Diagnóstico de la leishmaniasis: de la observación microscópica del parásito a la detección del ADN / Leishmaniasis diagnosis: going from microscopic observation of parasite to DNA detection

Introducción: la leishmaniasis es una enfermedad causada por varias especies del género Leishmania, de la cual se han incrementado los reportes en los últimos años. Diversos factores genéticos, inmunológicos y asociados al parásito determinan el establecimiento de la infección y la ocurrencia de enfermedad, que se presenta en formas clínicas muy diversas, lo cual condiciona, entre otros elementos, el método diagnóstico que se aplica. Métodos: se hizo una revisión de la literatura básica y actualizada sobre aspectos generales de la leishmaniasis: la enfermedad y su situación epidemiológica, el ciclo de vida y la transmisión, vectores, presentaciones clínicas y diagnóstico; este último acápite contiene información sobre los principales métodos que se utilizan en el presente. Se puntualizó en la forma en que se apoya el diagnóstico desde el grupo de Leishmania del Instituto de Medicina Tropical "Pedro Kourí", que constituye el centro nacional de referencia para esta enfermedad tropical. Resultados: se muestra información actualizada sobre los temas escogidos, con un enfoque orientador y práctico, dirigido al personal de salud que debe enfrentar casos con sospecha de leishmaniasis. Se muestran tablas y gráficos que resumen de manera organizada aspectos relevantes, así como el algoritmo de trabajo que se sigue en el instituto con relación al diagnóstico de esta enfermedad, con énfasis especial en las aplicaciones al diagnóstico molecular que ha realizado el grupo de trabajo. Conclusiones: debido a que la leishmaniasis permanece aún sin control, el diagnóstico oportuno continúa siendo una necesidad. Todos los métodos aportan información de utilidad para la toma de decisiones en el tratamiento clínico, la imposición del tratamiento y el enfoque epidemiológico de esta parasitosis. Entre ellos, proponemos un algoritmo de trabajo en nuestro laboratorio, con el empleo de los métodos que resultan más útiles de acuerdo a nuestras condiciones y experiencias.

Introduction: leishmaniasis is a disease caused by several species from Leishmania genus, which has been increasingly reported in the last few years. Several genetic, immunological factors and others related to this parasite have been associated to the outcome of the infection, and the occurrence of illness in varied clinical forms. All the aforementioned has an impact on the diagnostic method that should be used. Methods: a basic and recent literature review was made, mainly focused on general aspects of leishmaniasis as epidemiological situation of disease, life cycle and transmission, vectors, clinical presentation and diagnosis; the latter shows information about the main methods used at present. The procedure followed by the Leishmania group at "Pedro Kourí" Institute of Tropical Medicine to support the diagnostic activities was presented as well. Results: updated practical information about the chosen topics was presented, with a practical guiding approach aimed at the health personnel that must face suspected leishmaniasis cases. Tables and figures summarized relevant aspects in an organized form, as well as the working algorithm of Institute concerning diagnosis was presented. The application of molecular diagnosis by this working team was particularly underlined. Conclusions: as leishmaniasis is still out of control, opportune diagnosis remains a must. All the methods provide useful information for taking decisions on clinical management, treatment and epidemiology of this parasitosis; hence, a working algorithm was submitted in our lab based on the most useful methods under our present conditions and experience.

Chemistry, cytotoxicity and antileishmanial activity of the essential oil from Piper auritum

Leishmaniasis is one of the most important parasitic infections, but current treatments are unsatisfactory due to their toxicity, cost and resistance. Therefore, the development of new antileishmanial compounds is imperative. Many people who live in endemic areas use plants as an alternative to treat the disease. In this paper, we characterised the essential oil from Piper auritum, evaluated its cytotoxicity and determined its antileishmanial activity. The chromatogram obtained by gas chromatography revealed 60 peaks and we found that safrole was the most abundant compound, composing 87 percent of the oil. The oil was active against the promastigotes of Leishmania major, Leishmania mexicana, Leishmania braziliensis and Leishmania donovani with a favourable selectivity index against peritoneal macrophages from BALB/c mice. The Piper-oil inhibited the growing of intracellular amastigotes of L. donovani with an IC50 value of 22.3 ± 1.8 ìg/mL. This study demonstrates the usefulness of the essential oils as a promising alternative to treat leishmaniasis.