An unidentified cluster of infection in the Peruvian Amazon region

Cornejo, A.; Gomes, Cláudia; Suárez, Luis; Martínez-Puchol, Sandra; Bustamante, Pershing; Pons, María J.; Ruiz, Joaquı́m; Valle-Mendoza, Juana del

doi:10.3855/jidc.6235

Cited by 8 publications

(6 citation statements)

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“…This problem is further enhanced by the unspecific initial symptoms of Carrion’s disease, common to a several pathologies existing in these areas, such as dengue and other arboviral diseases, malaria or tuberculosis [ 7 , 20 ]. All of this leads to misdiagnosis of patients [ 20 , 21 ] and the non treatment of asymptomatic carriers, thereby perpetuating disease transmission. The present data highlight the non-concordance between symptomatology and antibody levels.…”

Section: Discussionmentioning

confidence: 99%

Succinyl-CoA Synthetase: New Antigen Candidate of Bartonella bacilliformis

et al. 2016

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BackgroundBartonella bacilliformis is the causative agent of Carrion’s disease, a neglected illness with mortality rates of 40–85% in the absence of treatment. The lack of a diagnostic technique to overcome misdiagnosis and treat asymptomatic carriers is of note. This study aimed to identify new B. bacilliformis antigenic candidates that could lead to a new diagnostic tool able to be implemented in endemic rural areas.Methodology/Principal FindingsBlood (n = 198) and serum (n = 177) samples were collected in northern Peru. Clinical data were recorded. Specific 16S rRNA amplification by RT-PCR, IFA and ELISA for IgM/IgG with whole cells as antigens was done. Western blot analysis and N-terminal amino acid sequencing detected seroreactive proteins. ELISAs for IgM/IgG for the antigenic candidates were performed. Of the population 33.3% reported at least one symptom compatible with Carrion’s disease; 25.4% (IFA), 27.1% (ELISA-IgG), 33.9% (ELISA-IgM) and 38.9% (RT-PCR) of samples were positive. Four proteins were considered potential antigenic candidates, including two new antigenic candidates, succinyl-CoA synthetase subunit α (SCS-α) and succinyl-CoA synthetase subunit β (SCS-β). On Western blot both Pap31 and SCS-α interacted with IgM, while GroEL and SCS-β interacted with IgG. The presence of specific antibodies against the antigenic candidates varied from 34.5% (IgG against SCS-α) to 97.2% (IgM against Pap31).Conclusions/SignificanceRT-PCR and the high levels of positivity for specific ELISAs demonstrate high levels of B. bacilliformis exposure and asymptomatic carriers among inhabitants. The new antigens identified might be used as a new rapid diagnostic tool to diagnose acute Carrion’s disease and identify asymptomatic carriers.

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Section: Discussionmentioning

confidence: 99%

Succinyl-CoA Synthetase: New Antigen Candidate of Bartonella bacilliformis

et al. 2016

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“…bacilliformis and CD has yet been developed to be available for endemic areas [8]. Currently, the infection is diagnosed by blood smear but this has several limitations including low sensitivity [9–10] and diagnosis error [11]. …”

Section: Introductionmentioning

confidence: 99%

Immunosuppressive and angiogenic cytokine profile associated with Bartonella bacilliformis infection in post-outbreak and endemic areas of Carrion's disease in Peru

et al. 2017

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Analysis of immune responses in Bartonella bacilliformis carriers are needed to understand acquisition of immunity to Carrion’s disease and may allow identifying biomarkers associated with bacterial infection and disease phases. Serum samples from 144 healthy subjects from 5 villages in the North of Peru collected in 2014 were analyzed. Four villages had a Carrion’s disease outbreak in 2013, and the other is a traditionally endemic area. Thirty cytokines, chemokines and growth factors were determined in sera by fluorescent bead-based quantitative suspension array technology, and analyzed in relation to available data on bacteremia quantified by RT-PCR, and IgM and IgG levels measured by ELISA against B. bacilliformis lysates. The presence of bacteremia was associated with low concentrations of HGF (p = 0.005), IL-15 (p = 0.002), IL-6 (p = 0.05), IP-10 (p = 0.008), MIG (p = 0.03) and MIP-1α (p = 0.03). In multi-marker analysis, the same and further TH1-related and pro-inflammatory biomarkers were inversely associated with infection, whereas angiogenic chemokines and IL-10 were positively associated. Only EGF and eotaxin showed a moderate positive correlation with bacteremia. IgM seropositivity, which reflects a recent acute infection, was associated with lower levels of eotaxin (p = 0.05), IL-6 (p = 0.001), and VEGF (p = 0.03). Only GM-CSF and IL-10 concentrations were positively associated with higher levels of IgM (p = 0.01 and p = 0.007). Additionally, IgG seropositivity and levels were associated with high levels of angiogenic markers VEGF (p = 0.047) and eotaxin (p = 0.006), respectively. Our findings suggest that B. bacilliformis infection causes immunosuppression, led in part by overproduction of IL-10. This immunosuppression probably contributes to the chronicity of asymptomatic infections favoring B. bacilliformis persistence in the host, allowing the subsequent transmission to the vector. In addition, angiogenic markers associated with bacteremia and IgG levels may be related to the induction of endothelial cell proliferation in cutaneous lesions during chronic infections, being possible candidate biomarkers of asymptomatic infections.

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“…Carrion’s disease is an overlooked and restricted disease that affects the poorest populations living in remote rural areas, which badly communicated, without equipped laboratories, and with many other illnesses with a common symptomatology [ 1 ]. Thus, correct diagnosis of Carrion’s disease is essential, particularly since misdiagnosis is frequent [ 12 , 19 ]. PCR techniques rank among the most rapid techniques to diagnose B .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of PCR Approaches for Detection of Bartonella bacilliformis in Blood Samples

et al. 2016

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BackgroundThe lack of an effective diagnostic tool for Carrion’s disease leads to misdiagnosis, wrong treatments and perpetuation of asymptomatic carriers living in endemic areas. Conventional PCR approaches have been reported as a diagnostic technique. However, the detection limit of these techniques is not clear as well as if its usefulness in low bacteriemia cases. The aim of this study was to evaluate the detection limit of 3 PCR approaches.Methodology/Principal FindingsWe determined the detection limit of 3 different PCR approaches: Bartonella-specific 16S rRNA, fla and its genes. We also evaluated the viability of dry blood spots to be used as a sample transport system. Our results show that 16S rRNA PCR is the approach with a lowest detection limit, 5 CFU/μL, and thus, the best diagnostic PCR tool studied. Dry blood spots diminish the sensitivity of the assay.Conclusions/SignificanceFrom the tested PCRs, the 16S rRNA PCR-approach is the best to be used in the direct blood detection of acute cases of Carrion’s disease. However its use in samples from dry blood spots results in easier management of transport samples in rural areas, a slight decrease in the sensitivity was observed. The usefulness to detect by PCR the presence of low-bacteriemic or asymptomatic carriers is doubtful, showing the need to search for new more sensible techniques.

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An unidentified cluster of infection in the Peruvian Amazon region

Cited by 8 publications

References 14 publications

Succinyl-CoA Synthetase: New Antigen Candidate of Bartonella bacilliformis

Succinyl-CoA Synthetase: New Antigen Candidate of Bartonella bacilliformis

Immunosuppressive and angiogenic cytokine profile associated with Bartonella bacilliformis infection in post-outbreak and endemic areas of Carrion's disease in Peru

Evaluation of PCR Approaches for Detection of Bartonella bacilliformis in Blood Samples

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