Asymptomatic Visceral Leishmania infantum Infection in US Soldiers Deployed to Iraq

Mody, Rupal; Lakhal-Naouar, Inès; Sherwood, Jeffrey E.; Koles, Nancy L.; Shaw, Dutchabong; Bigley, Daniel P; Co, Edgie-Mark A.; Copeland, Nathanial K.; Jagodzinski, Linda L.; Mukbel, Rami; Smiley, Rebecca; Duncan, Robert C.; Kamhawi, Shaden; Jerônimo, Selma M. B.; DeFraites, Robert F.; Aronson, Naomi

doi:10.1093/cid/ciy811

Cited by 26 publications

(34 citation statements)

References 59 publications

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“…shannoni is a competent vector [ 20 ]. A potential concern is the recent identification that 19.5% of Iraq-deployed American soldiers have blood testing which suggests that they have asymptomatic visceral leishmaniasis, including 1% with parasitemia as measured by polymerase chain reaction, persisting up to a decade after return to the U.S. [ 2 ]. With over 2.7 million persons having deployed to Iraq and Afghanistan in the past two decades, combined with general immigration from global VL endemic areas to the U.S., there could exist reservoirs for further transmission within North America.…”

Section: Human Leishmaniasis: Epidemiology In the United Statesmentioning

confidence: 99%

“…During the Persian Gulf War (1990–1992) Saudi Arabia deployment, eight servicemembers developed oligosymptomatic (so-called viscerotropic) leishmaniasis identified as due to Leishmania tropica [ 52 ], and in the more recent conflicts in Iraq and Afghanistan, 25 additional servicemembers have been diagnosed with active VL due to Leishmania infantum [ 1 , 53 ]. Additionally, 39 of 200 (19.5%) tested soldiers were found to have asymptomatic VL after deployment to Iraq, a diagnosis made using a combination of serology, blood PCR, and/or interferon gamma release assay (IGRA), suggesting that many thousands of returned soldiers may be persistently infected [ 2 ].…”

Section: Human Leishmaniasis: Epidemiology In the United Statesmentioning

confidence: 99%

“…Leishmaniasis is more common in the United States (U.S.) than most Americans realize, involving both autocthonous and imported infections. The recent deployment of millions of Americans to Iraq and Afghanistan has been associated with thousands of cases of cutaneous leishmaniasis (CL) [ 1 ], but even more concerning is the likelihood of large numbers of persons with unrecognized asymptomatic visceral leishmaniasis (VL) [ 2 ]. In this review, we will summarize the known epidemiology of leishmaniasis in the U.S., and then focus on a few emerging issues.…”

Section: Introductionmentioning

confidence: 99%

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Leishmaniasis in the United States: Emerging Issues in a Region of Low Endemicity

Curtin

Aronson

2021

Microorganisms

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Leishmaniasis, a chronic and persistent intracellular protozoal infection caused by many different species within the genus Leishmania, is an unfamiliar disease to most North American providers. Clinical presentations may include asymptomatic and symptomatic visceral leishmaniasis (so-called Kala-azar), as well as cutaneous or mucosal disease. Although cutaneous leishmaniasis (caused by Leishmania mexicana in the United States) is endemic in some southwest states, other causes for concern include reactivation of imported visceral leishmaniasis remotely in time from the initial infection, and the possible long-term complications of chronic inflammation from asymptomatic infection. Climate change, the identification of competent vectors and reservoirs, a highly mobile populace, significant population groups with proven exposure history, HIV, and widespread use of immunosuppressive medications and organ transplant all create the potential for increased frequency of leishmaniasis in the U.S. Together, these factors could contribute to leishmaniasis emerging as a health threat in the U.S., including the possibility of sustained autochthonous spread of newly introduced visceral disease. We summarize recent data examining the epidemiology and major risk factors for acquisition of cutaneous and visceral leishmaniasis, with a special focus on implications for the United States, as well as discuss key emerging issues affecting the management of visceral leishmaniasis.

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Section: Human Leishmaniasis: Epidemiology In the United Statesmentioning

confidence: 99%

Section: Human Leishmaniasis: Epidemiology In the United Statesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Leishmaniasis in the United States: Emerging Issues in a Region of Low Endemicity

Curtin

Aronson

2021

Microorganisms

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“…Several tests including ELISA, rK39, and Real-Time PCR were used to test blood samples, and a detailed risk factor survey was conducted for the study. Nearly 20% of the soldiers tested positive for asymptomatic VL, and those who were deployed to the Ninewa governorate showed a strong association with infection [ 196 ]. Furthermore, to assess the disease risk associated with the movement of host reservoirs and/or vectors, a quantitative risk assessment can be performed [ 188 ].…”

Section: Use Of Diagnostic Tools In Epidemiological Studiesmentioning

confidence: 99%

One Health Approach to Leishmaniases: Understanding the Disease Dynamics through Diagnostic Tools

et al. 2020

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Leishmaniases are zoonotic vector-borne diseases caused by protozoan parasites of the genus Leishmania that affect millions of people around the globe. There are various clinical manifestations, ranging from self-healing cutaneous lesions to potentially fatal visceral leishmaniasis, all of which are associated with different Leishmania species. Transmission of these parasites is complex due to the varying ecological relationships between human and/or animal reservoir hosts, parasites, and sand fly vectors. Moreover, vector-borne diseases like leishmaniases are intricately linked to environmental changes and socioeconomic risk factors, advocating the importance of the One Health approach to control these diseases. The development of an accurate, fast, and cost-effective diagnostic tool for leishmaniases is a priority, and the implementation of various control measures such as animal sentinel surveillance systems is needed to better detect, prevent, and respond to the (re-)emergence of leishmaniases.

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“…For example, some authors developed qPCR assay for New World species [ 15 , 16 ], while some others tested their primers in Old World species [ 17 , 18 ]. Since different reports describe the infection in travelers [ 19 , 20 ] and in military personnel operating in country endemic for leishmaniasis [ 21 , 22 , 23 ], the availability of a rapid pan -Leishmania assay, highly sensitive and able to provide a quantification and a partial classification, can certainly be useful. Moreover, a pan- Leishmania assay can also be exploited in eco-epidemiological studies, including identification of vectors and reservoirs [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a kDNA-Based qPCR Assay for the Detection and Quantification of Old World Leishmania Species

et al. 2020

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The parasite protozoan Leishmania, the causative agent of leishmaniasis, includes two subgenera of medical interest: Leishmania (Leishmania) and Leishmania (Viannia). Parasite species detection and characterization is crucial to choose treatment protocols and to monitor the disease evolution. Molecular approaches can speed up and simplify the diagnostic process. In particular, several molecular assays target the mitochondrial DNA minicircle network (kDNA) that characterizes the Leishmania genus. We previously proposed a qPCR assay targeting kDNA, followed by high resolution melt (HRM) analysis (qPCR-ML) to distinguish L. (L.) infantum and L. (L.) amazonensis from L. Viannia species. Successively, this assay has been integrated with other qPCR assays, to differentiate L. (L.) infantum, L. (L.) amazonensis and L. (L.) mexicana. In this work, we tested the applicability of our qPCR-ML assay on L. (L.) donovani, L. (L.) major, L. (L.) tropica and L. (L.) aethiopica, showing that the qPCR-ML assay can also amplify Old World species, different from L. (L.) infantum, with good quantification limits (1 × 10−4–1 × 10−6 ng/pcr tube). Moreover, we evaluated 11 L. (L.) infantum strains/isolates, evidencing the variability of the kDNA minicircle target molecules among the strains/isolates of the same species, and pointing out the possibility of quantification using different strains as reference. Taken together, these data account for the consideration of qPCR-ML as a quantitative pan-Leishmania assay.

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Asymptomatic Visceral Leishmania infantum Infection in US Soldiers Deployed to Iraq

Abstract: AVL was identified in 19.5 % of OIF deployers and travel to northwest Iraq correlated with infection. Further studies are needed to inform risk for reactivation VL in U.S. veterans and to target additional blood safety and surveillance measures.

Cited by 26 publications

References 59 publications

Leishmaniasis in the United States: Emerging Issues in a Region of Low Endemicity

Leishmaniasis in the United States: Emerging Issues in a Region of Low Endemicity

One Health Approach to Leishmaniases: Understanding the Disease Dynamics through Diagnostic Tools

Evaluation of a kDNA-Based qPCR Assay for the Detection and Quantification of Old World Leishmania Species

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