Anti - glucose regulated protein 78 [GRP78] antibody responses in Alum/ALM plus BCG vaccinee, visceral leishmaniasis, and Post Kala- azar Dermal leishmaniasis patients

The Glucose Regulated Protein 78 [GRP78] of Leishmania donovani is considered to be one of the potential Leishmania vaccine candidates. Using Enzyme-Linked Immunosorbent Assay [ELISA], we measured IgG antibody responses to GRP78 in 39 healthy Sudanese volunteers vaccinated with Leishmania Alum/ALM + BCG vaccine, 29 patients with visceral leishmaniasis [VL], and 26 patients with post kala-azar dermal leishmaniasis [PKDL]. There was, no significant statistical difference in plasma levels of GRP78 antibodies in immunized and control group [P=0.37]. Furthermore, no significant statistical difference in the levels of GRP78 antibodies in the pre and post vaccination plasma samples [P=0.60]. Plasma IgG levels to GRP78 was significantly higher in visceral leishmaniasis and PKDL patients compared with control group [P=0.00]. This study concludes that Alum/ALM vaccine does not induce a Th2 type of immune response. It also demonstrated clearly that VL and PKDL are associated with elevation of anti-GRP 78 antibodies and that GRP78 ELISA can be used to confirm diagnosis of Leishmania infections based on the clinical presentation

Safety, immunogenicity and possible efficacy of immunochemotherapy of persistent post Kala-azaz dermal leishmaniasis

Post kala-azar dermal leishmaniasis [PKDL] is a common skin condition that follows successful treatment of visceral leishmaniasis [VL] in Sudanese patients. Lesions persist for years in 15% of patients and are viewed as reservoirs for the disease. Drug treatment is protracted, toxic and costly. Cure is strongly correlated with conversion in the leishmanin skin test. To determine safety, immunogenecity and possible efficacy of Alum-precipitated autoclaved L. major + BCG VL candidate vaccine combined with sodium stibogluconate [SSG] in patients with persistent PKDL. Following informed consent, the vaccine mixture was administered in a stepwise manner as follows: 5 patients received a single intradermal injection of 10 microg, 5 patients received a single dose of 100 microg and 2 patients received 4 doses of 100 microg at weekly intervals. Subsequently, the three groups of patients received means of 63.0 +/- 8.0, 53.0 +/- 5.0 and 40 days courses of SSG treatment respectively and were cured. Side effects were minimal and were confined to the vaccine injection site. Following completion of the safety study, eight patients were injected with 4-6 vaccine doses of 100 microg/dose at weekly intervals in combination with SSG. Patients were closely followed up in hospital, with minimal side effects and complete clearance of the skin rash in forty days. Alum/ALM + BCG vaccine mixture plus SSG was safe and was apparently effective in healing persistent PKDL lesions. SSG treatment duration could be shortened with the SSG/vaccine combination

Leprosy in an endemic focus in the Sudan

The objectives of this study were active case detection, provision of multidrug treatment in primary health care settings and evaluation of the accuracy of the clinical system of classification that was adopted by the Leprosy Control Program of Sudan. The whole population of two villages in a remote area in eastern Sudan were examined initially and then followed up for three years in this prospective study. Patients from the surrounding villages, who were self reporting were also included in the study. The study was conducted in a primary health care setting, which was the only available form of health care facility in the study area. Communal consent was obtained following explanation and discussion with the Sheikhs. The population of the two villages were interviewed and examined clinically with particular reference to skin lesions. Informed consents to participate in the study were obtained from individuals with skin lesions. Skin biopsies were taken under local anaesthesia and aseptic conditions from suspicious lesions. Multi-drug therapy regimen [MDT] was given to those with proven disease. Response was measured by improvement in skin lesions and sensations every six months. Compliance was around 90%. According to the clinical classification 68.4% and 31.6% of the patients were multi-bacillary and pauci-bacillary respectively. There was 100% agreement between the clinical classification and Ridley and Jopling classification where all Tuberculoid [TT] patients were correctly diagnosed as pauci-bacillary and borderline Lepromatous [BL] and Lepromatous [LL] patients were correctly diagnosed as multibacillary. Seventy BT patients were misclassified as multi-bacillary disease. The clinical classification is adequate for the diagnosis and treatment of leprosy patients in remote areas of eastern Sudan

Antimony-resistant Leishmania donovani in eastern Sudan: incidence and in vitro correlation

A longitudinal study was done in a leishmaniasis -endemic region in eastern Sudan during the period November 2001-February 2003 to determine the incidence of failure of sodium stibogluconate treatment. We studied 820 confirmed visceral leishmaniasis patients. All were treated with sodium stibogluconate, 20 mg/kg body weight for at least 28 days. Parasites were isolated from lymph node aspirates from 22 participants identified as relapsed patients. All isolates were typed as Leishmania donovani based on polymerase chain reaction [PCR] amplification of parasite kDNA. Six parasites showed in vitro resistance to sodium stibogluconate using murine J774 macrophage amastigote testing method. The resistant isolates showed different restriction profiles when the amplified kDNA PCR products were digested with ALU1 restriction enzyme, indicating that resistance was mediated by different parasite clones