 was tested by RT-PCR. Five Leishmania species were detected: 121 (77.6%) samples were positive for Leishmania (Viannia) braziliensis, 18 (11.5%) were positive for Leishmania (V.) guyanensis, 3 (1.8%) for Leishmania (V.) lainsoni, 2 (1.3%) for Leishmania (Leishmania) amazonensis and 2 (1.3%) for Leishmania (V.) shawi. Six (3.9%) samples were positive for Leishmania sp. but the species could not be determined, and 4 (2.6%) samples were suggestive of mixed infection by L. (V.) braziliensis and L. (V.) guyanensis. The virus was detected in L. braziliensis (N = 54), L. guyanensis (N = 5), L. amazonensis (N = 2), L. lainsoni (N = 1) and inconclusive samples (N = 6). Patients presenting with CL+ML, DL and DCL were excluded from further analysis. Association between the presence of the virus and the disease outcome were tested among the remaining 147 patients (CL = 109 and ML = 38). Of them, 71.1% (n = 27) mucosal lesions were positive for LRV1, and 28.9% (n = 11) were negative. In cutaneous lesions, 36.7% (n = 40) were positive and 63.3% (n = 69) were negative for LRV1. The ratio P(ML|LRV1+)/P(ML|LRV1-) was 2.93 (CI95% 1.57…5.46; p<0.001), thus corroborating the hypothesis of the association between LRV1 and the occurrence of mucosal leishmaniasis, as previously described in animal models; it also indicates that LRV1 is not the only factor contributing to the disease outcome.
Leishmania braziliensis
Kinetoplastida
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Cutaneous leishmaniasis is a parasitic disease caused by over more than 20 Leishmania species, in both tropical and subtropical regions. There are three main forms of the disease: visceral leishmaniasis (VL), Cutaneous Leishmaniasis (CL) and Mucocutaneous Leishmaniasis (MCL), Leishmania braziliensis predominates in Guatemala. We present a case study of a 15-year-old female patient, referred from the Jutiapa hospital for presenting a lesion in the right ear of 3 months of evolution. When interviewing the patient, she mentions that several months ago she presented a "wheal" on her ear after being bitten by a mosquito, which turned red, grew and then she saw it open and form an ulcer with scabs on the ear. surface, which is not painful. The Giemsa-stained rub revealed the presence of Leishman bodies and the biopsy revealed amastigotes within the histiocytes, thus confirming the initial diagnosis of cutaneous Leishmaniasis. Due to the above, treatment with glucantime was started at a dose of 20mg/kg for 20 days, which improved the condition and resolved it. The patient's sister had the same condition, which was confirmed using the same techniques and is treated with what also resolves it. It is important to take cutaneous leishmania into account as a differential diagnosis in patients who present painless ulcers despite not being in a precisely endemic area.
Leishmania braziliensis
Tropical disease
Mucocutaneous zone
Giemsa stain
Leishmania tropica
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To identify the Leishmania species being responsible for cutaneous leishmaniasis in Multan.Parasites were isolated from clinically and parasitologically confirmed lesions of cutaneous leishmaniasis from 30 patients by fine needle aspiration (FNA). The bioptical materials were then cultured in Evans Tobie's medium and parasites isolated were identified by isoenzyme electrophoresis technique.Successful Leishmania isolates were obtained from 16 patients. All strains were identified by biochemical techniques as belonging to Leishmania tropica zimodeme MON7 variant PGD.The causative species was identified as Leishmania tropica.
Leishmania tropica
Kinetoplastida
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Disseminated cutaneous leishmaniasis is characterized by the presence of a large (≥10) number of lesions at several anatomic sites (head, limbs, and trunk). Most of the lesions are small, papular, and appear simultaneously with or secondarily to one or several ulcerated lesions of localized cutaneous leishmaniasis. We report the first case of disseminated cutaneous leishmaniasis in French Guiana. It concerns a 24-year-old woman who tested negative for human immunodeficiency virus (HIV). The disease began with three lesions that became ulcerated. One week later, multiple papulo-nodular lesions appeared. We counted a total of 425 lesions. Leishmania were observed in the lesions. The species involved was L. guyanensis , which has never been described in a case of disseminated cutaneous leishmaniasis. The patient was rapidly cured by a single course of pentamidine. Disseminated cutaneous leishmaniasis should be distinguished from other types of leishmaniasis with multiple lesions. These include anergic diffuse cutaneous leishmaniasis, post-kala-azar leishmaniasis, and leishmaniasis associated with HIV infection.
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