Epidemiological profile of patients co-infected with visceral leishmaniasis and HIV/AIDS in Northeast, Brazil

Abstract INTRODUCTION: Visceral leishmaniasis (VL) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-infection has been a research topic of interest worldwide. In Brazil, it has been observed that there is a relative underreporting and failure in the understanding and management of this important association. The aim of this study was to analyze epidemiological and clinical aspects of patients with VL with and without HIV/AIDS. METHODS: We conducted an observational and analytical study of patients with VL followed in a Reference Service in the State of Maranhão, Brazil from 2007-2013. RESULTS: In total 126 patients were enrolled, of which 61 (48.4%) were co-infected with HIV/AIDS. There were more males among those with HIV/AIDS (85.2%, P>0.05) or with VL only (81.5%, P>0.05). These findings significantly differed based on age group (P<0.003); the majority of patients were aged 31-40 years (41.0%) and 21-30 years (32.3%) among those with and without HIV/AIDS co-infection, respectively. The incidence of diarrhea and splenomegaly significantly differed between the two groups (P=0.0014 and P=0.019, respectively). The myelogram parasitic examination was used most frequently among those with HIV/AIDS (91.8%), followed by those with VL only (69.2%). VL recurrences and mortality were significantly higher in the HIV/AIDS co-infected patients (P<0.0001 and P=0.012, respectively). CONCLUSIONS: Patients with VL with or without HIV/AIDS co-infection were mostly adult men. Diarrhea was more frequent in HIV/AIDS co-infected patients, whereas splenomegaly was more common in patients with VL only. In the group of HIV/AIDS co-infected patients, there was a higher rate of VL recurrence and mortality.

Visceral leishmaniasis and leishmaniasis-HIV coinfection: comparative study

Abstract INTRODUCTION: This study aimed to draw clinical and epidemiological comparisons between visceral leishmaniasis (VL) and VL associated with human immunodeficiency virus (HIV) infection. METHOD: Retrospective study. RESULTS: Of 473 cases of VL, 5.5% were coinfected with HIV. The highest proportion of cases of both VL and VL/HIV were found among men. A higher proportion of VL cases was seen in children aged 0-10 years, whereas coinfection was more common in those aged 18-50 years. CONCLUSIONS: VL/HIV coinfected patients presented slightly differently to and had a higher mortality rate than those with VL only.

Avaliação dos indicadores de lesão miocárdica em cães com leishmaniose visceral / Changes in myocardial injury indicators in naturally infected dogs with visceral leishmaniasis

O objetivo deste estudo foi avaliar os indicadores laboratoriais, eletrocardiográficos e histológicos de lesão cardíaca em diferentes grupos clínicos de cães com leishmaniose visceral. Foram analisados marcadores séricos, traçado eletrocardiográfico e fragmentos de tecido cardíaco de 41 cães naturalmente infectados, distribuídos em três grupos: assintomático, oligossintomático e sintomático. Todos os animais apresentaram aumento na atividade sérica da enzima creatina quinase fração MB. No traçado eletrocardiográfico, o complexo de baixa voltagem foi o distúrbio de condução mais frequente (8/10). Na análise histológica, 75,6% dos cães apresentaram reação inflamatória com predomínio de infiltrados linfo-histiocítico (13/31) de intensidade discreta a moderada e distribuição multifocal. As alterações microscópicas identificadas no miocárdio foram independentes dos achados laboratoriais, eletrocardiográficos e do quadro clínico apresentado pelos animais estudados. A ausência de associação entre alterações histopatológicas e os parâmetros investigados alerta para a dificuldade de identificação de cardiopatia em cães com leishmaniose visceral e ressalta a importância de incluir a leishmaniose visceral no diagnóstico de patologias cardíacas principalmente em regiões endêmicas para o agente.

The aim of this study was to evaluate the laboratory indicators, electrocardiographic and cardiac histological lesions in different clinical groups of dogs with visceral leishmaniasis. Serum markers were analyzed in conjunction with the electrocardiographic tracing and heart tissue fragments of 41 naturally infected dogs which were divided into three groups: asymptomatic, oligosymptomatic and symptomatic. All animals showed increased activity in serum creatine kinase MB fraction. In the electrocardiographic tracing, low voltage complex was the most frequent conduction disorder (8/12). In the histological analysis, 75.6% of the dogs showed inflammatory reaction with predominance of linfohistiocítico infiltrates (13/31) of mild to moderate intensity and multifocal distribution. Microscopic changes identified in the myocardium were independent laboratory findings, an electrocardiographic and clinical picture presented by the studied animals. The lack of association between histopathological changes and the parameters investigated indicate the difficulty in disease identification in dogs with visceral leishmaniasis and highlights the importance of including visceral leishmaniasis in the diagnosis of heart disease especially in endemic regions to the agent.

Kidney involvement in leishmaniasis ? a review

Leishmaniasis is an infectious disease caused by protozoa of the genus Leishmania transmitted by insects of the genus Lutzomyia sp. or Phlebotomus sp. The main syndromes are cutaneous leishmaniasis, mucocutaneous leishmaniasis, visceral leishmaniasis (kala-azar) and post-kala-azar dermal leishmaniasis. This article reviews kidney involvement in cutaneous and visceral leishmaniasis, highlighting the aspects of their pathophysiology, clinical manifestations, histopathological findings, outcome and treatment.

THE SERO-CONVERSION AND EVALUATION OF RENAL ALTERATIONS IN DOGS INFECTED BY Leishmania (Infantum) chagasi / Soro-conversão e avaliação das alterações renais em cães infectados por Leishmania (Infantum) chagasi

This study investigated the sero-conversion period in which dogs from endemic areas test positive for visceral leishmaniasis (VL) as well as the early post-infection period in which renal alterations are observed. Dogs that were initially negative for Canine Visceral Leishmaniasis (CVL) were clinically evaluated every three months by serological, parasitological and biochemical tests until sero-conversion was confirmed, and six months later a subsequent evaluation was performed. Samples of kidney tissues were processed and stained with Hematoxylin and Eosin (H&E), Periodic Acid Schiff (PAS) and Masson’s trichrome stain and lesions were classified based on the WHO criteria. Of the 40 dogs that initially tested negative for VL, 25 (62.5%) exhibited positive serological tests during the study period. Of these 25 dogs, 15 (60%) tested positive within three months, five (20%) tested positive within six months and five (20%) tested positive within nine months. The dogs exhibited antibody titers between 1:40 and 1:80 and 72% of the dogs exhibited clinical symptoms. The Leishmania antigen was present in the kidneys of recently infected dogs. We found higher levels of total protein and globulin as well as lower levels of albumin in the infected dogs when compared to the control dogs. Additionally, infected dogs presented levels of urea and creatinine that were higher than those of the uninfected dogs. Glomerulonephritis was detected in some of the dogs examined in this study. These data suggest that in Teresina, the sero-conversion for VL occurs quickly and showed that the infected dogs presented abnormal serum proteins, as well as structural and functional alterations in the kidneys during the early post-infection period.

Este estudo investigou o período em que o cão torna-se positivo para leishmaniose visceral (VL) em área endêmica e as alterações renais no período recente pós-infecção. Cães negativos para VL foram avaliados clinicamente a cada três meses por testes sorológicos, parasitológicos e bioquímicos até a soro-conversão e seis meses após. Foram colhidos tecido renal de seis cães, submetidos a processamento de rotina e corados com HE, PAS e Masson e as lesões foram classificadas com base nos critérios da OMS. Dos 40 cães nagativos para VL, 25 (62,5%) apresentaram sorologia positiva durante o estudo. Desses, 15 (60%) tornaram-se positiva nos primeiros três meses, cinco (20%) tornaram-se positivas dentro de seis meses e cinco (20%) tornaram-se positivas dentro de nove meses. Os cães apresentavam títulos de anticorpos entre 1:40 e 1:80, e 72% mostraram sinais clínicos. Antígeno de Leishmania estava presente no rim. Foram encontrados níveis mais elevados de proteína total e globulina, e menores níveis de albumina em cães infectados quando comparados aos controles. Além disso, os cães infectados apresentaram níveis de uréia e creatinina maior do que os cães controles. Glomerulonefrite foi observada em cinco cães. Os resultados sugerem que em Teresina a soro-conversão para VL ocorre rapidamente e os cães apresentam proteínas séricas anormais e alterações na estrutura e função dos rins em um período recente pós-infecção.

Functionality of drug efflux pumps in antimonial resistant Leishmania donovani field isolates.

The recent upsurge of antimony (Sb) resistance is a major impediment to successful chemotherapy of visceral leishmaniasis (VL). Mechanisms involved in antimony resistance have demonstrated an upregulation of drug efflux pumps; however, the biological role drug efflux pumps in clinical isolates remains to be substantiated. Thus, in this study, the functionality of drug efflux pumps was measured in promastigotes and axenic amastigotes isolated from VL patients, who were either Sb-sensitive (AG83, 2001 and MC9) or resistant (NS2, 41 and GE1) using rhodamine123 as a substrate for multidrug resistant (MDR) pumps and calcein as a substrate for multidrug resistance-associated proteins (MRP) respectively; their specificity was confirmed using established blockers. Sb-resistant (Sb-R) isolates accumulated higher amounts of R123, as compared to Sb-sensitive (Sb-S) isolates. Verapamil, a MDR inhibitor failed to alter R123 accumulation, suggesting absence of classical MDR activity. In Sb-R isolates, both promastigotes and axenic amastigotes accumulated significantly lower amounts of calcein than Sb-S isolates and probenecid, an established pan MRP blocker, marginally increased calcein accumulation. Depletion of ATP dramatically increased calcein accumulation primarily in Sb-R isolates, indicating existence of a MRP-like pump, which was more active in Sb-R isolates. In conclusion, our data suggested that overfunctioning of a MRP-like pump contributed towards generation of Sb-R phenotype in L. donovani field isolates.

Renal changes in golden hamsters experimentally infected with leishmania d. infantum on top of schistosoma mansoni infection

This work aimed to study the concomitant infection of L. d. infantum on top of S. mansoni infection in Syrian golden hamsters, the model animal for both parasites. The results showed that the renal changes were more or less the same as infection with either parasite alone. Both parasites produce mesangial cell proliferation and mesangial matrix increase. Some glomeruli showed complete replacement of the capillary tuft with structureless homogenous material. In one S. mansoni positive control hamster, Schistosoma eggs were seen within granulomas and atrophic glomeruli. However, the leishmanial infection, more or less suppressed the schistosomal infection. The leishmanial infection itself became more prominent and the renal lesion appeared earlier and was more obvious

La leishmaniosis del nuevo mundo

La leishmaniosis es una enfermedad tropical de gran importancia en nuestro país, pero algunas veces los clínicos pasan por alto este diagnóstico debido a que no reconocen sus manifestaciones clínicas ni conocen los métodos diagnósticos. Se presenta una revisión sobre la leishmaniosis del nuevo mundo-tanto la visceral como la tegumentaria-, partiendo del agente causal del vector- género Lutzomyia-, con énfasis en los aspectos clínicos y epidemiológicos. Finalmente, se describen los métodos para su diagnóstico; los directos encaminados a la demostración del parásito y los indirectos que evalúan la respuesta inmunológica del huésped frente a la infección.

Descripcion de un caso de Leishmanaiasis visceral (Kala Azar) Proveniente del nor-este del departamento de Santa Cruz (Provincia Angel Sandoval) Bolivia / Presentation of a case of visceral leishmaniasis (Kalaazar) in the northeast area (Province Angel Sandoval) of the departament of Santa Cruz, Bolivia

Se describe un caso de Leishmaniasis visceral (Kala azar)) autoctono. Se trato de un nino de 7 meses de edad proveniente de la provincia Angel Sandoval, y nor-este del Departamento de Santa Cruz, (Bolivia); cercano a la frontera con el Brasil. El paciente tenia fiebre, hepato-esplenomegalia y pancitopenia. En el mielograma se encontro amastigotes de Leishmania e hipoplasia. La reaccion de formol-gelificacion fue positiva. Se demostro la ocurrencia de Leishmaniasis visceral en el Departamento de Santa Cruz

Absence of clinical abnormalities suggesting renal involvement during the long-term course of visceral leishmaniasis

Anormalidades das funçöes renais têm sido demonstradas em pacientes portadores de leishmaniose visceral; embora haja tendência à normalizaçäo logo após o tratamento antiparasitário, algumas dessas anormalidades persistem. Com o propósito de estudar o curso clínico a longo prazo do envolvimento renal na leishmaniose visceral, 32 pacientes foram estudados na área endêmica, pelo menos 6 meses após a cura clínica da doença, e comparado a um grupo-controle de 28 indivíduos. Em nenhum paciente se documentou história ou dados clínicos sugestivos de doença renal. A avaliaçäo laboratorial foi normal em todos os pacientes, exceto 3 com sumários de urina anormais em um, proteinúria leve e hematúria microscópica num único sumário de urina (três outros foram normais) e leucocitúria em dois outros pacientes. Concluiu-se que na leishmaniose visceral o envolvimento renal é discreto e transitório, havendo desaparecimento das alteraçöes sugestivas de disfunçäo após a cura da doença parasitária