Diagnosis of Mediterranean visceral leishmaniasis by detection of Leishmania-related antigen in urine and oral fluid samples

International audienceImplementation of simple diagnostic tests using non-invasive collection of biological specimens is of great importance in the diagnosis of pediatric visceral leishmaniasis caused by Leishmania infantum. Latex agglutination kit (KAtex) is widely used in the diagnosis mainly in L. donovani endemic areas. However its utilization in L. infantum endemic regions remains limited and its use on noninvasive biological specimen apart urine was not reported. In this study, KAtex kit was used to detect Leishmania-related antigen in urine and oral fluid of 35 L. infantum visceral leishmaniasis cases and 62 controls including non-infectious disease and infectious disease controls (34 and 28 respectively). Sensitivity and specificity of urine based KAtex were 51.4% and 98.3% respectively, whereas, sensitivity and specificity of oral-fluid based KAtex were 80% and 88.3% respectively. Although, sensitivity of oral-fluid KAtex (R) was high, its specificity varied significantly according to the presence or the absence of an infectious disease (71.4% versus 97%, p = 0.01)

Risk factors for mortality of children with zoonotic visceral leishmaniasis in Central Tunisia

<div><p>Background</p><p>Zoonotic visceral leishmaniasis (ZVL) caused by <i>Leishmania infantum</i> is endemic with an epidemiological profile of a paediatric disease in Tunisia. In the context of a high fatality rate, identifying risk factors for in-hospital mortality in children treated for ZVL is of major epidemiological importance.</p><p>Design</p><p>A retrospective (case-control) study included 230 immuno-competent children diagnosed and confirmed with primary ZVL in the paediatric department of the University Hospital of Kairouan between 2004 and 2014. Forty-seven per cent (47%) were children under 18 months of age, and with a male ⁄ female ratio of 1.01:1.</p><p>Results</p><p>The overall case-fatality was 6% (n = 14). The risk factors for in-hospital death identified by a multivariate analysis were: bleeding at admission (OR = 25.5, 95% CI: 2.26–287.4; p = 0.009), white cell count less than 4000/mm3 (OR = 5.66, 95% CI: 1.16–27.6; p = 0.032), cytolysis (OR = 28.13, 95% CI: 4.55–173.6; p < 0.001), and delay between onset of symptoms and admission ≥ 15 days (OR = 11, 95% CI: 1.68–72; p = 0.012).</p><p>Conclusion</p><p>The results strongly suggest that paediatric patients admitted 15 days after onset of symptoms, with bleeding, white cell counts below 4,000/mm³, and cytolysis at admission should be considered severe cases and subsequently, they are at high risk of mortality. A better understanding of factors associated with death of children from ZVL may contribute to decrease mortality.</p></div

Univariate analysis of risk factors of mortality in children with ZVL.

<p>Univariate analysis of risk factors of mortality in children with ZVL.</p

Characteristics of children with ZVL.

<p>Characteristics of children with ZVL.</p

Multivariate analysis of risk factors of mortality in children with ZVL.

<p>Multivariate analysis of risk factors of mortality in children with ZVL.</p

Representation of the categorized clinical data and variables versus morbidity in 2 dimensions resulting from the MCA, in order to describe potential grouping either for individual observations or variables.

<p>Representation of the categorized clinical data and variables versus morbidity in 2 dimensions resulting from the MCA, in order to describe potential grouping either for individual observations or variables.</p

Report of the Tunisian Registry of Primary Immunodeficiencies: 25-Years of Experience (1988-2012)

International audiencePrimary immunodeficiencies (PIDs) are a large group of diseases characterized by susceptibility to not only recurrent infections but also autoimmune diseases and malignancies. The aim of this study was to describe and analyze the distribution, clinical features and eventual outcome of PID among Tunisian patients. We reviewed the record of 710 patients diagnosed with Primary Immunodeficiency Diseases (PIDs) from the registry of the Tunisian Referral Centre for PIDs over a 25-year period. The male-to-female ratio was 1.4. The median age at the onset of symptoms was 6 months and at the time of diagnosis 2 years. The estimated prevalence was 4.3 per 100,000 populations. The consanguinity rate was found in 58.2 % of families. According to the International Union of Immunological Societies classification, spectrums of PIDs were as follows: combined T-cell and B-cell immunodeficiency disorders account for the most common category (28.6 %), followed by congenital defects of phagocyte (25.4 %), other well-defined immunodeficiency syndromes (22.7 %), predominant antibody deficiency diseases (17.7 %), diseases of immune dysregulation (4.8 %), defect of innate immunity (0.4 %) and complement deficiencies (0.4 %). Recurrent infections, particularly lower airway infections (62.3 %), presented the most common manifestation of PID patients. The overall mortality rate was 34.5 %, mainly observed with combined immunodeficiencies. The distribution of PIDs was different from that reported in Western countries, with a particularly high proportion of Combined Immunodeficiencies and phagocyte defects in number and/or function. More is needed to improve PID diagnosis and treatment in our country