Role of molecular approaches to distinguish post kala-azar dermal leishmaniasis from leprosy: A case study

Roy, Sutopa; Roy, Madhurima; Nath, Shankha; Chaudhuri, Surya Jyati; Ghosh, Manab Kumar; Mukherjee, Souvik; Chatterjee, Mitali

doi:10.25259/ijdvl_415_2022

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…Another challenge is that the clinical features of macular PKDL are practically indistinguishable from those of other hypopigmentary dermatoses prevalent in the same geographical area, including leprosy, another neglected tropical disease, 24 pityriasis versicolor, 25 and rarely even vitiligo. 26 Additionally, most hypopigmentary disorders have a considerable component of social rejection, and women who presently comprise almost 50% of PKDL cases 5 are often reluctant to enter the treatment fold.…”

Section: Discussionmentioning

confidence: 99%

Monitoring the Long-Term Effectiveness of Miltefosine in Indian Post-Kala-Azar Dermal Leishmaniasis

Roy,

Moulik,

Roy

et al. 2024

The American Journal of Tropical Medicine and Hygiene

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Post-kala-azar dermal leishmaniasis (PKDL), the dermal sequel to visceral leishmaniasis (VL), is characterized by hypopigmented macules (macular) and/or papules and nodules (polymorphic). Post-kala-azar dermal leishmaniasis plays a significant role in disease transmission, emphasizing the need for monitoring chemotherapeutic effectiveness. Accordingly, this study aimed to quantify the parasite burden in PKDL patients after treatment with miltefosine by a quantitative polymerase chain reaction (qPCR). A Leishmania kinetoplastid gene-targeted qPCR was undertaken using DNA from skin biopsy specimens of patients with PKDL at three time points, i.e., at disease presentation (week 0, n = 157, group 1), upon completion of treatment (week 12, n = 39, group 2), and at any time point 6 months after completion of treatment (week ≥ 36, n = 54, group 3). A cycle threshold (Ct) < 30 was considered the cutoff for positivity, and load was quantified as the number of parasites/µg genomic DNA (gDNA); cure was considered when samples had a Ct > 30. The parasite load at disease presentation (group 1) was 10,769 (1,339–80,441)/µg gDNA (median [interquartile range]). In groups 2 and 3, qPCR results were negative in 35/39 cases (89.7%) and 48/54 cases (88.8%), respectively. In the 10/93 (10.8%) qPCR-positive cases, the parasite burdens in groups 2 and 3 were 2,420 (1,205–5,661)/µg gDNA and 22,195 (5,524–100,106)/µg gDNA, respectively. Serial monitoring was undertaken in 45 randomly selected cases that had completed treatment; all cases in groups 2 or 3 had a Ct > 30, indicating cure. Overall, qPCR confirmed an 89.2% cure (as 83/93 cases showed parasite clearance), and the persistent qPCR positivity was attributed to nonadherence to treatment or unresponsiveness to miltefosine and remains to be investigated.

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Section: Discussionmentioning

confidence: 99%

Monitoring the Long-Term Effectiveness of Miltefosine in Indian Post-Kala-Azar Dermal Leishmaniasis

Roy,

Moulik,

Roy

et al. 2024

The American Journal of Tropical Medicine and Hygiene

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Portable smartphone-based molecular test for rapid detection of Leishmania spp.

Kobialka,

Ceruti,

Roy

et al. 2024

Infection

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Purpose Leishmaniasis, caused by the parasite of the genus Leishmania, is a neglected tropical disease which is endemic in more than 60 countries. In South-East Asia, Brazil, and East Africa, it mainly occurs as kala-azar (visceral leishmaniasis, VL), and subsequently as post kala-azar dermal leishmaniasis (PKDL) in a smaller portion of cases. As stated per WHO roadmap, accessibility to accurate diagnostic methods is an essential step to achieve elimination. This study aimed to test the accuracy of a portable minoo device, a small battery-driven, multi-use fluorimeter operating with isothermal technology for molecular diagnosis of VL and PKDL. Methods Fluorescence data measured by the device within 20 min are reported back to the mobile application (or app) via Bluetooth and onward via the internet to a backend. This allows anonymous analysis and storage of the test data. The test result is immediately returned to the app displaying it to the user. Results The limit of detection was 11.2 genome copies (95% CI) as determined by screening a tenfold dilution range of whole Leishmania donovani genomes using isothermal recombinase polymerase amplification (RPA). Pathogens considered for differential diagnosis were tested and no cross-reactivity was observed. For its diagnostic performance, DNA extracted from 170 VL and PKDL cases, comprising peripheral blood samples (VL, n = 96) and skin biopsies (PKDL, n = 74) from India (n = 108) and Bangladesh (n = 62), was screened. Clinical sensitivity and specificity were 88% and 91%, respectively. Conclusion Minoo devices can offer a convenient, cheaper alternative to other molecular diagnostics. Its easy handling makes it ideal for use in low-resource settings to identify parasite burden.

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Immune dysregulation and inflammation causing hypopigmentation in post kala-azar dermal leishmaniasis: partners in crime?

Sengupta

Roy

Dey

et al. 2023

Trends in Parasitology

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Role of molecular approaches to distinguish post kala-azar dermal leishmaniasis from leprosy: A case study

Cited by 3 publications

References 10 publications

Monitoring the Long-Term Effectiveness of Miltefosine in Indian Post-Kala-Azar Dermal Leishmaniasis

Monitoring the Long-Term Effectiveness of Miltefosine in Indian Post-Kala-Azar Dermal Leishmaniasis

Portable smartphone-based molecular test for rapid detection of Leishmania spp.

Immune dysregulation and inflammation causing hypopigmentation in post kala-azar dermal leishmaniasis: partners in crime?

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