Control of mucocutaneous leishmaniasis, a neglected disease: results of a control programme in Satipo Province, Peru.

Mucocutaneous leishmaniasis (MCL) is an important health problem in many rural areas of Latin America, but there are few data on the results of programmatic approaches to control the disease. We report the results of a control programme in San Martin de Pangoa District, which reports one of the highest prevalences of MCL in Peru. For 2 years (2001--2002), the technicians at the health post were trained in patient case management, received medical support and were supplied with antimonials. An evaluation after 2 years showed the following main achievements: better diagnosis of patients, who were confirmed by microscopy in 34% (82/240) of the cases in 2001 and 60% of the cases (153/254) in 2002; improved follow-up during treatment: 237 of 263 (90%) patients who initiated an antimonial therapy ended the full treatment course; improved follow-up after treatment: 143 of 237 (60%) patients who ended their full treatment were correctly monitored during the required period of 6 (cutaneous cases) or 12 (mucosal cases) months after the end of treatment. These achievements were largely due to the human and logistical resources made available, the constant availability of medications and the close collaboration between the Ministry of Health, a national research institute and an international non-governmental organization. At the end of this period, the health authorities decided to register a generic brand of sodium stibogluconate, which is now in use. This should allow the treatment of a significant number of additional patients, while saving money to invest in other facets of the case management

Leishmania isoenzyme polymorphisms in Ecuador: Relationships with geographic distribution and clinical presentation

Background: Determinants of the clinical presentation of the leishmaniases are poorly understood but Leishmania species and strain differences are important. To examine the relationship between clinical presentation, species and isoenzyme polymorphisms, 56 Leishmania isolates from distinct presentations of American tegumentary leishmaniasis (ATL) from Ecuador were analyzed. Methods: Isolates were characterized by multilocus enzyme electrophoresis for polymorphisms of 11 isoenzymes. Patients were infected in four different ecologic regions: highland and lowland jungle of the Pacific coast, Amazonian lowlands and Andean highlands. Results: Six Leishmania species constituting 21 zymodemes were identified: L. (Viannia) panamensis (21 isolates, 7 zymodemes), L. (V.) guyanensis (7 isolates, 4 zymodemes), L. (V.) braziliensis (5 isolates, 3 zymodemes), L. (Leishmania) mexicana (11 isolates, 4 zymodemes), L. (L.) amazonensis (10 isolates, 2 zymodemes) and L. (L.) major (2 isolates, 1 zymodeme). L. panamensis was the species most frequently identified in the Pacific region and was associated with several clinical variants of cutaneous disease (CL); eight cases of leishmaniasis recidiva cutis (LRC) found in the Pacific highlands were associated with 3 zymodemes of this species. Mucocutaneous leishmaniasis found only in the Amazonian focus was associated with 3 zymodemes of L. braziliensis. The papular variant of CL, Uta, found in the Andean highlands was related predominantly with a single zymodeme of L. mexicana. Conclusion: Our data show a high degree of phenotypic variation within species, and some evidence for associations between specific variants of ATL (i.e. Uta and LRC) and specific Leishmania zymodemes. This study further defines the geographic distribution of Leishmania species and clinical variants of ATL in Ecuador

Leishmaniasis: new approaches to disease control.

The leishmaniases afflict the world's poorest populations. Among the two million new cases each year in the 88 countries where the disease is endemic (fig 1), it is estimated that 80% earn less than $2 a day. Human infections with Leishmania protozoan parasites, transmitted via the bite of a sandfly, cause visceral, cutaneous, or mucocutaneous leishmaniasis. The global burden of leishmaniasis has remained stable for some years, causing 2.4 million disability adjusted life years (DALYs) lost and 59 000 deaths in 2001. Neglected by researchers and funding agencies, leishmaniasis control strategies have varied little for decades, but in recent years there have been exciting advances in diagnosis, treatment, and prevention. These include an immunochromatographic dipstick for diagnosing visceral leishmaniasis; the licensing of miltefosine, the first oral drug for visceral leishmaniasis; and evidence that the incidence of zoonotic visceral leishmaniasis in children can be reduced by providing dogs with deltamethrin collars. There is also hope that the first leishmaniasis vaccine will become available within a decade. Here we review these developments and identify priorities for research

Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru.

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using

Native rodent species are unlikely sources of infection for Leishmania (Viannia) braziliensis along the Transoceanic Highway in Madre de Dios, Peru.

An estimated 2.3 million disability-adjusted life years are lost globally from leishmaniasis. In Peru's Amazon region, the department of Madre de Dios (MDD) rises above the rest of the country in terms of the annual incidence rates of human leishmaniasis. Leishmania (Viannia) braziliensis is the species most frequently responsible for the form of disease that results in tissue destruction of the nose and mouth. However, essentially nothing is known regarding the reservoirs of this vector-borne, zoonotic parasite in MDD. Wild rodents have been suspected, or proven, to be reservoirs of several Leishmania spp. in various ecosystems and countries. Additionally, people who live or work in forested terrain, especially those who are not regionally local and whose immune systems are thus naïve to the parasite, are at most risk for contracting L. (V.) braziliensis. Hence, the objective of this study was to collect tissues from wild rodents captured at several study sites along the Amazonian segment of the newly constructed Transoceanic Highway and to use molecular laboratory techniques to analyze samples for the presence of Leishmania parasites. Liver tissues were tested via polymerase chain reaction from a total of 217 rodents; bone marrow and skin biopsies (ear and tail) were also tested from a subset of these same animals. The most numerous rodent species captured and tested were Oligoryzomys microtis (40.7%), Hylaeamys perenensis (15.7%), and Proechimys spp. (12%). All samples were negative for Leishmania, implying that although incidental infections may occur, these abundant rodent species are unlikely to serve as primary reservoirs of L. (V.) braziliensis along the Transoceanic Highway in MDD. Therefore, although these rodent species may persist and even thrive in moderately altered landscapes, we did not find any evidence to suggest they pose a risk for L. (V.) braziliensis transmission to human inhabitants in this highly prevalent region

Leishmaniasis in the Argentine Republic: Temporal and geographical distribution from 2013 to 2017

ARTÍCULO PUBLICADO EN REVISTA EXTERNA. Objective: To assess the temporal and geographical distribution of confirmed cases of cutaneous, mucocutaneous and visceral leishmaniasis in the Argentine Republic from 2013 to 2017. Methods: A retrospective study was carried out using data collected from the Integrated Surveillance Bulletin database of the National System of Health Surveillance. Confirmed cases of cutaneous, mucocutaneous and visceral leishmaniasis up to the 52nd epidemiological week of each year was included. Results: In the 5 years period, 1 295 confirmed leishmaniasis cases were reported in the Argentine Republic. One thousand twenty-eight (1 028) cases corresponded to cutaneous leishmaniasis (87.10%), being the most common type of leishmaniasis. Mucocutaneous leishmaniasis was in the second place in the country with 115 cases reported, mostly in the Northwest and Northeast regions. A total of 52 individuals with visceral leishmaniasis were identified and Misiones Province was the most affected. Conclusions: It is important to analyze the temporal and geographical distribution of leishmaniasis in order to provide an adequate management and surveillance

Custo-efetividade de estratégias de prevenção contra a leishmaniose tegumentar americana na Argentina

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.Fil: Orellano, Pablo Wenceslao. Ministerio de Salud de Misiones. Instituto Nacional de Medicina Tropical; Argentina;Fil: Vazquez, n. Universidad de Buenos Aires. Facultad de Medicina; Argentina;Fil: Salomon, Oscar Daniel. Ministerio de Salud de Misiones. Instituto Nacional de Medicina Tropical; Argentina

Antiprotozoal activity of flavonoids from Eupatorium arnottianum

Dichloromethane and ethanol extracts of Eupatorium arnottianum were evaluated for invitroleishmanicidal activity. The dichloromethane extract produced 80% and 85% of growthinhibition on both Leishmania mexicana and Leishmania amazonensis promastigotes respectively,at a concentration of 100 μg/mL. At the same concentration, the ethanol extract inhibited thegrowth of L. mexicana and L. amazonensis promastigotes in 62% and 65% respectively. Bioassayguidedfractionation of these extracts led to the isolation and identification of flavonoids nepetin,eupatilin, jaceosidin, eriodictyol and hyperoside as bioactive compounds against both species ofLeishmania with IC50 values <10 μg/mL, with nepetin being the most active compound againstboth Leishmania species (IC50 values <2 μg/mL). On Trypanosoma cruzi epimastigotes, jaceosidin,eupatilin and nepetin were found to be the most active flavonoids, with IC50 values 0.06, 0.89 and2.94 μg/mL respectively. It was observed by transmission electron microscopy that eupatilin andjaceosidin induced intense cytoplasmic vacuolization on L. mexicana promastigotes, followedby parasite destruction. Nepetin induced a mild vacuolization, although the morphology ofparasites was preserved. On T. cruzi epimastigotes, eupatilin and jaceosidin induced a moderatevacuolization and some kinetoplast swelling while nepetin did not induce any significant effectson parasites. At the ultrastructural level, the differential effects of eupatilin and jaceosidin onboth trypanosomatids may indicate that these molecules affect selectively certain targets onLeishmania spp. We conclude that plants from the Eupatorium genus could be an importantsource of compounds (flavonoids) with leishmanicidal and trypanocidal activity, thus constitutingan interesting option for the treatment of parasitic diseases.Fil: Clavin, Maria Liliana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Metabolismo del Fármaco. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Metabolismo del Fármaco; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Farmacología. Cátedra de Farmacognosia; ArgentinaFil: Cazorla, Silvia Ines. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Inmunología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; ArgentinaFil: Spina Zapata, Renata María. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Cienicas Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; ArgentinaFil: Sosa, Miguel Angel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Cienicas Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; ArgentinaFil: Malchiodi, Emilio Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Inmunología; ArgentinaFil: Martino, Virginia Susana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Metabolismo del Fármaco. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Metabolismo del Fármaco; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Farmacología. Cátedra de Farmacognosia; ArgentinaFil: Frank, Fernanda María. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Inmunología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; ArgentinaFil: Muschietti, Liliana Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Metabolismo del Fármaco. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Metabolismo del Fármaco; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Farmacología. Cátedra de Farmacognosia; Argentin

Review and new therapeutic alternatives for the treatment of cutaneous Leishmaniasis

Podeu consultar el llibre complet a: http://hdl.handle.net/2445/63704Leishmaniasis comprises a group of diseases caused by protozoa of the genus Leishmania and has two basic clinical forms, visceral Leishmaniasis and cutaneous Leishmaniasis. The clinical features of Leishmaniasis depend on the species of Leishmania, the interaction between host and parasite and the immune response. This work focuses on cutaneous leishmaniosis because although it is not a deadly disease it results in significant scars and facial disfigurements, thus being clinically important. Furthermore, the first-line treatment consists of intravenous or intramuscular administration of intralesional pentavalent antimonials, which are highly toxic, making hospitalization of patients compulsory during treatment, with the associated financial costs. Herein, we review studies on drugs and treatments with fewer side effects and easier routes of administration such as topical administration. Recent research shows that the topical route of administration holds promise for the future treatment of cutaneous leishmaniosis

Mucocutaneous leishmaniasis: case report and literature review of a rare endonasal infection

Leishmaniasis is a protozoal infection transmittedby a sandfly vector. In Germany, leishmaniasis ofthe mucous membranes is a rare condition andusually due to extension of local skin disease intothe mucosal tissue via direct extension,bloodstream or lymphatics. We report a case ofendonasal leishmaniasis in a female Germanresident who presented in a university hospitalwith nasal obstruction. Histology of the left nasalseptum biopsy was suggestive of leishmaniasis.The molecular detection of DNA was positive forleishmania infantum. The patient was successfullytreated as a case of mucocutaneous leishmaniasisreceiving liposomal amphotericin follow up visitsshowed significant improvement with norecurrence