Parasitological and molecular search for Leishmania natural infection in phlebotomine sand flies in peri-urban and rural sites of an Argentinean area endemic for tegumentary leishmaniasis.

Leishmaniases are neglected tropical diseases caused by Leishmania spp. parasites transmitted by the bite of phlebotomine sand flies. In Argentina, the most endemic area of American tegumentary leishmaniasis (ATL) has been Orán department, Province of Salta, where Leishmania (Viannia) braziliensis prevails and Nyssomyia neivai is considered as its vector, although there is no accurate and sufficient information in this regard. The aim of this work was to search for natural infection by Leishmania spp. in sand flies from peri-urban and rural sites with ATL background in Orán department. For this, sand flies were caught at five sites; female sand flies captured with Shannon trap were dissected to microscopically examine their gut contents, while females captured with CDC traps were molecularly analyzed by duplex PCR with two primer pairs to simultaneously amplify kinetoplast DNA (kDNA) and mammalian actin. A total of 1921 females were captured, with Ny. neivai being the most abundant species (89%), followed by Migonemyia migonei (6%) and cortelezzii complex (3%). No natural infection was found in any of them neither by dissection nor by PCR, although the detection limit of kDNA PCR was up to 25 promastigotes. The absence of infected females in peri-urban sites suggest that the transmission did not take place in those environments during the study period. Future searches for natural infection should focus on rural settings to deepen knowledge and elucidate the role of the circulating sand fly species as all have been linked to ATL transmission at other sites.

Experimental evidence of biological interactions among different isolates of Trypanosoma cruzi from the Chaco Region.

Many infectious diseases arise from co-infections or re-infections with more than one genotype of the same pathogen. These mixed infections could alter host fitness, the severity of symptoms, success in pathogen transmission and the epidemiology of the disease. Trypanosoma cruzi, the etiological agent of Chagas disease, exhibits a high biological variability often correlated with its genetic diversity. Here, we developed an experimental approach in order to evaluate biological interaction between three T. cruzi isolates belonging to different Discrete Typing Units (DTUs TcIII, TcV and TcVI). These isolates were obtained from a restricted geographical area in the Chaco Region. Different mixed infections involving combinations of two isolates (TcIII + TcV, TcIII + TcVI and TcV + TcVI) were studied in a mouse model. The parameters evaluated were number of parasites circulating in peripheral blood, histopathology and genetic characterization of each DTU in different tissues by DNA hybridization probes. We found a predominance of TcVI isolate in blood and tissues respect to TcIII and TcV; and a decrease of the inflammatory response in heart when the damage of mice infected with TcVI and TcIII + TcVI mixture were compared. In addition, simultaneous presence of two isolates in the same tissue was not detected. Our results show that biological interactions between isolates with different biological behaviors lead to changes in their biological properties. The occurrence of interactions among different genotypes of T. cruzi observed in our mouse model suggests that these phenomena could also occur in natural cycles in the Chaco Region.

A monoallelic deletion of the TcCRT gene increases the attenuation of a cultured Trypanosoma cruzi strain, protecting against an in vivo virulent challenge.

Trypanosoma cruzi calreticulin (TcCRT) is a virulence factor that binds complement C1, thus inhibiting the activation of the classical complement pathway and generating pro-phagocytic signals that increase parasite infectivity. In a previous work, we characterized a clonal cell line lacking one TcCRT allele (TcCRT+/-) and another overexpressing it (TcCRT+), both derived from the attenuated TCC T. cruzi strain. The TcCRT+/- mutant was highly susceptible to killing by the complement machinery and presented a remarkable reduced propagation and differentiation rate both in vitro and in vivo. In this report, we have extended these studies to assess, in a mouse model of disease, the virulence, immunogenicity and safety of the mutant as an experimental vaccine. Balb/c mice were inoculated with TcCRT+/- parasites and followed-up during a 6-month period. Mutant parasites were not detected by sensitive techniques, even after mice immune suppression. Total anti-T. cruzi IgG levels were undetectable in TcCRT+/- inoculated mice and the genetic alteration was stable after long-term infection and it did not revert back to wild type form. Most importantly, immunization with TcCRT+/- parasites induces a highly protective response after challenge with a virulent T. cruzi strain, as evidenced by lower parasite density, mortality, spleen index and tissue inflammatory response. TcCRT+/- clones are restricted in two important properties conferred by TcCRT and indirectly by C1q: their ability to evade the host immune response and their virulence. Therefore, deletion of one copy of the TcCRT gene in the attenuated TCC strain generated a safe and irreversibly gene-deleted live attenuated parasite with high immunoprotective properties. Our results also contribute to endorse the important role of TcCRT as a T. cruzi virulence factor.

Desarrollo de una PCR en tiempo real para la cuantificación de leishmania SP en muestras de pacientes con leishmaniasis tegumentaria americana / Development of a real time PCR assay for the quantification of leishmania SP in samples from patients with american tegumentary leishmaniasis

INTRODUCCION: La leishmaniasis tegumentaria americana (LTA) es una enfermedad endémica reemergente en la provincia de Salta. Los recursos terapéuticos disponibles presentan serias limitaciones. Se han detectado numerosos casos de fallas terapéuticas debido a que el criterio de curación se basa en la evolución clínica de las lesiones.OBJETIVO: A fin de contar con un sistema adecuado para monitorear la enfermedad, se propuso optimizar una PCR en tiempo real (RT-PCR) basada en el uso de un agente intercalante y oligonucleótidos que amplifican secuencias del ADN del kinetoplasto (KADN), directamente de muestras de raspados de lesiones (en pacientes con LTA) contenidas en buffer TE (Tris-EDTA), sin extracción de ADN.METODOS: Para obtener una curva estándar (CE) se realizaron diluciones seriadas de parásitos (p) de cepas de referencia de especies que circulan en la zona. También se compararon 3 métodos de procesamiento de muestras (PM): Buffer de lisis, Insta-GeneTM Matrix (BIO-RAD) y TE. Luego se analizaron negativos para evaluar la especificidad y sensibilidad del sistema. Estas muestras provenían de raspados de lesiones cutáneas o mucocutáneas, tomados con palillos de madera en 300 μl TE.RESULTADOS: El límite de detección fue de 0,001 p/300 μl TE. La CE construida a partir de una cepa de Leishmania Viannia braziliensis mostró una pendiente de -3,40, eficiencia de amplificación de 96,66%, coeficiente de Pearson (R2) de 0,997 e intersección en la ordenada de 44,079. Al comparar los PM, el método de buffer TE fue el más eficiente. La RT-PCR desarrollada mostró un 100% de especificidad frente a muestras controles negativos y un 100% de sensibilidad frente a controles positivos.CONCLUSIONES: El sistema analizado es altamente sensible y permite detectar parásitos de Leishmania sp directamente de muestras clínicas provenientes de raspados de lesiones.

INTRODUCTION: The american tegumentary leishmaniasis (ATL) is an endemic, re-emergent disease in the Province of Salta. The therapeutic resources which are available have serious limitations. Numerous treatment failures have been detected due to the fact that the evaluation of chemotherapy is based on the clinical outcome of lesionsOBJECTIVE: In order to find a system for the correct follow-up of the disease, the study aimed at optimized the real time PCR (RT-PCR) based on intercalating agent and primers that amplify kinetoplastic DNA sequences (KDNA), directly on samples from skin lesion scrappings (from patients with ATL) contained in buffer TE, without DNA purification..METHODS: To obtain a stardard curve (SC) serial dilutions of parasites (p) were made (from reference strains of species that circulate in the region). 3 different methods of sample processing (SP) were compared: Lysis buffer, Insta-GeneTM Matrix (BIO-RAD) and TE (Tris-EDTA). The study evaluated the specificity and sensibility of the system by analyzing positive (by conventional PCR) and negative clinical samples. These samples were from cutaneous or mucocutaneous lesion scrapings, taken with toothpicks in 300 μl TE.RESULTS: The detection limit was 0.001 p/300 μl TE. The SC built with a Leishmania Viannia braziliensis strain showed a slope of -3.40, amplification efficiency of 96.66%, Pearson coefficient (R2) of 0.997 and 44.079 x-intersection. When comparing the SP, the buffer TE method was the most efficient one. With respect to positive and negative control samples, this RT-PCR showed a sensitivity and specificity of 100% respectively.CONCLUSIONS: This system is highly sensitive and allows to detect Leishmania sp parasites directly from clinical samples of lesion scrapings.

Desarrollo de una PCR en tiempo real para la cuantificación de leishmania SP en muestras de pacientes con leishmaniasis tegumentaria americana / Development of a real time PCR assay for the quantification of leishmania SP in samples from patients with american tegumentary leishmaniasis

INTRODUCCION: La leishmaniasis tegumentaria americana (LTA) es una enfermedad endémica reemergente en la provincia de Salta. Los recursos terapéuticos disponibles presentan serias limitaciones. Se han detectado numerosos casos de fallas terapéuticas debido a que el criterio de curación se basa en la evolución clínica de las lesiones.OBJETIVO: A fin de contar con un sistema adecuado para monitorear la enfermedad, se propuso optimizar una PCR en tiempo real (RT-PCR) basada en el uso de un agente intercalante y oligonucleótidos que amplifican secuencias del ADN del kinetoplasto (KADN), directamente de muestras de raspados de lesiones (en pacientes con LTA) contenidas en buffer TE (Tris-EDTA), sin extracción de ADN.METODOS: Para obtener una curva estándar (CE) se realizaron diluciones seriadas de parásitos (p) de cepas de referencia de especies que circulan en la zona. También se compararon 3 métodos de procesamiento de muestras (PM): Buffer de lisis, Insta-GeneTM Matrix (BIO-RAD) y TE. Luego se analizaron negativos para evaluar la especificidad y sensibilidad del sistema. Estas muestras provenían de raspados de lesiones cutáneas o mucocutáneas, tomados con palillos de madera en 300 μl TE.RESULTADOS: El límite de detección fue de 0,001 p/300 μl TE. La CE construida a partir de una cepa de Leishmania Viannia braziliensis mostró una pendiente de -3,40, eficiencia de amplificación de 96,66%, coeficiente de Pearson (R2) de 0,997 e intersección en la ordenada de 44,079. Al comparar los PM, el método de buffer TE fue el más eficiente. La RT-PCR desarrollada mostró un 100% de especificidad frente a muestras controles negativos y un 100% de sensibilidad frente a controles positivos.CONCLUSIONES: El sistema analizado es altamente sensible y permite detectar parásitos de Leishmania sp directamente de muestras clínicas provenientes de raspados de lesiones.

INTRODUCTION: The american tegumentary leishmaniasis (ATL) is an endemic, re-emergent disease in the Province of Salta. The therapeutic resources which are available have serious limitations. Numerous treatment failures have been detected due to the fact that the evaluation of chemotherapy is based on the clinical outcome of lesionsOBJECTIVE: In order to find a system for the correct follow-up of the disease, the study aimed at optimized the real time PCR (RT-PCR) based on intercalating agent and primers that amplify kinetoplastic DNA sequences (KDNA), directly on samples from skin lesion scrappings (from patients with ATL) contained in buffer TE, without DNA purification..METHODS: To obtain a stardard curve (SC) serial dilutions of parasites (p) were made (from reference strains of species that circulate in the region). 3 different methods of sample processing (SP) were compared: Lysis buffer, Insta-GeneTM Matrix (BIO-RAD) and TE (Tris-EDTA). The study evaluated the specificity and sensibility of the system by analyzing positive (by conventional PCR) and negative clinical samples. These samples were from cutaneous or mucocutaneous lesion scrapings, taken with toothpicks in 300 μl TE.RESULTS: The detection limit was 0.001 p/300 μl TE. The SC built with a Leishmania Viannia braziliensis strain showed a slope of -3.40, amplification efficiency of 96.66%, Pearson coefficient (R2) of 0.997 and 44.079 x-intersection. When comparing the SP, the buffer TE method was the most efficient one. With respect to positive and negative control samples, this RT-PCR showed a sensitivity and specificity of 100% respectively.CONCLUSIONS: This system is highly sensitive and allows to detect Leishmania sp parasites directly from clinical samples of lesion scrapings.

Serological evaluation of specific-antibody levels in patients treated for chronic Chagas' disease.

Serological tests are the main laboratory procedures used for diagnosis during the indeterminate and chronic stages of Chagas' disease. A serological regression to negativity is the main criterion used to define parasitological cure in treated patients. The aim of this work was to monitor the individual specificities of antibody levels for 3 years posttreatment in 18 adult patients. Conventional serological techniques (hemagglutination assays and enzyme-linked immunosorbent assay [ELISA]) were modified by using recombinant antigens to detect early markers of treatment effectiveness. For this purpose, serum samples were taken before and during treatment and every 6 months after treatment for at least 3 years. When hemagglutination assays were used, a decrease in antibody levels was observed in only one patient. When ELISA with serum dilutions was used, antibody clearance became much more apparent: in 77.7% (14/18) of the patients, antibody titers became negative with time. This was observed at serum dilutions of 1/320 and occurred between the 6th and the 30th months posttreatment. The immune response and the interval for a serological regression to negativity were different for each patient. For some of the recombinant antigens, only 50% (9/18) of the patients reached the serological regression to negativity. Recombinant antigen 13 might be a good marker of treatment effectiveness, since 66.6% (six of nine) of the patients presented with an early regression to negativity for specific antibodies to this antigen (P = 0.002).

Use of the polymerase chain reaction (PCR) for early evaluation of etiological treatment in young adults, chronically infected with Trypanosoma cruzi

Foi realizado o tratamento etiológico com benznidazol, no Estado de Salta, Argentina, em 14 pacientes infectados crônicos por Trypanosoma cruzi, de 18 a 30 anos de idade, com Reação em Cadeia da Polimerase (PCR) positiva. Um grupo controle de cinco pacientes, da mesma idade, também com PCR positiva, não recebeu tratamento. O seguimento após tratamento foi realizado com PCR e sorologia convencional. Após 6 meses de tratamento foi observada negativização da PCR de 14/16 (85,7por cento) nos pacientes tratados versus 20por cento no grupo controle (p=0,001). A sorologia foi positiva em todos os pacientes depois do tratamento. Os resultados da PCR pós-tratamento, podem ser um indício de cura no tratamento de infectados chagásicos crônicos, adultos jovens.