Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)

Aronson, Naomi; Herwaldt, Barbara L.; Libman, Michael; Pearson, Richard D.; López‐Vélez, Rogelio; Weina, Peter J.; Carvalho, Edgar M.; Ephros, Moshe; Jerônimo, Selma M. B.; Magill, Alan J.

doi:10.1093/cid/ciw670

Cited by 272 publications

(170 citation statements)

References 459 publications

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“…Treat mucocutaneous and complex cutaneous leishmaniasis with daily intravenous sodium stibogluconate (20 mg/kg) for 20 days 1. Complex cutaneous leishmaniasis features more than four lesions, where lesion diameter is >50 mm or >1 cm in cosmetically or functionally sensitive areas such as face or joints; where there is large regional adenopathy or local subcutaneous nodules; the host is immunocompromised; and the condition is unresponsive to simple treatment 12…”

Section: Discussionmentioning

confidence: 99%

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An ulcer that will not heal

Clegg

Hall

Lockwood

2018

BMJ

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Section: Discussionmentioning

confidence: 99%

“…Treat simple cutaneous leishmaniasis lesions with weekly intralesional injections of sodium stibogluconate, and complex cutaneous leishmaniasis with daily intravenous sodium stibogluconate (20 mg/kg) for 20 days 12…”

Section: Answersmentioning

confidence: 99%

An ulcer that will not heal

Clegg

Hall

Lockwood

2018

BMJ

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“…eishmaniasis is endemic in the tropics, subtropics, and southern Europe and encompasses diverse clinical syndromes, including cutaneous, mucosal, and potentially life-threatening visceral forms (1)(2)(3)(4). Overall, leishmaniasis in humans is caused by ϳ20 Leishmania spp.…”

mentioning

confidence: 99%

“…in the subgenera Viannia and Leishmania; Ͼ1 species may be found in the same geographic region. Species identification often has clinical relevance, such as implications regarding whether and which treatment is indicated and whether and how to monitor for potential sequelae of the infection (e.g., mucosal leishmaniasis, which is typically caused by New World species in the Viannia subgenus, particularly, but not only, by Leishmania [Viannia] braziliensis in certain geographic regions) (1,(3)(4)(5)(6)(7).…”

mentioning

confidence: 99%

“…in human clinical specimens using parasitologic and molecular techniques. In contrast to the traditional parasitologic approach for Leishmania species identification (in vitro culture of parasites followed by isoenzyme analysis [multilocus enzyme electrophoresis]), molecular approaches are typically more sensitive, less labor-intensive, and more rapid (i.e., they provide results within days rather than weeks or months) (4,(8)(9)(10)(11). The sensitivity, specificity, and utility of DNA-based methods for genus-, subgenus/ complex-, and species-level characterization of Leishmania parasites have been discussed extensively (10)(11)(12)(13)(14)(15)(16).…”

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Detection and Differentiation of Leishmania spp. in Clinical Specimens by Use of a SYBR Green-Based Real-Time PCR Assay

et al. 2017

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Leishmaniasis in humans is caused by Leishmania spp. in the subgenera Leishmania and Viannia. Species identification often has clinical relevance. Until recently, our laboratory relied on conventional PCR amplification of the internal transcribed spacer 2 (ITS2) region (ITS2-PCR) followed by sequencing analysis of the PCR product to differentiate Leishmania spp. Here we describe a novel real-time quantitative PCR (qPCR) approach based on the SYBR green technology (LSG-qPCR), which uses genus-specific primers that target the ITS1 region and amplify DNA from at least 10 Leishmania spp., followed by analysis of the melting temperature (T m ) of the amplicons on qPCR platforms (the Mx3000P qPCR system [Stratagene-Agilent] and the 7500 real-time PCR system [ABI Life Technologies]). We initially evaluated the assay by testing reference Leishmania isolates and comparing the results with those from the conventional ITS2-PCR approach. Then we compared the results from the real-time and conventional molecular approaches for clinical specimens from 1,051 patients submitted to the reference laboratory of the Centers for Disease Control and Prevention for Leishmania diagnostic testing. Specimens from 477 patients tested positive for Leishmania spp. with the LSG-qPCR assay, specimens from 465 of these 477 patients also tested positive with the conventional ITS2-PCR approach, and specimens from 10 of these 465 patients had positive results because of retesting prompted by LSG-qPCR positivity. On the basis of the T m values of the LSG-qPCR amplicons from reference and clinical specimens, we were able to differentiate four groups of Leishmania parasites: the Viannia subgenus in aggregate; the Leishmania

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Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

2018

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IMPORTANCE Leishmaniasis is recognized as an endemic human disease in Africa, the Middle East, Asia, and South America. Yet despite case reports of endemic human leishmaniasis in the United States, and well-documented occurrences of disease in various animal vectors and reservoirs, the endemicity of leishmaniasis in North America has not yet been established. Moreover, leishmaniasis is not a federally reportable disease in the United States. Clinical awareness of endemic disease therefore remains low, with North American physicians considering leishmaniasis a tropical disease. OBJECTIVE To assess the endemicity of human leishmaniasis in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional multicenter observational study reviewed cases of human leishmaniasis occurring in the United States from 2007 through 2017. Previously diagnosed, deidentified cases of leishmaniasis were reported by the institutions of the authors and acknowledged contributors, as well as the Texas Department of State Health Services. Cases of leishmaniasis were identified by searching by disease name (leishmaniasis) or International Classification of Diseases, 9th and 10th Revisions diagnosis codes in the respective laboratory information systems. EXPOSURES Via examination of deidentified demographics, cases of leishmaniasis were classified as one of the following: (1) documentation of no history of travel outside of the United States within 10 years; (2) positive history of travel outside of the United States within 10 years; or (3) unknown or no documentation of travel history. MAIN OUTCOMES AND MEASURES Cases of leishmaniasis were considered endemic if identified in patients with documentation of no travel history outside of the United States within 10 years. RESULTS Of the 69 novel cases of human cutaneous leishmaniasis identified in this study, 41 (59%) were endemic; the median age at diagnosis was 61 years (range, 3-89 years), and 28 (68%) of the endemic cases occurred in female patients. Twenty-two (32%) cases had documentation of Leishmania speciation performed by polymerase chain reaction, and in 100% of these cases the infectious organism was identified as Leishmania mexicana. CONCLUSIONS AND RELEVANCE Human cutaneous leishmaniasis is endemic in the United States, and, at least regionally, is acquired endemically more frequently than it is via travel. Our data argue in favor of making leishmaniasis a federally reportable disease and may have substantial implications on North American public health initiatives, with climate models predicting the number of citizens exposed to leishmaniasis will double by 2080.

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Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)

Cited by 272 publications

References 459 publications

An ulcer that will not heal

An ulcer that will not heal

Detection and Differentiation of Leishmania spp. in Clinical Specimens by Use of a SYBR Green-Based Real-Time PCR Assay

Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

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