Studies on the sand fly fauna (Diptera: Psychodidae) in high-transmission areas of cutaneous leishmaniasis in the Republic of Suriname

Sand flies (Diptera: Psychodidae) are the vectors of Leishmania parasites, the causative agents of leishmaniasis. Cutaneous leishmaniasis is an increasing public health problem in the Republic of Suriname and is mainly caused by Leishmania (Vianna) guyanensis, but L. (V.) braziliensis, L. (L.) amazonensis, and L. (V.) naiffi also infect humans. Transmission occurs predominantly in the forested hinterland of the country. Information regarding the potential vectors of leishmaniasis in Suriname is limited. This study aims to broaden the knowledge about vectors involved in the transmission of cutaneous leishmaniasis in Suriname. For this purpose, sand flies were characterized in various foci of cutaneous leishmaniasis in the country, the districts of Para, Brokopondo, and Sipaliwini. Sand flies were collected in areas around mining plots and villages using CDC light traps in the period between February 2011 and March 2013. They were categorized by examination of the spermathecea (females) and the external genitalia (males). A total of 2,743 sand fly specimens belonging to 34 different species were captured, including four species (Lutzomyia aragaoi, Lu. ayrozai, Lu. damascenoi, and Lu. sordellii) that had never before been described for Suriname. Five percent of the catch comprised Lu. squamiventris sensu lato, one female of which was positive with L. (V.) braziliensis and was captured in a gold mining area in Brokopondo. Other sand fly species found positive for Leishmania parasites were Lu. trichopyga, Lu. ininii, and Lu. umbratilis, comprising 32, 8, and 4%, respectively, of the catch. These were captured at gold mining areas in Brokopondo and Sipaliwini, but the Leishmania parasites they had ingested could not be identified due to insufficient amounts of DNA. The sand fly fauna in Suriname is highly diverse and comprises Lutzomyia species capable of transmitting Leishmania parasites. Four new Lutzomyia species have been found, and four species - Lu. squamiventris (s.l.), Lu. trichopyga, Lu. ininii, and Lu. umbratilis - have been found to harbor Leishmania parasites. The latter were among the most abundant species captured. These observations may contribute to the understanding of leishmaniasis transmission and the development of control programs in Surinam

Evaluation of point of care tests for the diagnosis of cutaneous leishmaniasis in Suriname

Background: Cutaneous leishmaniasis (CL) is a serious health problem in Suriname. To expand the diagnostic options, two newly developed diagnostic tests, i.e. the rapid diagnostic test CL Detect™ Rapid Test (CL Detect) and the Loopamp™ Leishmania Detection Kit (Loopamp) were evaluated. Methods: Diagnostic test performance was compared to the routine diagnostic approach in place, i.e. clinical symptoms combined with microscopy, and to polymerase chain reaction (PCR), which was used as a reference standard. The study population (n = 93) was a typical representation of the CL affected population in Suriname and mainly infected with Leishmania guyanensis. Results: CL Detect had a very low sensitivity compared to microscopy (36.7%) or PCR (35.8%), due to a high number of false negative results. The specificity of the CL Detect compared to microscopy and PCR was 85.7 and 83.3% respectively. Loopamp sensitivity was 84.8% compared to microscopy and 91.4% compared to PCR. The Loopamp test had a moderate specificity (42.9%) compared to microscopy, but a good specificity compared to PCR (91.7%). Conclusion: The CL Detect is not likely to be a good replacement for the routine diagnostic procedure for CL in Suriname. The high sensitivity of the easy to perform Loopamp enables the implementation of sensitive molecular diagnosis in resource limited settings

Efficacy analyses: Responses to treatment at follow-up 6 weeks and 12 weeks after treatment according to treatment of cutaneous leishmaniasis patients in Suriname from 2010–2013.

<p>¹ Proportion of individuals cured in 3-day regimen group minus proportion of individuals cured in 7-day regimen group.</p><p>* The left side of the 90% confidence interval exceeds the non-inferior margin of 15%. It can therefore not be concluded that the 3-day regimen is non-inferior to the 7-day regimen.</p><p>** The left side of the 90% confidence interval exceeds the non-inferior margin of 15%; furthermore the right-side of the 90% confidence interval and the right side of the 95% confidence interval (not presented) is below 0, indicating that the 3-day regimen is not only non-inferior but the proportion of parasitological cured in this group is also lower than in the 7-day regimen group.</p><p>^#<b>7-day regimen</b>: 20 of 28 patients not clinical cured at follow up-visit week 6 did not accept the additional 3 injections of 300 mg PI as required according to the protocol; 2 of 8 patients not clinical cured but receiving additional injections received less than 3 injections; 1 patient clinical cured according to dermatologists based on clinical pictures was not considered cured by the care provider and received additional 3 injections, 1 person was lost to follow up but did receive additional treatment; overall 4 of these 24 did not had outcome data at follow up week visit 12. In conclusion: 20 patients in the 7 day regimen were not included in the per protocol analyses because of failure with respect to the additional treatment. 3 day regimen: 12 of 22 patients not clinical cured at follow up-visit week 6 did not accept the additional 3 injections of 300 mg PI as required according to protocol; 3 of 10 patients not clinical cured but receiving additional regimen received less than 3 injections; overall 2 of these 15 did not had outcome data at follow up week visit 12. In conclusion: 13 patients in the 3 day regimen were not included in the per protocol analyses because of failure with respect to the additional treatment.</p><p>Efficacy analyses: Responses to treatment at follow-up 6 weeks and 12 weeks after treatment according to treatment of cutaneous leishmaniasis patients in Suriname from 2010–2013.</p

Results of SKINDEX-29 and EQ-5D questionnaires on treatment visit 1 and follow-up visits 6 weeks according to treatment group of cutaneous leishmaniasis patients in Suriname from 2010–2013.

<p>* One patient in the 7 day regimen withdrew before the 1^st treatment visit; 15 patients in the 7 day regimen group and 26</p><p>patients in the 3 day regimen group did not show up.</p><p># P value: Mann Whitney test for continuous outcomes</p><p>Chi² test for categorical outcomes.</p><p>Results of SKINDEX-29 and EQ-5D questionnaires on treatment visit 1 and follow-up visits 6 weeks according to treatment group of cutaneous leishmaniasis patients in Suriname from 2010–2013.</p

Case Report: First Case of Cutaneous Leishmaniasis Caused by Leishmania (Viannia) braziliensis in Suriname

The main causative agent of cutaneous leishmaniasis (CL) in Suriname is Leishmania (Viannia) guyanensis. This case report presents a patient infected with Leishmania (Viannia) braziliensis, a species never reported before in Suriname. This finding has clinical implications, because L. braziliensis has a distinct clinical phenotype characterized by mucocutaneous leishmaniasis, a more extensive and destructive form of CL that requires different treatment. Clinicians should be aware that chronic cutaneous ulcers in patients from the Guyana region could be caused by L. braziliensi

Baseline characteristics of included patients with cutaneous leishmaniasis in Suriname from 2010–2013 according to treatment group.

<p>*<b>Ethnicity</b>: Maroon-descendent of runaway slaves, traditionally living in the interior / Amerindians-indigenous population / Creole-descendants from slaves, traditionally living in urbanized areas / Hindustani-descendants of British-Indian immigrants / Javanese-descendants of Dutch-Indian immigrants.</p><p>Baseline characteristics of included patients with cutaneous leishmaniasis in Suriname from 2010–2013 according to treatment group.</p