USE OF THE POLYMERASE CHAIN REACTION FOR THE DIAGNOSIS OF ASYMPTOMATIC Leishmania INFECTION IN A VISCERAL LEISHMANIASIS-ENDEMIC AREA

Silva, Luciana da; Romero, Héctor Dardo; Fagundes, Aline; Nehme, N. S.; Fernandes, O.; Rodrigues, Virmondés; Costa, Rosane Dias; Prata, Áluízio

doi:10.1590/s0036-46652013000200006

Cited by 22 publications

(21 citation statements)

References 25 publications

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“…11 However, the utility of PCR in asymptomatic HIV-co-infected patients may be of limited use because the detection of Leishmania is not always correlated with clinical disease. 33,34 In the same period, a total of six cases of symptomatic visceral leishmaniasis were confirmed by our laboratory (incidence: 0.95 cases per 100 000 inhabitants), three of the cases were found in immusuppressed patients with no documented HIV infection (one patient with ulcerative colitis treated with infliximab, one patient with giant cell arteritis treated with prednisone, and one patient with brain metastases treated with dexamethasone), and the remaining three cases occurred in patients with HIV infection and symptomatic visceral leishmaniasis.…”

Section: Discussionmentioning

confidence: 99%

Screening for subclinicalLeishmaniainfection in HIV-infected patients living in eastern Spain

Ena

Pasquau

López-Perezagua

et al. 2014

Pathogens and Global Health

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Background:We anticipated that patients with HIV infection living in endemic areas were at greater risk of infection which can reactivate due to immunosuppression; therefore, we analyzed the prevalence of latent Leishmania infantum infection in patients infected with HIV. Methods: A total of 179 patients with HIV infection were screened for the presence of anti-Leishmania antibodies using indirect immunofluorescent antibody test (IFAT) (Leishmania-spot IF; bioMé rieux, Marcy l'Etoile, France). All patients were followed up for at least 1 year. The primary end-point was to confirm the presence of Leishmania infection. Results: Significant titer of antibodies to Leishmania was detected in six (3%; 95% confidence interval: 0.5-5.5%) asymptomatic patients. Two of them had visceral leishmaniasis that was confirmed by parasite visualization in clinical samples, the presence of Leishmania promastigotes in Novy-MacNeal-Nicolle culture, polymerase chain reaction (PCR)-based methods, and/or urinary antigen test. Among 173 patients with indirect immunofluorescent antibody test below 1 : 40, one HIV-infected patient severely immunosuppressed, confirmed negative by IFAT, was diagnosed of visceral leishmaniasis. Conclusion: The use of indirect immunofluorescent antibody test for Leishmania screening is not justified in asymptomatic patients with HIV infection living in endemic areas due to the small rate of significant antibody titer and the low frequency of clinical disease.

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Section: Discussionmentioning

confidence: 99%

Screening for subclinicalLeishmaniainfection in HIV-infected patients living in eastern Spain

Ena

Pasquau

López-Perezagua

et al. 2014

Pathogens and Global Health

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“…No association was observed between the results of PCR, serological and skin tests. The authors concluded that a positive PCR result in subjects from the endemic area does not indicate a risk of progression to VL, nor is it associated with a positive result in the serological tests [58].…”

Section: Asymptomatic Cases Of Leishmania Infection and Studies On Blmentioning

confidence: 99%

Transfusion transmitted leishmaniasis. What to do with blood donors from endemic areas?

Mansueto

Seidita

Vitale

2014

Travel Medicine and Infectious Disease

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Summary Leishmaniasis clinical spectrum ranges from cryptic infection to fatal visceral leishmaniasis. Cryptic infection can be found in blood donors from areas endemic for leishmaniasis all over the world. Although leishmaniasis is a classic vector-borne disease, cases of transfusion transmitted leishmaniasis have been reported especially in nonendemic areas. Most of these cases regarded infants or children. This paper reviews the literature on this specific feature and the impact of leishmaniasis on transfusion medicine. Relevant literature was found through PubMed. The reference lists of selected articles identified further sources. Conclusions: Blood donations by emigrants or travelers from endemic areas require special attention. Routine diagnostic methods should be implemented in blood banks to exclude donors that are positive for Leishmania, and individuals who suffered from visceral leishmaniasis should be prohibited from donating blood. The use of leukodepletion filters at the time of collection should be recommended in at-risk areas especially for high-risk recipients. ª

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“…The assessment of the risk resulting from latent infection is, however, problematic as a positive blood PCR in an asymptomatic individual may not necessarily signify the presence of live parasites. PCR positivity may occasionally persist for many months after successful therapy even in immunocompetent patients and may represent a resolved clinical or subclinical infection . Also there is a concern of cross‐reactivity with Trypanosoma cruzi with use of some primers …”

Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

Leishmaniasis in solid organ and hematopoietic stem cell transplant recipients

Gajurel

Dhakal

Deresinski

2016

Clinical Transplantation

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Leishmaniasis occurs in <1% of solid organ and hematopoietic stem cell transplant recipients in endemic countries in which transplants are performed. Visceral leishmaniasis (VL) makes up the bulk of reported cases. The onset generally occurs months after transplantation and the mode of acquisition is often impossible to determine, but de novo vector-borne infection and reactivation of inapparent infection are thought to be the principal means. The potential role of clinically inapparent donor infection is uncertain and screening is not currently recommended, nor is it recommended for recipients from endemic areas, some of whom may have detectable circulating protozoan nucleic acid. While transplant recipients with VL often present with the non-specific findings of fever and cytopenia, the additional presence of hepatosplenomegaly in patients from endemic areas should lead to a directed diagnostic evaluation with bone marrow examination and PCR testing of marrow and peripheral blood having a high yield. Management may often be complicated by the presence of concomitant infections. A lipid formulation of amphotericin B is the preferred treatment, especially for VL, but the relapse rate in transplant recipients is approximately 25%. PCR monitoring of blood for either secondary prophylaxis or preemptive therapy requires further study.

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USE OF THE POLYMERASE CHAIN REACTION FOR THE DIAGNOSIS OF ASYMPTOMATIC Leishmania INFECTION IN A VISCERAL LEISHMANIASIS-ENDEMIC AREA

Cited by 22 publications

References 25 publications

Screening for subclinicalLeishmaniainfection in HIV-infected patients living in eastern Spain

Screening for subclinicalLeishmaniainfection in HIV-infected patients living in eastern Spain

Transfusion transmitted leishmaniasis. What to do with blood donors from endemic areas?

Leishmaniasis in solid organ and hematopoietic stem cell transplant recipients

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