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Background Major depressive disorder (MDD) associated with chronic neglected tropical diseases (NTDs) has been identified as a significant and overlooked contributor to overall disease burden. Cutaneous leishmaniasis (CL) is one of the most prevalent and stigmatising NTDs, with an incidence of around 1 million new cases of active CL infection annually. However, the characteristic residual scarring (inactive CL) following almost all cases of active CL has only recently been recognised as part of the CL disease spectrum due to its lasting psychosocial impact. Methods and findings We performed a multi-language systematic review of the psychosocial impact of active and inactive CL. We estimated inactive CL (iCL) prevalence for the first time using reported WHO active CL (aCL) incidence data that were adjusted for life expectancy and underreporting. We then quantified the disability (YLD) burden of co-morbid MDD in CL using MDD disability weights at three severity levels. Overall, we identified 29 studies of CL psychological impact from 5 WHO regions, representing 11 of the 50 highest burden countries for CL. We conservatively calculated the disability burden of co-morbid MDD in CL to be 1.9 million YLDs, which equalled the overall (DALY) disease burden (assuming no excess mortality in depressed CL patients). Thus, upon inclusion of co-morbid MDD alone in both active and inactive CL, the DALY burden was seven times higher than the latest 2016 Global Burden of Disease study estimates, which notably omitted both psychological impact and inactive CL. Conclusions Failure to include co-morbid MDD and the lasting sequelae of chronic NTDs, as exemplified by CL, leads to large underestimates of overall disease burden.

BackgroundThe sandfly Phlebotomus papatasi is the vector of Leishmania major, the main causative agent of Old World cutaneous leishmaniasis (CL) in Saudi Arabia. Sandflies inject saliva while feeding and the salivary protein PpSP32 was previously shown to be a biomarker for bite exposure. Here we used recombinant PpSP32 to evaluate human exposure to Ph. papatasi bites, and study the association between antibody response to saliva and CL in endemic areas in Saudi Arabia.Methodology/Principal FindingsIn this observational study, anti-PpSP32 antibodies, as indicators of exposure to sandfly bites, were measured in sera from healthy individuals and patients from endemic regions in Saudi Arabia with active and cured CL. Ph. papatasi was identified as the primary CL vector in the study area. Anti-PpSP32 antibody levels were significantly higher in CL patients presenting active infections from all geographical regions compared to CL cured and healthy individuals. Furthermore, higher anti-PpSP32 antibody levels correlated with the prevalence and type of CL lesions (nodular vs. papular) observed in patients, especially non-local construction workers.ConclusionsOur findings suggest a possible correlation between the type of immunity generated by the exposure to sandfly bites and disease outcome.

Traditionally, hamsters are experimentally inoculated in the snout or the footpad. However in these sites an ulcer not always occurs, measurement of lesion size is a hard procedure and animals show difficulty to eat, breathe and move because of the lesion. In order to optimize the hamster model for cutaneous leishmaniasis, young adult male and female golden hamsters (Mesocricetus auratus) were injected intradermally at the dorsal skin with 1 to 1.5 x l0 7 promastigotes of Leishmania species and progression of subsequent lesions were evaluated for up to 16 weeks post infection. The golden hamster was selected because it is considered the adequate bio-model to evaluate drugs against Leishmania as they are susceptible to infection by different species. Cutaneous infection of hamsters results in chronic but controlled lesions, and a clinical evolution with signs similar to those observed in humans. Therefore, the establishment of the extent of infection by measuring the size of the lesion according to the area of indurations and ulcers is feasible. This approach has proven its versatility and easy management during inoculation, follow up and characterization of typical lesions (ulcers), application of treatments through different ways and obtaining of clinical samples after different treatments. By using this method the quality of animal life regarding locomotion, search for food and water, play and social activities is also preserved. Video LinkThe video component of this article can be found at http://www.jove.com/video/3533/ Protocol 1. Infection of Hamsters AnimalsInbred female and male golden hamsters (Mesocricetus auratus), 6-8 weeks, weighing 140-160 g are used. They are housed at the animal facility, in temperature-controlled accommodation, fed with standard rodent dried food and provided with water ad libitum. All the procedures involving animals are approved by the institutional Ethical Committee for Experimental Animal Use. Before experimental infection with dermotropic Leishmania parasites animals are sexed, marked and weighted according to standardized procedures. For sexing, animals are inspected for distinctive features such as the visualization of the mammary line and the short ano-genital distance in females, or the visualization of testicles and a greater distance between the anus and foreskin in males. Then, animals are marked by ear piercing or by staining an area of the skin with a swab soaked in picric acid. For ear perforation, after clean with 70% alcohol the ear is pierced using an ear punch for rodents. A region with blood vessels must be avoided. Sedation or anesthesia with a mixture 9:1 of Ketamine (50 mg/kg) and Xilacine (20 mg/kg) intraperitoneally in a volume of 260-300μl 25-G needle is recommended. Finally, animals are weighed by placing them in a trap or box that is conditioned on a precision balance. ParasitesPromastigotes of dermotropic Leishmania species, such as L. amazonensis, are cultured in biphasic Novy-MacNeal-Nicolle (NNN) culture medium at 26°C. Metacyclic (station...

Introducción. Diversos estudios a nivel taxonómico y molecular sugieren que Lutzomyia longipalpis, principal vector de la leishmaniasis visceral en Latinoamérica, es un complejo de especies con amplia distribución a lo largo del continente y con adaptaciones a diferentes hábitats. Objetivo. Realizar vigilancia entomológica en el área de influencia de la hidroeléctrica Miel I. Materiales y métodos. Se utilizaron trampas adhesivas en una intersección de 400 km, aproximadamente, para la captura de insectos, los cuales fueron identificados con la clave taxonómica de Young y Duncan. Resultados. En este estudio se reporta la presencia de Lu. longipalpis en los municipios de Norcasia a una altitud de 392 msnm y en Marquetalia a 1.387 msnm; es el primer reporte a esta altura para esta especie en Colombia. Conclusiones. Se sugiere que la ampliación de la distribución geográfica y altitudinal de Lu. longipalpis en el país podría estar relacionada con la existencia del complejo de especies Lu. longipalpis, o a factores ambientales como el aumento de temperatura debido al cambio climático global que viene sucediendo en las últimas décadas. Esta última hipótesis sugeriría que se están creando nuevos hábitats propicios para el establecimiento de Lu. longipalpis, lo cual genera un nuevo riesgo epidemiológico de posibles nuevos focos de leishmaniasis visceral en el país. Introduction: Diverse taxonomical and molecular studies suggest that Lutzomyia longipalpis, main vector of visceral leishmaniasis in Latin America, is a complex of species widely distributed throughout the continent and adapted to different habitats. Objective: To carry out entomological surveillance in the area of influence of the Miel I Hydroelectric Plant. Materials and methods: Adhesive traps were used in a transect covering an area of approximately 400 km for the capture of insects, which were then identified using the Young and Duncan taxonomical key. Results: This study reports the presence of Lutzomyia longipalpis in the municipalities of Norcasia at an altitude of 392 masl, and in Marquetalia at 1,387 masl. Conclusions: We suggest that the increase in the geographical and altitudinal distribution could be related to the existence of the Lu. longipalpis species complex, or to environmental factors, such as the rise in temperature due to global climate changes, which create the establishment of Lu. longipalpis, generating a new epidemiological risk for new visceral leishmaniasis foci in the country.