Visceral leishmaniasis in immunocompromised patients with and without AIDS: a comparison of clinical features and prognosis

Fernández-Guerrero, Manuel L.; Robles, Pablo Hernando; Rivas, Pedro; Mójer, Francisca; Muñíz, Gemma; Górgolas, Miguel

doi:10.1016/j.actatropica.2003.09.009

Cited by 64 publications

(53 citation statements)

References 30 publications

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“…Bone marrow invasion can result in severe anemia, leukopenia, and thrombocytopenia (4,5). In the absence of effective treatment, persons with kala-azar become immunosuppressed and typically die, often by a secondary bacterial or other infection (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Multiplex analysis of circulating cytokines in the sera of patients with different clinical forms of visceral leishmaniasis

et al. 2006

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Background: The clinical spectrum of visceral leishmaniasis (VL), a chronic intracellular parasitic disease, ranges from a subclinical, asymptomatic infection to severe clinical disease (kala‐azar). In experimental leishmaniasis, mice that have a Th1 response to infection tend to have limited disease while a Th2 response is associated with disease progression. Humans with VL most often have mixed rather than polarized responses. However, most clinical studies have used methods that require a relatively large sample volume, thus limiting their scope. Measuring multiple cytokine levels in blood samples using a multiplexed microsphere assay (MMA) may be useful to further evaluate the Th1/Th2 paradigm in humans. Methods: Bangladeshi individuals (n = 120) living in an area endemic for VL were categorized into one of the five clinical categories. Sera from these individuals were measured for levels of IL‐2, IL‐4, IL‐5, IL‐6, IL‐8, IL‐10, IL‐12, IFN‐γ, and TNF‐α by multiplexed microsphere cytokine immunoassay. Results: Circulating IL‐8, IL‐10, and IL‐12 differed significantly among the clinical groups. Persons with kala‐azar demonstrated the highest median levels of IL‐8 and IL‐10 but lower median levels of IL‐12. Conclusions: The MMA for cytokines is an extremely time‐and sample‐efficient method for characterizing circulating cytokine levels in visceral leishmaniasis patients. © 2006 International Society for Analytical Cytology

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Section: Introductionmentioning

confidence: 99%

Multiplex analysis of circulating cytokines in the sera of patients with different clinical forms of visceral leishmaniasis

et al. 2006

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“…The most severe form of the disease in humans, visceral leishmaniosis (VL), is frequently fatal if left untreated (World Health Organization, Ready, 2010, Desjeux, 2004. Common clinical signs and clinicopathological abnormalities include organomegaly, lymphadenopathy, pyrexia, anaemia, leukopaenia and thrombocytopaenia (Fernandez-Guerrero et al, 2004, Maltezou et al, 2000, Lita et al, 2002, Papadopoulou et al, 2005. The cutaneous form of the disease is reported to be more benign and can manifest as single (Murray et al, Bongiorno et al, 2009) or multiple lesions ).…”

Section: Epidemiology In Humansmentioning

confidence: 99%

Data collection to characterise the impact of canine leishmaniosis and modelling of the role of animals in spreading Leishmania infantum within the European Union

Mattin

Brodbelt

Wylie

et al. 2014

EFSA Supporting Publications

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Canine leishmaniosis (CanL) is a major zoonosis transmitted by sand flies which can potentially cause severe fatal disease in humans and dogs. The disease is endemic in southern Europe and there are concerns about its introduction into the non-endemic areas of the European Union (EU). The objectives of this work were to investigate the efficacy of different control measures using a systematic review (SR), assess the role of dogs in the spread of Leishmania Infantum (L. infantum) in the EU and evaluate potential mitigation measures using simulation modelling, and evaluate the impact of the disease in endemic areas. The SR evaluated the effectiveness and safety of control measures for CanL using 23 clinical trials conducted on a total of 5861 dogs. Significant benefits were observed in the intervention groups for a number of vaccine types, deltamethrin collars, spot-ons, and prophylactic medication with domperidone. However, these results require confirmation in adequately powered well designed randomised controlled trials. The results of the stochastic simulation modelling suggest that there is a high risk of endemicity for disease-free EU regions with presence of a competent vector and where infected dogs are introduced. When evaluated individually and at a high level of implementation, the best mitigation measures in decreasing order of effectiveness were: repellent, vaccine, prophylactic medication and insecticide. Some combinations of mitigation measures showed a joint effect higher than the effect of individual measures. Test and exclusion of positive dogs moving into non-endemic areas was effective for low numbers of imports, but its benefits diminished as the number of imported dogs increased, given the low sensitivity of the diagnostic test used. The results of the impact assessment suggest clinical CanL is a common diagnosis in endemic parts of the EU. The estimated percentage of practice-attending dogs with a veterinary diagnosis of CanL by country was as follows: France 0.71%, Spain 3.71%, Portugal 2.92%, Italy 4.25% and Greece 7.80%. CanL can have a significant impact on the welfare of affected dogs and economic implications for owners, both for prevention and treatment. It is estimated that the use of preventative collars in these five countries cost dog owners €54 million in 2012 alone. The incidence of clinical human leishmaniosis is much lower than CanL, with reported data suggesting between 20 and 380 hospital admissions per country per year. Costs relating to hospital fees and time off work may amount to approximately €4.5million/year in Spain, Portugal, Italy and Greece. The current economic crisis is likely to have an adverse impact on the prevention and control of CanL.

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“…More than 20 Leishmania species can infect humans, with most infections due to Leishmania donovani group, specifically Leishmania infantatum [93]. In countries where leishmaniasis is endemic, such as India, Nepal, Bangladesh, and Sudan, visceral disease is more commonly encountered in immunocompetent than in immunosuppressed hosts, but disseminated infection is more common in immunosuppressed hosts [94][95][96]. Among HIV-infected people, higher HIV load is associated with higher prevalence of Leishmania coinfection, and lower CD4 + cell count is associated with visceral and disseminated forms of leishmaniasis [94,95].…”

Section: Leishmaniasismentioning

confidence: 99%

Parasitic Central Nervous System Infections in Immunocompromised Hosts: Malaria, Microsporidiosis, Leishmaniasis, and African Trypanosomiasis

Snydman¹,

Walker²,

Kublin³

et al. 2006

Clinical Infectious Diseases

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Immunosuppression associated with HIV infection or following transplantation increases susceptibility to central nervous system (CNS) infections. Because of increasing international travel, parasites that were previously limited to tropical regions pose an increasing infectious threat to populations at risk for acquiring opportunistic infection, especially people with HIV infection or individuals who have received a solid organ or bone marrow transplant. Although long-term immunosuppression caused by medications such as prednisone likely also increases the risk for acquiring infection and for developing CNS manifestations, little published information is available to support this hypothesis. In an earlier article published in Clinical Infectious Diseases, we described the neurologic manifestations of some of the more common parasitic CNS infections. This review will discuss the presentation, diagnosis, and treatment of the following additional parasitic CNS infections: malaria, microsporidiosis, leishmaniasis, and African trypanosomiasis.As detailed in our previous article [1], the risk of acquiring fungal, viral, bacterial or parasitic infection is increased in patients receiving immunosuppressive therapy after transplantation and in people with advanced HIV infection. CNS infection occurs in 5%-10% of transplant recipients and up to 19% of patients with AIDS [2]. Patients with advanced HIV infection (CD4 + cell count, <200 cells/mm 3 ) and patients who require high levels of immunosuppression because of graft rejection or graft-versus-host disease are at greater risk than others of developing opportunistic CNS infections. Although parasitic CNS infection can occur in any host, some infections are more common among patients undergoing specific types of transplantation (table 1). The clinical and radiographic manifestations of parasitic CNS infection are often similar in immunocompromised and immunocompetent hosts, but certain infections may blunt or enhance these manifestations in immunosuppressed hosts [3,4]. Although neurologic symptoms vary somewhat by infecting parasite, they are mainly determined by the location(s) of the infection within the CNS (table 2).Evaluation of the immunosuppressed host presenting with neurologic symptoms or signs of infection should be guided by (1) the degree of immunosuppression, type of transplant received,

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Visceral leishmaniasis in immunocompromised patients with and without AIDS: a comparison of clinical features and prognosis

Cited by 64 publications

References 30 publications

Multiplex analysis of circulating cytokines in the sera of patients with different clinical forms of visceral leishmaniasis

Multiplex analysis of circulating cytokines in the sera of patients with different clinical forms of visceral leishmaniasis

Data collection to characterise the impact of canine leishmaniosis and modelling of the role of animals in spreading Leishmania infantum within the European Union

Parasitic Central Nervous System Infections in Immunocompromised Hosts: Malaria, Microsporidiosis, Leishmaniasis, and African Trypanosomiasis

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