[Visceral leishmaniasis in Xinjiang Uygur Autonomous Region during the COVID-19 pandemic: a case report].

OBJECTIVE: To perform an epidemiological investigation on a case of visceral leishmaniasis reported from Shule County, Kashi Prefecture, Xinjiang Uygur Autonomous Region in 2021, so as to provide insights into differential diagnosis of visceral leishmaniasis during the COVID-19 pandemic. METHODS: The epidemiological history of this case was collected, and the case was diagnosed for Leishmania infection with the immunochromatographic (rK39) strip test, bone marrow smear microscopy and PCR assay. RESULTS: The patient had typical clinical symptoms of leishmaniasis, including irregular fever, hepatosplenomeg- aly, low serum albumin and elevated globulin. Bone marrow smear microscopy identified L. donovani amastigotes, and both rK39 strip test and PCR assay were positive, while the case was tested negative for SARS-CoV-2. COVID-19 was therefore excluded and visceral leishmaniasis was diagnosed. Standard full-dose treatment with sodium stibogluconate was given, and no Leishmania was found on blood smears during the reexamination. No recurrence was found during the followup after discharge for hospital. CONCLUSIONS: During the COVID-19 pandemic, it is recommended to increase the perception of differential diagnosis of visceral leishmaniasis among first-contact doctors, and reinforce the capability of differential diagnosis and health education of visceral leishmaniasis among medical and healthcare institutions at all levels, to prevent missed diagnosis and misdiagnosis of visceral leishmaniasis.

Spatio-temporal relative risks and priority areas for visceral leishmaniasis control in Brazil, between 2001 and 2020.

Visceral leishmaniasis (VL) is a pressing public health problem in Brazil. The proper implementation of disease control programs in priority areas is a challenge for healthcare managers. The present study aimed to analyze the spatio-temporal distribution and identify high risk areas of VL occurrence in the Brazilian territory. We analyzed data regarding new cases with confirmed diagnosis of VL in Brazilian municipalities, from 2001 to 2020, extracted from the Brazilian Information System for Notifiable Diseases. The Local Index of Spatial Autocorrelation (LISA) was used to identify contiguous areas with high incidence rates in different periods of the temporal series. Clusters of high spatio-temporal relative risks were identified using the scan statistics. The accumulated incidence rate in the analyzed period was 33.53 cases per 100,000 inhabitants. The number of municipalities that reported cases showed an upward trend from 2001 onward, although there was a decrease in 2019 and 2020. According to LISA, the number of municipalities considered a priority increased in Brazil and in most states. Priority municipalities were predominantly concentrated in the states of Tocantins, Maranhão, Piauí, and Mato Grosso do Sul, in addition to more specific areas of Pará, Ceará, Piauí, Alagoas, Pernambuco, Bahia, São Paulo, Minas Gerais, and Roraima. The spatio-temporal clusters of high-risk areas varied throughout the time series and were relatively higher in the North and Northeast regions. Recent high-risk areas were found in Roraima and municipalities in northeastern states. VL expanded territorially in Brazil in the 21st century. However, there is still a considerable spatial concentration of cases. The areas identified in the present study should be prioritized for disease control actions.

Versatile Use of Mycobacterium indicus pranii (MIP) Vaccine

Mycobacterium indicus pranii (MIP) earlier known as Mw is a soil-borne, non-pathogenic, saprophytic and rapidly growing strain of mycobacteria. MIP is approved as a vaccine/ immunomodulator for various indications including mycobacterium infections like leprosy in humans. Its administration has resulted in satisfactory clinical improvement, accelerated bacillary clearance, and increased immune responses to Mycobacterium leprae antigens, thereby shortening the full recovery time of the patients. It also shares its antigens with M.tuberculosis. In the last decade, RCTs have been done establishing immunotherapeutic properties of MIP in the treatment of leprosy, tuberculosis, warts and experimently in leishmaniasis. Through its immune inducing and cytotoxic property, it has also proved beneficial for human use especially in treating lung cancer. The beneficial role of it is also being explored in breast, cervical, oral, liver, and bladder cancers. Various studies on MIP have shown that it has immune-modulating properties in humans. The curiosity of the human mind has led to it being tried in Covid treatment trials. The results have shown that administering MIP has lowered inflammatory markers in Covid 19 patients, promising us for it to be a potential treatment option. More RCTs with a larger sample size should be done to establish this. Cytokine storm seen in bacterial sepsis is also decreased with MIP administration. Considering the encouraging results in hastening recovery in various diseases it appears that MIP is perhaps not being exploited to its fullest potential. © 2023, Hind Kusht Nivaran Sangh (Indian Leprosy Association). All rights reserved.

Global leishmaniasis surveillance: 2021, assessing the impact of the COVID-19 pandemic

This article discusses the global report on leishmaniasis surveillance, highlighting its significance as a major health problem in four eco-epidemiological regions of the world. The report provides an update on the GHO leishmaniasis indicators reported by 45 member states to WHO up to 2021 and describes specific indicators such as gender and age distribution, relapses, the AmBisomeR donation programme selected outbreaks, case fatality rates for visceral leishmaniasis, rates of co-infection with HIV and visceral leishmaniasis (VL), and the burden of post-kala-azar dermal leishmaniasis. It also discusses the impact of the COVID-19 pandemic on leishmaniasis surveillance efforts and the Kala-azar Elimination Programme in South-East Asia, as well as highlights adverse events after the administration of antileishmanial drugs and the need for continued surveillance efforts to control and eliminate leishmaniasis globally.

Visceral leishmaniasis in the COVID-19 pandemic era.

Visceral l eishmaniasis (VL), also known as kala-azar, had once been targeted for elimination in 2020, which now has been shifted to 2030. The year 2020 was also the year in which the world was gripped by the coronavirus disease 2019 (COVID-19) pandemic. This review sheds light on the impact of COVID-19 on VL elimination programmes and the increasing incidences of COVID-19/VL cases. Lockdowns were imposed worldwide that led to the suspension of surveys, active case finding and mass drug administration, which are important activities to manage neglected tropical diseases. Healthcare machinery was redirected to control the pandemic and acute resource shortages were seen. Budget cuts from funding agencies and donors also came as a severe blow. Priority changes for manufacturers of drugs and diagnostic kits have also exacerbated the situation. Cases where patients were co-infected with VL and COVID-19 were reported across various settings and in people of various age groups, posing unprecedented challenges in diagnosis and treatment. Concerted efforts from all stakeholders are required to understand and deal with the impact that this pandemic has had on VL.

AN UNUSUAL CASE OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS ASSOCIATED WITH M.CHIMAERA OR LARGE CELL NEUROENDOCRINE CARCINOMA

CASE: 56-year-old Caucasian male presented to the hospital with worsening weakness, exertional dyspnea, dry and nonproductive cough, and a 5-pound weight loss in 2 weeks associated with loss of appetite. He has a significant medical history of mitral valve repair in July 2014, status post bioprosthetic mitral valve replacement in August 2019- culture-negative treated with ceftriaxone, vancomycin, and doxycycline for 6 weeks complicated with CVA, atrial flutter, tobacco abuse, alcohol abuse. His shortness of breath worsened quickly with O2 saturations dropping to 85% and had to be placed on BiPAP followed by high flow nasal cannula/ noninvasive ventilation and became febrile. He was then transferred to ICU for acute hypoxemic respiratory failure. Differentials could be very broad ranging from infections like visceral leishmaniasis, atypical/tuberculous mycobacteria, histoplasmosis, Ehrlichia, Bartonella, Brucella, adeno, disseminated HSV, hematological like Langerhans cell histiocytosis, multicentric Castleman disease. In this patient, differentials included hemophagocytic lymphohistiocytosis, COVID-19. Covid was negative x2. His lab abnormalities as well as diagnostic testing revealed hemophagocytic lymphohistiocytosis. He was empirically started on antibiotics and dexamethasone 20 mg to be continued for 2 weeks then taper if the patient has continued improvement. Dexamethasone was tapered over 8 weeks. On later admissions, Carious test was positive for M. chimaera, and core biopsy of the lung nodule showed large cell neuroendocrine carcinoma. IMPACT/DISCUSSION: Hemophagocytic lymphohistiocytosis (HLH) is a rare but very dangerous condition, characterized by abnormal activation of the immune system, causing hemophagocytosis, inflammation, and potentially widespread organ damage. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity, is most commonly seen in children. Secondary HLH is commonly associated with infections or malignancies. Most current information on diagnosis and treatment is based on pediatric populations. The HLH-2004 diagnostic criteria are the most commonly used diagnostic criteria and were developed for children;but used in adults as commonly as in children, although there is a gap in the knowledge. The HLH-2004 diagnosis criteria state that diagnosis of HLH can be established if either a molecular diagnosis is made consistent with HLH or diagnostic criteria for HLH is fulfilled, which includes meeting 5 of 8 criteria. These are lab and clinical findings including fever, splenomegaly, significant cytopenia, hypertriglyceridemia and/or hypofibrinogenemia, hemophagocytosis in bone marrow/spleen or lymph nodes, low or no NK cell activity, ferritin >500 ug/L or sCD25 >2400 U/mL. CONCLUSION: HLH is a disease that needs to be diagnosed and treated promptly, it is fatal otherwise. Treatment is mostly tailored to the patient's root cause, treat the cause, and symptomatic treatment with dexamethasone and etoposide.

Third Case of Visceral Leishmaniasis in COVID-19: Mini Review Article.

BACKGROUND: In the currently ongoing coronavirus pandemic, coinfections with unrelated life-threatening febrile conditions may pose a particular challenge to clinicians. Leishmaniasis is a zoonosis that may present general symptoms, including fever, malaise, and arthralgia, rendering it indistinguishable from COVID-19. METHODS: In this paper, we aim to draw attention to this issue and analyze the clinical characteristics of the coinfection SARS-CoV-2/Leishmania through a systematic review of the literature. We were motivated by the observation of the first case of visceral leishmaniasis and COVID-19 in a paediatric patient. CONCLUSION: Our case is a reminder for healthcare providers to consider the diagnosis of visceral leishmaniasis in patients presenting with febrile syndrome in endemic regions during the COVID-19 pandemic.

Zika, Nipah and Kala-azar: Emerging lethal infectious diseases amid COVID-19 as an escalating public health threat in South India.

As of 6 June 2022, a sum 25,782 of active cases and 524,701 deaths due to Coronavirus disease-19 (COVID-19) have been recorded in India. Stewing in the flares of the pandemic, Kerala is entwined in the wrath of multiple emerging infectious diseases. India, a home to 1.3 billion people, recently faced a devastating second wave of COVID-19 during May of 2021, with a ruckus of chronic shortage of medicine, oxygen supplies, ventilators, besides, being challenged by secondary infections and chronic health ailments. The state of Kerala, alone contributes to 50% COVID-19 caseload, besides, recent simultaneous outbreaks of Zika Virus Disease (ZVD), Nipah Virus Disease (NiVD) and Kala-azar (black fever) on July 8, September 5 and 8, 2021 respectively. Syndemicity and a high case fatality rates of these highly contagious diseases coupled with post infection sequelae, overwhelm the already fragile healthcare system. Thus, these lethal infectious diseases along with an anticipated third wave of COVID-19 pose a serious public health threat in and around South India. With this narrative review, we aim to discuss the challenges that the emergence of intersecting outbreaks of Zika, Nipah, Kala-azar presents with, in the nation, amidst the global pandemic of COVID-19 and provide recommendations so as to help alleviate the situation. The syndemicity of COVID-19 with other infectious diseases, calls for adequate surveillance and monitoring of diseases' outbreaks. To avoid the worst situations like pandemic, the health ministry, public and private health stakeholders in India should strengthen the public healthcare delivery system and providence of quick medical facilities to control the rate of mortality and morbidity during outbreaks.

Summary of national data of class A, B and C communicable diseases in China, September 2021

In September 2021 (from 00:00, 1 September to 24: 00, 30 September), a total of 500 929 cases of notifiable communicable diseases, including 2 172 deaths, were reported in China (except Hong Kong, Macao Special Administrative Regions and Taiwan Province, the same below). In communicable diseases in class A, no case and no death were reported. In communicable diseases in class B, no cases and no deaths of severe acute respiratory syndrome, poliomyelitis, human infection with highly pathogenic avian influenza virus, diphtheria and human infection with avian influenza A(H7N9) virus were reported. For the remaining 22 communicable diseases in class B, 272 332 cases were reported, a decrease of 0.9% compared with last month (274 917 cases) and a decrease of 5% compared with the same period in 2020 (287 923 cases). The first 5 diseases in terms of reported case number were viral hepatitis, pulmonary tuberculosis, syphilis, gonorrhea and brucellosis, accounting for 94% of the total reported cases in class B. A total of 2 172 deaths were reported, an increase of 5% (95 deaths) compared with last month (2 077 deaths) and a decrease of 5% compared with the same period in 2020 (2 291 deaths). According to the website of the National Health Commission of China, a total of 1 264 confirmed COVID-19 cases were reported, without death, by 31 provinces (municipalities, autonomous regions) and Xinjiang Production and Construction Corps from 00:00, 1 September to 24: 00, 30 September, 2021. In class C communicable diseases, a total of 228 597 cases were reported, an increase of 10% compared with last month (207 153 cases) and a decrease of 7% compared with the same period in 2020 (247 112 cases). The first 3 diseases in terms of reported case number were other infectious diarrhea, hand foot and mouth disease (HFMD) and influenza, accounting for 93% of the total reported cases in class C. Compared with last month, except filariasis, visceral leishmaniasis, leprosy and other infectious diarrhea which decreased by 1 case, 11 cases (39%), 12 cases (33%) and 12 747 cases (12%) respectively, the reported cases of all other diseases increased, the diseases with obvious case increases were HFMD (15 352 cases, 22%), influenza (14 160 cases, 66%) and mumps (4 253 cases, 51%). Compared with the same period in 2020, the diseases with reported case increases were influenza (17 269 cases, 95%), visceral leishmaniasis (4 cases, 31%), rubella (19 cases, 27%) and typhus fever (32 cases, 18%), filariasis had no incidences in both years, and the diseases with obvious reported case decreases were HFMD (26 506 cases, 23%). other infectious diarrhea (5 628 cases, 6%) and mumps (523 cases, 4%). No death caused by class C communicable diseases was reported, same to the last month and a decrease of 3 deaths compared with the same period in 2020 (3 deaths).

Cinnamomum camphora: A long history for epidemics control

Camphor (C10H16O) is a white crystalline solid exist in enantiomeric form R and S camphor. It is a terpenoid obtained from turpentine oil. Synthetically it is synthesized by catalytic process as alpha pinene. Naturally camphor is obtained by steam distillation of woods of Cinnamomum camphora tree, also known as Camphor tree, camphor laure and camphor wood. Camphor has many pharmacological properties. It acts as antiviral, anticancerous, antimicrobial, insecticidal, anticoccidial, anti-nociceptive and antitussive drug. In addition, it can be used as skin penetrating enhancer. Camphor gives a soothing and cooling effect, which helps to reduce pain. The reason behind its soothing effect is camphor act as a counter-irritant by activating heat sensitive transient receptor potential vanilloid subtype 1 and transient receptor potential vanilloid subtype 3 receptors and inhibits the transient receptor potential melastatin-subfamily member 8 receptor. As a result, these receptors provide a sensation of scalding heat and pain (nociception) and could be used to treat neuropathic pain associated with multiple sclerosis, chemotherapy, or amputation, as well as pain associated with the inflammatory response of damaged tissue such as in osteoarthritis. Camphor has a history of epidemics cure. During leishmaniosis (kala-azar) pandemic in 14th century, camphor was used as fumigant to control the spread of plague in European countries. In 19th century when cholera, small pox and influenza spreads, camphor was used as mothballs in Indian subcontinent as a (cough reliever) agent. During 18th century Russian influenza “flu pandemic” founder of Homeopathy Hahnemann in 1831, published his research work on camphor and suggested camphor as a “divine remedy” for influenza given in extremely small doses. In the same year, several companies launched to sell menthol rub as natural rub ointment consisting camphor as prevention measures for spread of influenza. As the recent epidemic of COVID-19 arises, prevention and control of spread of disease is an alarming issue. This article covered the glimpse of uses and importance of camphor in the history of epidemic cure.

A rare case of visceral Leishmaniasis and CoViD-19 co-infection. Misdiagnosis in the CoViD era

Background: CoViD-19 is a global pandemic, with high mortality and morbidity. Leishmaniases are protozoan diseases transmitted by phlebotomine sand flies, with increasing incidence worldwide. In the CoViD-19 pandemic era the focus was on the coronavirus infection but similarities in the febrile course and other manifestations of some diseases may lead to clinical misdiagnosis and can lead to patient harm from delay in the correct treatment. Description of the case: We describe a case of a 28-year-old patient who was hospitalized for SARS-CoV-2 pneumonia. He presented a mild fever (37.7°), progressive weakness and headache. PCR test for CoViD-19 was positive, and there was ground glass opacities in the lower left lobe of the lung on computed tomography scan. On physical examination, patient was febrile and hepatosplenomegaly was note. Laboratory investigation demonstrated pancytopenia with hemoglobin -8.9 g/dl, RBC 2.58 × 106/μl, WBC 1 × 103/μl, platelet count 63 × 103/μl. A diagnosis of visceral leishmaniasis (kala-azar) was made based on the bone marrow aspiration cytology. The patient was treated by intravenous administration of amphotericine B, he responded favorably to treatment. Conclusions: This case demonstrated that the diagnosis and management of other infectious diseases can be challenging in times of this pandemic. The vigilance for timely diagnosis needed for patients suspected of having CoViD-19 is imperative but it should not deter us from recognizing possible differential diagnoses.

Visceral leishmaniasis and COVID-19 coinfection - A case report.

As the COVID-19 pandemic spreads across the globe, it will undoubtedly cross paths with long endemic infectious diseases in different areas. Interactions between SARS-CoV2 and well-known pathogens will likely give rise to unfamiliar clinical presentations, depending on complex and as yet unknown immunological interactions. We present a case of coinfection with COVI19 and visceral leishmaniasis and discuss recent reports regarding coexistence of SARS-CoV2 and Leishmania spp. to date.

Should an intersection between visceral leishmaniasis endemicity and the COVID-19 pandemic be considered?

The COVID-19 pandemic caused by the infection with the novel Coronavirus SARS-CoV-2, revealed individual and global vulnerabilities, in which we highlight the social, economic, and political aspects and the health systems' organization in the countries. Brazil remains with a high transmission rate and presents a centripetal distribution as observed through a more sustained growth in the number of municipalities affected, outlining a profile of invasion of poor communities. Several vulnerabilities overlap with precarious housing conditions, lack of basic sanitation, malnutrition, and endemicity for neglected chronic diseases such as visceral leishmaniasis (VL). COVID-19 and VL evidently do not share clinical features, but exactly because of the distinct immunopathogenesis between the diseases, patients with VL may present a vulnerability in the immune system against antiviral responses. Considering that VL susceptibility seems to be related to an inefficient and polarized immune response, it is likely that in endemic areas, the overlap of social weaknesses added to individual vulnerability by immune polarization may aggravate the COVID-19 condition. In this sense, we reinforce that possible relationships between endemic neglected diseases such as VL and pandemic SARS-CoV-2 infection need to be further considered and investigated.