Efficiency of noninvasive sampling methods (swab) together with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis

Traditional diagnostic methods used to detect American Tegumentary Leishmaniasis, such as histopathology using biopsy samples, culture techniques, and direct search for parasites, have low sensitivity and require invasive collection procedures. This study evaluates the efficiency of noninvasive sampling methods (swab) along with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis using skin and mucous samples from 25 patients who had tested positive for leishmaniasis. The outcome of the tests performance on swab samples was compatible with PCR results on biopsy samples. The findings have also shown that PCR-kDNA test is more efficient than PCR-HSP70 and qPCR tests (sensitivity of 92.3%, 40.7%, and 41%, respectively). Given the high sensitivity of the tests and the fact that the sampling method using swabs affords greater patient comfort and safety, it could be said that this method is a promising alternative to conventional biopsy-based methods for the molecular diagnosis of leishmaniasis

Can COVID-19 impact the natural history of paracoccidioidomycosis? Insights from an atypical chronic form of the mycosis

Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably

Genetic variability of Leishmania (Leishmania) infantum causing human visceral leishmaniasis in the Southeastern Brazil

Leishmania infantum is a protozoan that causes visceral leishmaniasis (VL) in the Americas and some regions of Europe. The disease is mainly characterized by hepatosplenomegaly and fever, and can be fatal. Factors related to the host and parasite can contribute to the transmission of Leishmania and the clinical outcome. The intraspecific genetic variability of L. infantum strains may be one of these factors. In this study, we evaluated the genetic variability of L. infantum obtained from bone marrow smear slides from patients in the Sao Paulo State, Brazil. For this, the minicircle of the kDNA hypervariable region was used as target by Sanger sequencing. By analyzing the similarity of the nucleotides and the maximum likelihood tree (Fasttree), we observed a high similarity (98%) among samples. Moreover, we identified four different profiles of L. infantum. In conclusion, L. infantum strains from Sao Paulo State, Brazil, showed low diversity measured by minicircle of the kDNA hypervariable region

Prevalence of SARS-CoV-2 infection among health care workers in a reference hospital in Brazil

Health care workers (HCW) are the frontline workforce for COVID-19 patient care and, consequently, are exposed to SARS-CoV-2 infection due to close contact to infected patients. Here, we evaluate the prevalence of SARS-CoV-2 infection among HCW from an infectious disease hospital, reference center for COVID-19 care in the metropolitan area of Sao Paulo city, Brazil. Among 2,204 HCW, 1,417 (64.29%) were subjected to detection of anti-SARS-CoV-2 antibodies by chemiluminescent immunoassay. Out of the total, 271 (19.12%) presented anti-SARS-CoV-2 antibodies. Prevalence varied according to HCW categories. The highest prevalence was observed in workers from outsourced companies, cooks and kitchen assistants, hospital cleaning workers, and maintenance workers. On the other hand, resident physicians and HCW from the institution itself presented lower prevalence (nurses, nursing assistants, physicians, laboratory technicians). Social and environmental factors are important determinants, associated with exposure in the hospital environment, which can determine the greater or lesser risk of infection by pathogens that spread rapidly by air

Visceral leishmaniasis caused by Leishmania (Leishmania) amazonensis associated with Hodgkin’s lymphoma

Visceral leishmaniasis (VL) is mainly caused by Leishmania (Leishmania) donovani and Leishmania (L.) infantum; however, other Leishmania species have been associated with VL. We report a case of a patient simultaneously diagnosed with VL caused by Leishmania (L.) amazonensis and Hodgkin’s lymphoma. After treatment with liposomal amphotericin B and chemotherapy, the patient presented a clinical cure. This case report reinforces the hypothesis that other Leishmania species can cause visceral lesions mainly related to immunosuppression

Review of the current treatments for leishmaniases

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-07-28T12:51:15Z No. of bitstreams: 1 Lindoso JAL Review-of-the-current-treatments-for-leish.pdf: 211384 bytes, checksum: 61778a967ff340e48f91656f3031ca1d (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-07-28T13:02:12Z (GMT) No. of bitstreams: 1 Lindoso JAL Review-of-the-current-treatments-for-leish.pdf: 211384 bytes, checksum: 61778a967ff340e48f91656f3031ca1d (MD5)Made available in DSpace on 2017-07-28T13:02:12Z (GMT). No. of bitstreams: 1 Lindoso JAL Review-of-the-current-treatments-for-leish.pdf: 211384 bytes, checksum: 61778a967ff340e48f91656f3031ca1d (MD5) Previous issue date: 2012Laboratorio de Investigação Médica (LIM-38) do Hospital das Clínicas da Faculdade de Medicina, USP and Conselho Nacional de Pesquisa.Instituto de Infectologia Emilio Ribas-SES. São Paulo, SP, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilUniversidade de São Paulo. Faculdade de Medicina. Departamento de Doenças Infecciosas. São Paulo, SP, BrasilUniversidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical de São Paulo. São Paulo, SP, BrasilAbstract: Leishmaniases are vector-borne zoonotic diseases that are prevalent in tropical and subtropical areas in the world, with two million new cases occurring yearly. Visceral and tegumentary forms of leishmaniasis are known. The latter form may present as localized cutaneous or mucosal forms, disseminated, diffuse forms, or leishmaniasis recidiva cutis. Visceral leishmaniasis is caused by parasites of the species Leishmania (Leishmania) donovani and L. (L.) infantum, and tegumentary leishmaniasis is caused by 15 other species, with distinct distributions in the Old and New World. The varied clinical manifestations, the multitude of Leishmania species, and the increasing incidence of HIV coinfection make the diagnosis and treatment of leishmaniases complex. Since there are no solid data relating clinical manifestations, treatment outcomes and Leishmania species the decision regarding the best therapeutic option is almost entirely based on clinical manifestations. Because most of the literature is focused on leishmaniasis in the Old World, in this review we present data on the treatment of New World leishmaniasis in more detail. Ranked therapeutic options, clinical trials, and also observations, even with a restricted number of subjects, on treatment outcome of visceral and different forms of tegumentary leishmaniasis, are presented. Treatment for leishmaniasis in HIV-coinfected patients is addressed as well. Some of these data strongly suggest that the differences in the outcome of the treatment are related to the Leishmania species. Therefore, although it is not possible at most points of care to identify the species causing the infection – a process that requires a well equipped laboratory – the infecting species should be identified whenever possible. More recent approaches, such as the use of immunomodulators and immunotherapy, and the lines for development of new candidate drugs are mentione

NOVAS PROPOSTAS NO TRATAMENTO DA INFECÇÃO CRÔNICA ATIVA POR LEISHMANIA EM PACIENTE HIV/AIDS: UM RELATO DE CASO

A coinfecção Leishmania-HIV é considerada doença emergente de alta gravidade em várias regiões do mundo. É notável a maior taxa de gravidade, mortalidade e prevalência da Leishmaniose Visceral Humana em pessoas vivendo com o HIV, explicada pela simbiose na fisiopatologia de ambas as infecções. O tratamento efetivo destes pacientes, especialmente nos quais a infecção por Leishmania se dá de forma persistente ou recidivante, é desafiador, e hoje já discute-se tratamento duplo com Miltefosina e Anfotericina para estes. O caso a seguir tem como objetivo discutir outras possibilidades de tratamento das formas recidivantes. Trata-se de paciente do sexo feminino, 54 anos, procedente de Petrolina-PE. Possuía o diagnóstico de portadora do vírus do HIV desde 2007 e de Síndrome de Sjogren. Em 2013, apresentou astenia, febre e perda ponderal, quando recebeu o primeiro diagnóstico de Leishmaniose Visceral através de exame sorológico e realizou tratamento com Glucantime durante 20 dias. Entretanto, necessitou de mais 3 ciclos de tratamento nos dois anos subsequentes, até 2015. Procurou novamente o serviço de saúde em 2018 por recaída dos sintomas, quando foi realizado mielograma com evidência de invasão medular por Leishmania, e foi novamente internada para realizar tratamento com Anfotericina Lipossomal. Mesmo após essa ocasião, precisou repetir esquema terapêutico por cerca de 7 outras vezes, ainda que mantivesse profilaxia com Anfotericina a cada 15 dias entre estes. Evoluiu com falha imunológica importante e contagem de TCD4 = 46, mantendo sintomas constitucionais. Após a última recidiva em 2022, paciente procura serviço especializado para adequação de esquema terapêutico. Proposto, na ocasião, terapia dupla com Anfotericina B Lipossomal e Glucantime durante 20 dias em regime hospitalar – devido contraindicação à biterapia com Miltefosina pelo diagnóstico de Sjogren. Foram realizados controles eletrocardiográficos e laboratoriais no período, sem alterações significativas. Na alta hospitalar, seguiu em uso de profilaxia com Anfotericina B Lipossomal quinzenal e acompanhamento ambulatorial, apresentando boa resposta imunológica após esquema de TARV proposto. A resposta clínica ao tratamento em biterapia com Glucantime e Anfotericina para o paciente HIV com forma recidivante foi satisfatória para controle sintomático, reforçando que esquema pode ser possível – sendo necessários estudos clínicos para comprovação de eficácia

American visceral leishmaniasis: Factors associated with lethality in the state of São Paulo, Brazil

Objectives. To identify factors associated with death in visceral leishmaniasis (VL) cases. Patients and Methodology. We evaluated prognostic factors for death from VL in São Paulo state, Brazil, from 1999 to 2005. A prognostic study nested in a clinical cohort was carried out by data analysis of 376 medical files. A comparison between VL fatal cases and survivors was performed for clinical, laboratory, and biological features. Association between variables and death was assessed by univariate analysis, and the multiple logistic regression model was used to determine adjusted odds ratio for death, controlling confounding factors. Results. Data analysis identified 53 fatal cases out of 376 patients, between 1999 and 2005 in São Paulo state. Lethality was 14.1 (53/376), being higher in patients older than fifty years. The main causes of death were sepsis, bleeding, liver failure, and cardiotoxicity due to treatment. Variables significantly associated with death were severe anemia, bleeding, heart failure, jaundice, diarrhea, fever for more than sixty days, age older than fifty years, and antibiotic use. Conclusion. Educational health measures are needed for the general population and continuing education programs for health professionals working in the affected areas with the purpose of identifying and treating early cases, thus preventing the disease evolution towards death. © 2012 Geraldine Madalosso et al