Seroepidemiology and molecular diversity of Leishmania donovani complex in Georgia

Background Leishmaniasis includes multiple clinical syndromes, most notably visceral, cutaneous, and mucosal forms. Visceral leishmaniasis (VL), also known as kala-azar, is a potentially fatal disease endemic to large parts of Africa and Asia, and in South-Eastern Europe (Greece, Turkey, Georgia). Visceral leishmaniasis is a parasitic zoonosis caused by species of the L. donovani complex. In the classical epidemiological model the main reservoir for VL are canines. Methods The study included a cohort of 513 individuals of both genders (190 males and 323 females) from the ages of 1 to 70 years that were screened in ten villages across two districts in Kakheti using the Kalazar Detect™ rK39 rapid diagnostic test. The phylogenetic diversity patterns of local strains, based on the rDNA internal transcribed spacer (ITS) sequences, were assessed for samples obtained from patients with suspected L. donovani infection, from canine reservoirs and from Phlebotomus sand flies obtained from different geographical areas of Georgia and from Azerbaijan. Results Out of a total of 600 domestic dog blood samples 95 (15.8 %) were positive by rK39 rapid diagnostic tests. For symptomatic domestic dogs, the testing of conjunctival swabs or bone marrow aspirates revealed a higher VL incidence in Kvareli District (Kvareli; 19.4 %, n = 329) compared with that observed for Sagarejo District (Sagarejo; 11.4 %, n = 271). A total of 231 sand flies of both genders were collected during the 2-month period; of the 114 females, 1.75 % were PCR positive for the presence of Leishmania spp. Conclusions VL infection rates remain high in both canines and humans in Georgia, with disease in several known natural foci. The genetic relationships derived from rDNA internal transcribed spacer (ITS) sequence comparisons identified genetic subgroups, revealing preliminary insights into the genetic structure of L. donovani complex members currently circulating in the South Caucasus and demonstrates the utility of ITS-based genotyping in the resource-limited country of Georgia

Epidemiology of visceral leishmaniasis in Georgia

ObjectiveThe purpose of this study was to describe the epidemiology ofvisceral leishmaniasis in Georgia and to define new control measures.IntroductionVisceral leishmaniasis (VL) is a zoonotic, protozoal infection thatis endemic in Georgia, which commonly affects young children.In recent years, the incidence of VL has increased sharply and thegeographic distribution has increased. Recently, VL moved to highlypopulated areas as new foci appeared from 2010-2015, during which,610 laboratory confirmed cases of VL were registered in Georgia.The majority of cases were found in East Georgia (94.2%) and 5.8%of cases in West Georgia (representing new foci of VL in Georgia).MethodsBlood samples from 2,100 individuals suspected to have VL weretested using the rk39 based VL rapid diagnostic test, an enzyme-linkedimmunosorbent assay (ELISA). Also, 1,575 randomly selected dogs(stray and pet) and 77 wild canids were tested for VL using the sameELISA. Confirmed human cases were followed up for 9-12 months.ResultsThe most affected age group was 0-5 years (72.2%). Of thepatients, 13.9% were HIV positive and lethal outcomes were observedin 2.1%of patients. Mortality was associated with delayed diagnosisand HIV co-infection. Relapse developed in 6.4% of cases. AmongHIV positive patients, secondary prophylaxis was conducted withliposomal amphotericin B, which decreased the number of relapses by76% in 12-24 month follow-ups. A high incidence of VL in humanswas associated with a high prevalence of leishmaniasis in stray anddomestic dogs. Leishmania antibodies were found in 23.7% of strayand domestic dogs and 2.6% of wild animals screened in Tbilisi.ConclusionsOverall, the VL situation in Georgia is concerning and new controlmeasures are needed. Our study revealed a high prevalence of VLin humans and dogs in East Georgia. Early and accurate diagnosis/treatment and effective control measures should be conductedregularly to prevent the spread of VL in Georgia. In addition,secondary prophylaxis in HIV infected patients is also recommended

Epidemiology of visceral leishmaniasis in Georgia

ObjectiveThe purpose of this study was to describe the epidemiology ofvisceral leishmaniasis in Georgia and to define new control measures.IntroductionVisceral leishmaniasis (VL) is a zoonotic, protozoal infection thatis endemic in Georgia, which commonly affects young children.In recent years, the incidence of VL has increased sharply and thegeographic distribution has increased. Recently, VL moved to highlypopulated areas as new foci appeared from 2010-2015, during which,610 laboratory confirmed cases of VL were registered in Georgia.The majority of cases were found in East Georgia (94.2%) and 5.8%of cases in West Georgia (representing new foci of VL in Georgia).MethodsBlood samples from 2,100 individuals suspected to have VL weretested using the rk39 based VL rapid diagnostic test, an enzyme-linkedimmunosorbent assay (ELISA). Also, 1,575 randomly selected dogs(stray and pet) and 77 wild canids were tested for VL using the sameELISA. Confirmed human cases were followed up for 9-12 months.ResultsThe most affected age group was 0-5 years (72.2%). Of thepatients, 13.9% were HIV positive and lethal outcomes were observedin 2.1%of patients. Mortality was associated with delayed diagnosisand HIV co-infection. Relapse developed in 6.4% of cases. AmongHIV positive patients, secondary prophylaxis was conducted withliposomal amphotericin B, which decreased the number of relapses by76% in 12-24 month follow-ups. A high incidence of VL in humanswas associated with a high prevalence of leishmaniasis in stray anddomestic dogs. Leishmania antibodies were found in 23.7% of strayand domestic dogs and 2.6% of wild animals screened in Tbilisi.ConclusionsOverall, the VL situation in Georgia is concerning and new controlmeasures are needed. Our study revealed a high prevalence of VLin humans and dogs in East Georgia. Early and accurate diagnosis/treatment and effective control measures should be conductedregularly to prevent the spread of VL in Georgia. In addition,secondary prophylaxis in HIV infected patients is also recommended

Epidemiological and Clinical Features of Brucellosis in the Country of Georgia

<div><p>Background</p><p>Brucellosis is an endemic disease in the country of Georgia. According to the National Center for Disease Control and Public Health of Georgia (NCDC), the average annual number of brucellosis cases was 161 during 2008–2012. However, the true number of cases is thought to be higher due to underreporting. The aim of this study was to provide current epidemiological and clinical information and evaluate diagnostic methods used for brucellosis in Georgia.</p><p>Methodology</p><p>Adult patients were eligible for participation if they met the suspected or probable case definition for brucellosis. After consent participants were interviewed using a standardized questionnaire to collect information on socio-demographic characteristics, epidemiology, history of present illness, and clinical manifestation. For the diagnosis of brucellosis, culture and serological tests were used.</p><p>Results</p><p>A total of 81 participants were enrolled, of which 70 (86%) were from rural areas. Seventy-four percent of participants reported consuming unpasteurized milk products and 62% consuming undercooked meat products before symptom onset. Forty-one participants were positive by the Wright test and 33 (41%) were positive by blood culture. There was perfect agreement between the Huddelston and Wright tests (<i>k</i> = 1.0). Compared with blood culture (the diagnostic gold standard), ELISA IgG and total ELISA (IgG + IgM), the Wright test had fair (<i>k</i> = 0.12), fair (<i>k</i> = 0.24), and moderate (<i>k</i> = 0.52) agreement, respectively.</p><p>Conclusions</p><p>Consumption of unpasteurized milk products and undercooked meat were among the most common risk factors in brucellosis cases. We found poor agreement between ELISA tests and culture results. This report also serves as an initial indication that the suspected case definition for brucellosis surveillance purposes needs revision. Further research is needed to characterize the epidemiology and evaluate the performance of the diagnostic methods for brucellosis in Georgia.</p></div

Six patients positive by blood culture, but negative by Wright and/or ELISA tests.

<p>Six patients positive by blood culture, but negative by Wright and/or ELISA tests.</p

Epidemiological characteristics of the study participants.

<p>Epidemiological characteristics of the study participants.</p

Sensitivity, specificity, and Kappa values of serological tests compared with blood culture (the gold standard) for brucellosis diagnosis.

<p>Sensitivity, specificity, and Kappa values of serological tests compared with blood culture (the gold standard) for brucellosis diagnosis.</p

Complaints, signs/symptoms, and physical examination of the study participants.

<p>Complaints, signs/symptoms, and physical examination of the study participants.</p