Systematic review and meta-analysis of human visceral leishmaniasis in Iran
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Visceral leishmaniasis (VL) is a protozoan disease caused by some Leishmania donovani complex species and is considered as an endemic zoonotic parasitic disease in Iran. This study was performed to determine the prevalence of human VL in Iran. Data were systematically gathered from 1985 to 2018 in Islamic Republic of Iran from the following electronic databases: PubMed, Google Scholar, Science Direct, Scopus, Web of Science, Magiran, Irandoc, Iranmedex and Scientific Information Database (SID). In total, 29 studies reporting the prevalence of VL from different areas of Iran met our suitability criteria. The Q test and the I2 statistics were applied to determine heterogeneities. The Egger's and Begg's test was used to check the presence of publication bias. The pooled prevalence of VL in Iran measured by random-effects was estimated at 1% (95% CI:1-2) in urban areas, 3% (95% CI:2-4) in rural areas and 2% (95% CI: 2-3) in total. The majority of VL cases during the last 33 years were reported in the northwest and south provinces of Iran. There was a high degree of heterogeneity (I2 = 98.2%, Q test: p = 0.0002) and Begg's (z = 3.62, p < 0.001) and Egger's (bias =5.9, 95% CI = 2.70-9.11) tests were significant for the study of publication bias. After correction, the total prevalence was estimated to be 0.3% (95% CI: 0.2-0.9).The prevalence of VL in Iran was 0.3%, and this rate was much higher in the northwest and south of the country. These results are desirable for managing the control programs of this disease.The complication of visceral leishmaniasis is post-kala-azar dermal leishmaniasis (PKDL). PKDL typically occurs as a result of treatment failure or parasite resistance to treatment regimens, as well as poor patient follow-up. In the treatment of visceral leishmaniasis and post-kala-azar dermal leishmaniasis, Liposomal Amphotericin B is considering as first-line therapy. We're going to show you a case where Liposomal Amphotericin B was used to treat it. Keywords: visceral leishmaniasis, post-kala-azar dermal leishmaniasis, PKDL, kala-azar
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Visceral leishmaniasis (VL) or kala-azar is an infection disease caused by hemiflagellate protozoan parasites (Leishmania donovani) and transmitted to humans by the phlebotomine sandfly. Leishmaniasis is distributed worldwide and 13 million people are estimated to be infected, with about 1.8 million new cases each year. All antileishmanial drugs are toxic and most have to be used parenterally for prolonged period. The therapy has been further complicated by large number of infected children and declining effectiveness of pentavalent antimonial compounds. Although the lipid formulations of amphotericin B are an important advance in therapy, their high cost precludes their use. Miltefosine, a phosphocholine analogue originally developed as antimalignant drug, has been found to be highly active against Leishmania in vitro and in animal model. Based on these experiences this drug was tried against human visceral leishmaniasis and found to be highly effective in children. The aim of this review is to evidence the pharmacodymamic and pharmacokinetic characteristics and the safety, tolerance and efficacy of this drug for treatment of visceral leishmaniasis in children.
Miltefosine
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Canine leishmaniasis
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Since 1980, the development of leishmaniasis in Algeria has been marked by a considerable increase in the number of cases of both visceral leishmaniasis (1121 cases recorded) and cutaneous leishmaniasis (more than 2000 cases per year). New Leishmania infantum and L. major foci have appeared in the north and south of the country. During this period, 100 strains of Leishmania isolated from humans, other mammals and sandflies have been identified. The presence of L. majormon-25 in Psammomys obesus and Phlebotomus papatasi has identified these species as the main reservoir and vector, respectively, of zoonotic cutaneous leishmaniasis. Similarly, the presence of L. infantummon-1 in Ph. perniciosus and dogs has implicated them as the vector and reservoir of visceral leishmaniasis. The isolation of the dermotropic zymodeme mon-24 of L. infantum from Ph. perfiliewi suggested that it was one of the main vectors of cutaneous leishmaniasis in the north of the country; the reservoir has not been identified. In addition, other zymodemes of Leishmania have been identified in visceral leishmaniasis patients, frequently associated with human immunodeficiency virus (mon-24, mon-33, mon-34 and mon-78), in patients with cutaneous leishmaniasis (mon-80), and in dogs with leishmaniasis (mon-34 and mon-77).
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Leishmaniasis is thought to be rare in The Gambia but in June 1980 two patients with this infection were seen at Fajara, one with cutaneous leishmaniasis and one with visceral leishmaniasis. A possible diagnosis of visceral leishmaniasis was considered only late in the course of the illness of the second patient who died a few days after specific chemotherapy was started. Visceral leishmaniasis must be considered as a possible cause of fever and splenomegaly in The Gambia and in adjacent parts of West Africa.
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Leishmaniasis - human immunodeficiency virus (HIV) coinfection can manifest itself as tegumentary or visceral leishmaniasis. Almost 35 countries have reported autochthonous coinfections. Visceral leishmaniasis is more frequently described. However, usual and unusual manifestations of tegumentary leishmaniasis have been reported mainly in the Americas, but the real prevalence of Leishmania infection in HIV-infected patients is not clear. Regarding the clinical manifestations, there are some reports showing unusual manifestations in visceral leishmaniasis and tegumentary leishmaniasis in HIV-infected patients; yet, the usual manifestations are more frequent. Leishmaniasis diagnosis relies on clinical methods, but serological tests are used to diagnose visceral leishmaniasis despite them having a low sensitivity to tegumentary leishmaniasis. The search for the parasite is used to diagnose both visceral leishmaniasis and tegumentary leishmaniasis. Nevertheless, in HIV-infected patients, the sensitivity of serology is very low. Drugs available to treat leishmaniasis are more restricted and cause severe side effects. Furthermore, in HIV-infected patients, these side effects are more prominent and relapses and lethality are more recurrent. In this article, we discuss the current challenges of tegumentary leishmaniasis and visceral leishmaniasis-HIV infection, focusing mainly on the clinical manifestations, diagnosis, and treatment of leishmaniasis.
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Visceral leishmaniasis is common in Brazil and is caused by Leishmania (Leishmania) infantum/chagasi. Post-kala-azar dermal leishmaniasis frequently follows visceral leishmaniasis caused by L. donovani, and para-kala-azar dermal leishmaniasis refers to an uncommon presentation wherein it occurs simultaneously along with visceral leishmaniasis. While post-kala-azar dermal leishmaniasis only occurs occasionally in L. infantum/chagasi infections, it frequently occurs in patients with concomitant immunosuppression (HIV co-infection). Here, we describe the first case of para-kala-azar dermal leishmaniasis in Brazil. It is important to raise awareness of post- and para-kala-azar dermal leishmaniasis in L. infantum endemic areas as these patients may contribute to visceral leishmaniasis transmission.
Leishmania chagasi
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