Increasing potential risk for American visceral leishmaniasis in Amapá, Brazil

Abstract: INTRODUCTION: The present note discusses some evidence on the increasing potential risk for American visceral leishmaniasis (AVL) transmission in the Northern Brazilian State of Amapá, the Guianan-Amazon biome. METHODS Early and present data about AVL were collected, including our recent entomological findings. RESULTS: The spread of the sand fly vector Lutzomyia longipalpis, and a sylvatic reservoir host, the crab-eating fox Cerdocyon thous in that region represents important findings related to the epidemiology of AVL in the Guianan-Amazon biome. CONCLUSIONS: These observations suggest that Brazilian authorities need to develop surveillance strategies in these risk areas.

Atypical mucocutaneous involvement with Leishmania donovani.

Mucocutaneous leishmaniasis has rarely been reported from India. The usual causative organisms of this infection are Leishmania braziliensis and L. tropica. Another species, L. donovani, which usually causes visceral leishmaniasis, has recently been reported to cause mucocutaneous disease in a few patients from Sri Lanka. We report two patients who had undiagnosed chronic skin lesions for several years. Skin biopsies revealed Leishmania and the species was characterized as L. donovani in both patients. There was considerable improvement in the skin lesions following treatment with liposomal amphotericin B.

Clinical and laboratory alterations in dogs naturally infected by Leishmania chagasi / Alterações clínicas e laboratoriais em cães naturalmente infectados por Leishmania chagasi

INTRODUCTION: Canine visceral leishmaniasis (CVL) is a zoonotic disease with different clinical manifestations. Parasitism often occurs in bone marrow, but changes have been observed in peripheral blood and serum biochemical parameters. The aim of this study was to evaluate the hematological and biochemical parameters in dogs naturally infected by Leishmania chagasi. METHODS: Eighty-five adult dogs of both sexes and various weights and ages from the Zoonosis Control Center of Fortaleza (CCZ) were used, selected by immunofluorescence assay (IFA) and considered positive with IFA titers greater than 1:40 and by visualizing amastigotes of Leishmania chagasi in smears obtained by bone marrow aspiration. The dogs (n = 85) were grouped according to clinical signs: negative (CN = 7), subclinical (CS = 10), and clinical (CC = 68). Blood samples were collected for determination of hematological and biochemical serum values. The experimental protocol was approved by the CEUA/UECE. RESULTS: The most frequent clinical signs were cachexia (77.9 percent), keratitis (61.8 percent), and lymphadenopathy (55.9 percent), and 86.8 percent of the animals showed more than one clinical sign characteristic of CVL. In CC were observed reductions in red blood cells (63 percent), hematocrit (72 percent), and hemoglobin (62 percent), as well as leukocytosis (33 percent), neutropenia (28 percent), thrombocytopenia (50 percent), uremia (45 percent), hyperproteinemia (53 percent, p<0.05), hypergammaglobulinemia (62 percent, p<0.01), and hypoalbuminemia (58 percent). CONCLUSIONS: Animals with the clinical form of the disease demonstrate hematological and biochemical changes consistent with anemia, uremia, hyperproteinemia, and hyperglobulinemia, which present themselves as strong clinical markers of visceral leishmaniasis associated with the signs previously reported.

INTRODUÇÃO: A leishmaniose visceral canina (LVC) é uma zoonose com diferentes manifestações clínicas. O parasitismo ocorre frequentemente na medula óssea e têm sido relatadas alterações hematológicas e bioquímicas. Objetivou-se avaliar os parâmetros clínicos, hematológicos e bioquímicos de cães naturalmente infectados por Leishmania chagasi. MÉTODOS: Utilizaram-se 85 cães adultos, ambos os sexos, peso e idade variados, oriundos do Centro de Controle de Zoonoses de Fortaleza, selecionados pela reação de imunofluorescência indireta (RIFI), sendo considerados positivos os animais com títulos de RIFI > 1:40 e pelo exame parasitológico das formas amastigotas de Leishmania chagasi em esfregaços de medula óssea. Os cães foram agrupados conforme os sinais clínicos associados à doença: negativos (CN=7); subclínicos (CS=10) e clínicos (CC=68). Amostras de sangue foram coletadas para determinação dos parâmetros hematológicos e bioquímicos séricos. O protocolo experimental foi aprovado pelo CEUA/UECE, protocolo n° 08622833-1. RESULTADOS: Os sinais clínicos mais frequentes foram caquexia (77,9 por cento), ceratoconjuntivite (61,8 por cento) e linfadenopatia (55,9 por cento), sendo que 86, 8 por cento dos animais apresentaram mais de um sinal clínico característico de LVC. Em CC foram observadas reduções nas hemácias (63 por cento), hematócrito (72 por cento) e hemoglobina (62 por cento), leucocitose (33 por cento), neutropenia (28 por cento), trombocitopenia (50 por cento), uremia (45 por cento), hiperproteinemia (53 por cento, p<0,05), hiperglobulinemia (62 por cento, p<0,01) e hipoalbuminemia (58 por cento). CONCLUSÕES: Concluiu-se que os animais com a forma clínica da doença apresentam alterações condizentes com anemia, uremia, hiperproteinemia e hiperglobulinemia, as quais se apresentam como marcadores clínicos da leishmaniose visceral, associados aos sinais previamente relatados.

The use of conjunctival swab samples for PCR screening for visceral leishmaniasis in vaccinated dogs / O uso de amostras de swab conjuntival para triagem por PCR da leishmaniose visceral em cães vacinados

The polymerase chain reaction (PCR) has been shown to provide a rapid and sensitive technique for Leishmania detection. The aim of this study was to evaluate the technique of noninvasive conjunctival swabs (CS) as a sampling method for molecular screening for visceral leishmaniasis (VL) in a group of 42 police dogs, all of them vaccinated against VL, and to compare the results with those obtained by serological tests. The serological assays were performed independently by three laboratories. Laboratories 1 and 2 were private laboratories and laboratory 3 was the National Reference Laboratory. The first serological screening performed by laboratory 1 showed 15 reactive dogs and 4 indeterminate. Laboratory 2 confirmed only 3 reactive dogs and 2 indeterminate. Laboratory 3 confirmed 7 reactive dogs and 3 indeterminate. The PCR diagnosis using the CS procedure was performed on all 42 animals and was able to detect Leishmania DNA in 17 dogs. The PCR assay confirmed all the cases that were simultaneously reactive in the serological tests by two laboratories. The results showed that the CS technique was a sensitive and practical method for sample collection, thus allowing reliable diagnostic tests through PCR.

A PCR (do inglês Polymerase Chain Reaction) tem demonstrado ser uma técnica rápida e sensível para detecção de Leishmania. O objetivo deste estudo foi avaliar a técnica não invasiva do swab conjuntival na identificação por PCR de animais infectados em um grupo de 42 cães policiais, todos vacinados contra a Leishmaniose Visceral (VL), e comparar os resultados com aqueles obtidos pelos testes sorológicos. Os ensaios sorológicos foram realizados independentemente por três laboratórios. Os laboratórios 1 e 2 eram privados. O laboratório 3 era o Laboratório de Referência Nacional. A primeira triagem sorológica realizada pelo laboratório 1 apresentou 15 cães reativos e 4 indeterminados. O laboratório 2 confirmou apenas 3 cães reativos e 2 animais indeterminados. O laboratório 3 confirmou 7 cães reativos e 3 cães foram classificados como indeterminados. O diagnóstico pela PCR, utilizando o procedimento do swab conjuntival, foi realizado em todos os 42 animais e foi capaz de detectar DNA de Leishmania em 17 cães. A PCR confirmou todos os casos simultaneamente reativos nos testes sorológicos de dois laboratórios. Os resultados demonstraram que o swab conjuntival é um método sensível e prático para coleta de amostra, permitindo um diagnóstico consistente através da PCR.

[Seroepidemiological study of visceral leishmaniasis [Kala-azar] in Ardabil province, Iran, 1986 - 2009]

Visceral Leishmaniasis [kala-azar] is the most important endemic disease in Northwestern Iran, particularly in Ardabil province. This study aimed to review the Seroepidemiological studies which have been performed in Ardabil province during 1986-2009. In this descriptive analytical study, studies which have been carried out from 1986 through 2009 in Northwestern Iran about clinical, diagnostic and epidemiological features of Kala azar, using DAT, were reviewed. Collected data were analyzed using the SPSS software. in total, 2703 of human visceral leishmaniasis were detected by direct agglutination test [DAT] in Ardabil province, 1787 [66.1%] of them were from Meshkin-shahr district, 837 [31%] cases were from Moghan district, and 79 [2.9%] cases were from Ardabil district. Ninety eight percent of the cases were under 10 years old while only 0.5% of the VL cases were >/= 20 years old and 17% of them were under 1 year of age. Currently Kala-Azar is the most important endemic disease in Northwestern Iran, particularly in Ardabil province. Anti-Leishmania antibodies at the titers of >/= 1:3200 using DAT along with clinical signs including fever, anemia and hepatosplenomegaly are considered as active visceral leishmaniasis. DAT antibody titer of 1/800 and lower and absent of clinical signs is considered as negative VL.

Primary laryngeal leishmaniasis: a rare case report.

Laryngeal leishmaniasis is extremely rare. We report a case of primary laryngeal leishmaniasis in a 70-year-old male who was admitted with complaints of gradual progressive hoarseness of the voice, dyspnea, cough for the past 3 months and noisy breathing for the past 5 days. An X-ray of the soft tissue of the neck showed a prevertebral soft tissue mass causing narrowing of the airway at the C6-C7 vertebral level. A computerized tomography (CT) scan showed a soft tissue mass in the subglottic region causing significant narrowing of the airway. A direct laryngoscopy showed a pinkish-white, friable mass involving the subglottic region and the anterior half of the vocal cords. With the clinical suspicion of malignancy, an endoscopic biopsy was done. A histopathological examination showed diffuse mixed inflammatory cell infiltrate in subepithelium with numerous Leishmania donovani bodies in the cytoplasm of histiocytes.

Acute erythroid toxicity in visceral leishmaniasis: a rare complication of antimonial therapy.

The spectrum of side-effects of sodium stibogluconate is well described, however, little is known regarding the acute erythroid toxicity caused by this drug. We hereby present a case with this unusual complication of antimonial therapy. A 6-year-old male with leishmaniasis was started on parenteral sodium stibogluconate. During the course of treatment, his hemoglobin (Hb) dropped from 7.2 g/dl to 3.5 g/dl. Bone-marrow aspirate showed karyorrhexis in many erythroid precursors with several Leishmania donovanii bodies. Sodium stibogluconate was stopped and amphotericin-B was started. Four days after the cessation of the antimonials, the patient's Hb improved to 5 gm/dl with a corrected reticulocyte count of 10% indicating bone-marrow erythroid regeneration. The exact mechanism of this acute erythroid toxicity of sodium stibogluconate remains unexplored.

L. (L.) chagasi in aids and visceral leishmaniasis (kala-azar) co-infection / L. (L.) chagasi em lesões cutâneas na co-infecção aids-calazar

Concomitant skin lesions in visceral leishmaniasis (VL) or kala-azar are rare, being more common the description of post-kala-azar dermal leishmaniasis occurring post treatment of kala-azar. Skin lesions caused by Leishmania donovani are frequently seen in the aids-VL co-infection. In Brazil cutaneous or mucosal forms of tegumentary leishmaniasis concomitant with aids are more commonly registered. Here we present a case of aids-VL co-infection, with unusual cutaneous and digestive compromising attributed to L. (L.) chagasi, with special attention to ecthymatous aspect of the lesion, allied to the absence of parasite on the histological skin biopsy.

Lesões cutâneas, na vigência da leishmaniose visceral (LV) ou calazar, são raramente observadas, sendo mais comum a ocorrência após o tratamento do calazar, conhecidas como lesões dérmicas pós calazar. Lesões cutâneas causadas por Leishmania donovani são freqüentemente observadas na co-infecção AIDS-LV. No Brasil, a concomitância das formas cutânea ou mucosa da leishmaniose tegumentar com a AIDS é mais comumente relatada. A seguir, relata-se um caso de co-infecção AIDS-LV com inusitado comprometimento digestivo e cutâneo, atribuído a L. (L.) chagasi, chamando a atenção para o aspecto ectimatóide da lesão cutânea, aliado à ausência do parasito ao exame histopatológico da pele.

Outbreak of cutaneous leishmaniasis in Somniani, Balochistan - implementation of preventive measures for deployed personnel of armed forces

To evaluate the number of cutaneous leishmaniasis [CL] cases reporting from Somniani between years 2001 to 2005 and to explore the preventive measures being used against sandfly bite. This observational study was conducted at the dermatology department of Combined Military Hospital, Malir Cantonment, Karachi from January 2001 to December 2005. Between year 2001 and 2005, suspected cases of CL reporting from Somniani, Balochistan were identified, evaluated, diagnosed and included in this study. Diagnosis was based on clinical examination, slit skin smear for detection of Leishman-Donovan [LD] bodies and skin biopsy for histopathology. Patients were then asked to fill a structured, anonymous, self-administered and close ended questionnaire which included questions about the use of various preventive measures against cutaneous leishmaniasis. A total of 108 patients were diagnosed as CL from Somniani during the study period. The peak was seen in year 2004 [n=58] which coincided with increased troop activity in the area. Nodulo-ulcerative lesions were the commonest mode of presentation. Skin biopsy for histopathology was the most effective method of diagnosis. Overall only 28% personnel were using preventive measures against sand fly bite. Only 15% personnel had disease awareness. Lack of application of preventive measures and knowledge of disease were the reasons for increase in CL cases

Epidemiological, clinical and therapeutic features of pediatric kala-azar.

Kala-azar (visceral leishmaniasis) is endemic in southern Iran. We retrospectively evaluated 367 infants and children with visceral leishmaniasis at hospitals affiliated to Shiraz University of Medical Sciences in Fars Province (located in the southwestern part of Iran). Seasonal variation was observed with more cases presenting in late winter, spring and a few in summer. The predominant clinical features in these patients were chronic fever, pallor, weight loss, abdominal distention, and hepatosplenomegaly. Lymphadenopathy was less common. Common laboratory abnormalities included anemia, leukopenia, thrombocytopenia, hypoalbuminemia and hypergammaglobulinemia. Liver function tests were deranged in two-thirds of patients. Immuno-fluorescence antibody (IFA) test was positive in all patients and all had positive bone marrow smears or cultures for Leishmania donovani. Patients responded well to Glucantim therapy with a cure rate of 96.7%. Relapse was observed in 8.2%(30) of patients. Mortality in this series was 7.3%. Twenty-three patients died during therapy. Jaundice and grossly deranged liver function tests were bad prognostic signs.

Profile of fatal visceral leishmaniasis at an Indian tertiary care center.

Visceral leishmaniasis is a highly morbid and incapacitating infection, which usually presents with prolonged fever, weight loss and hepato-splenomegaly. Despite the availability of effective treatment, the disease can have a high mortality even at referral centers. A case series of fatal visceral leishmaniasis, encountered during a prospective, two year period is presented. All the patients died due to multisystem organ failure. However, delayed diagnosis due to atypical manifestations was an important factor contributing to the fatal outcome of the patients. Instead of relying solely on the classical clinical features of visceral leishmaniasis, simple laboratory findings like pancytopenia, altered albumin/globulin ratio and appositive aldehyde and rK 39 dipstick tests can help in making an early diagnosis even in atypical cases, thereby reducing the mortality of visceral leishmaniasis.

Detección de leishmanía causante de leishmaniasis visceral mediante reacción en Cadena de la Polimerasa basado en secuencias teloméricas / Detection of leishmanía cause of visceral leishmaniasis through Polymerase Chain Reaction based on sequences teloméricas

Ensayo de reacción en cadena de la Polimerasa (PCR) basado sobre secuencias teloméricas de Leishmanía donovani para la detección de Leishmaniasis visceral. la comparación del del procesamiento y resultado con muestras de sangre y suero de 32 pacientes, permitió mayores ventajas cuando se trabajo con muestras de suero. La evaluación de especificdad sobre el ADN purificado para Leishmania del Nuevo Mundo, nos permitió reconocer a todos los parásitos aislados de las cepas del complejo donovani, permitiendo evaluar en pacientes con Leishmaniasis.

Chronic diarrhea and malabsorption caused by Leishmania donovani.

Chronic diarrhea and malabsorption are uncommon in immunocompetent patients with visceral leishmaniasis. We report two immunocompetent patients with visceral leishmaniasis where the predominant presentation was chronic diarrhea. One of them had clinically overt malabsorption and duodenal mucosa was loaded with Leishmania donovani bodies. The other patient had diffuse colonic aphthous and discrete ulcerations and Leishmania donovani bodies were seen in the crush smears of the colonic mucosa. With amphotericin B, there was reversal of malabsorption and healing of colonic ulcers.

First case of cutanous leishmaniasis in Nepalese patient.

Visceral Leishmaniasis (VL) is a serious disease caused by Leishmania donovani (LD) complex and prevalent in the temperate and tropical zones of the earth. VL, endemic in the southern plains of the 14 districts in the Terai region of Nepal, is considered a major public health problem. Cutanous leishmaniasis (CL) is prevalent mainly in the tropics and subtropics, affects nearly 1.5 million people worldwide. No reported cases of CL have been identified in Nepal until now. We report the first case of CL in a Nepalese patient.

Hemophagocytic syndrome associated with visceral leishmaniasis.

The present paper reports a case of 6-year-old male child, suffering from pallor, fever and hepatosplenomegaly. A clinical diagnosis of enteric fever with a second possibility of malaria was considered. Laboratory findings included bicytopenia, hyperbilirubinemia and raised liver enzymes. Bone marrow examination revealed active hemophagocytosis. On extensive search few amastigote forms of Leishmania donovani were seen. Patient was negative for other viral, bacterial and malaria infections. The final diagnosis of hemophagocytic syndrome associated with visceral leishmaniasis was made. There was response of anti-Leishmanial treatment with improvement in clinical condition.

Epidemiology of a new focus of localized cutaneous leishmaniasis in Himachal Pradesh.

A new focus of localised cutaneous leishmaniasis has emerged along the Satluj River valley in the mountainous region of north west Himachal Pradesh. The main endemic region extends from Pooh subdivision of Kinnaur district to Kumarsain subdivision of Shimla district with adjoining Nirmand subdivision of Kullu District comprising 86 villages. The climate of the affected areas varies from temperate to subtropical. A total of 285 cases were recorded from 1988 to January, 2005. The age of these patients varied from 10 months to 75 years, with 63 children (<12Years), and a male to female ratio of 1: 0.9. The duration of disease was 15 days to 48 months with majority (85%) presenting between 1-6 months. The number of lesions varied from 1-8, and were mostly seen on exposed parts of the body. Morphologically, lesions were asymptomatic, dry, nodular or crusted nodulo-ulcerative plaques. Tissue smear positivity for amastigotes was 43%. The characterization of 14 strains of these Leishmania revealed presence of both Leishmania tropica (n=3) and Leishmania donovani (n=11). Identification of the 42 sandflies collected from the peridomestic environment of the patients, revealed Phlebotomus longiductus - 29, P. major 8, P. kandelaki 2, while 2 remained unidentified. The patients were treated with intralesional sodium stibogluconate and majority showed excellent response.

Post-kala-azar dermal leishmaniasis: a histopathological study.

BACKGROUND: Post-kala-azar dermal leishmaniasis follows an attack of visceral leishmaniasis and is caused by the same organism, i.e. Leishmania donovani. METHODS: In the present study, biopsy specimens from hypopigmented macules, nodules or plaques of 25 patients clinically diagnosed as PKDL were evaluated for epidermal and dermal changes and for the presence or absence of Leishmania donovani bodies (LDBs). RESULTS: The hypopigmented macules showed a patchy perivascular and periappendageal infiltrate with no demonstrable LDBs in any of the biopsies. In the nodular and plaque lesions, the infiltrate was diffuse, beneath an atrophic epidermis (74%) and follicular plugging (95.6%) was seen in most biopsies. The infiltrate consisted of lymphocytes, histiocytes and plasma cells in decreasing order of presence. LDBs could be demonstrated in only 10 (43.5%) biopsy specimens from nodular and plaque lesions and were never numerous. CONCLUSIONS: Histopathological features of PKDL are elucidated and discussed.

Sensitivity of splenic and bone marrow aspirate study for diagnosis of kala-azar.

Fifty adult patients of kala-azar were included in this prospective study from Medicine Unit-I of Mymensingh Medical College Hospital. Splenic and bone marrow aspiration were done simultaneously to compare the sensitivity and other related merits and demerits of each procedure. Splenic aspiration appeared to be more sensitive procedure than bone marrow aspiration. Leishman - Donovan (LD) bodies were found in 90 percent and 72 percent of the spleen and bone marrow aspirates respectively. Splenic aspiration was found more acceptable to patients (96%) as it was less painful. Both the procedures were hazardless. There was no major complication except mild pain after splenic aspiration; even a few patients had history of epistaxis. Splenic aspiration was also more acceptable by the physicians because of an easy and reliable diagnostic procedure.