Comparative Study of rK39 Leishmania Antigen for Serodiagnosis of Visceral Leishmaniasis: Systematic Review with Meta-Analysis

Visceral Leishmaniasis (VL) is a neglected tropical disease for which serodiagnostic tests are available, but not yet widely implemented in rural areas. The rK39 recombinant protein is derived from a kinesin-like protein of parasites belonging to the Leishmania donovani complex, and has been used in the last two decades for the serodiagnosis of VL. We present here a systematic review and meta-analysis of studies evaluating serologic assays (rK39 strip-test, rK39 ELISA, Direct Agglutination Test [DAT], Indirect Immunofluorescence test [IFAT] and ELISA with a promastigote antigen preparation [p-ELISA]) to diagnose VL to determine the accuracy of rK39 antigen in comparison to the use of other antigen preparations. Fourteen papers fulfilled the inclusion and exclusion selection criteria. The summarized sensitivity for the rK39-ELISA was 92% followed by IFAT 88% and p-ELISA 87%. The summarized specificity for the three diagnostic tests was 81%, 90%, and 77%. Studies comparing the rK39 strip test with DAT found a similar sensitivity (94%) and specificity (89%). However, the rK39 strip test was more specific than the IFAT and p-ELISA. In conclusion, we found the rK39 protein used either in a strip test or in an ELISA is a good choice for the serodiagnosis of VL

Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients: A Literature Review

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-11-12T19:09:10Z No. of bitstreams: 1 Badaro R Leishmaniasis....pdf: 158970 bytes, checksum: f93eac0bff32d08bf553dbd76380001c (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2014-11-12T19:09:20Z (GMT) No. of bitstreams: 1 Badaro R Leishmaniasis....pdf: 158970 bytes, checksum: f93eac0bff32d08bf553dbd76380001c (MD5)Made available in DSpace on 2014-11-12T19:24:15Z (GMT). No. of bitstreams: 1 Badaro R Leishmaniasis....pdf: 158970 bytes, checksum: f93eac0bff32d08bf553dbd76380001c (MD5) Previous issue date: 2014Universidade Federal da Bahia. Complexo Hospitalar Prof Edgard Santos. Salvador, BA, BrasilUniversidade Federal da Bahia. Complexo Hospitalar Prof Edgard Santos. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório Avançado de Saúde Pública. Salvador, BA, Brasil / Escola Bahiana de Medicina e Saúde Pública. Faculdade de Medicina. Salvador, BA, BRasilUniversidade Federal da Bahia. Complexo Hospitalar Prof Edgard Santos. Salvador, BA, BrasilUniversity of California San Diego. Division of Infectious Diseases. La Jolla, CA, USAFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório Avançado de Saúde Pública. Salvador, BA, Brasil / Escola Bahiana de Medicina e Saúde Pública. Faculdade de Medicina. Salvador, BA, BRasilIntroduction: After the onset of highly active antiretroviral therapy (HAART), some HIV-infected patients present a severe inflammation in response to a latent or a previously treated opportunistic pathogen termed immune reconstitution inflammatory syndrome (IRIS). Few reports of tegumentary and visceral leishmaniasis have been described in association with IRIS. Methods: A systematic literature review of IRIS in association with leishmaniasis identified 34 reported cases. Results and Discussion: The majority of these occurred in males 4 months following the onset of HAART. The mean CD4 count before HAART was 94 + 77 cells/mm3, increasing to 5 times the initial value between the onset of HAART and IRIS presentation. Visceral leishmaniasis and post–kala-azar dermal leishmaniasis were the most commonly reported clinical manifestations, followed by tegumentary leishmaniasis and uveitis. Conclusions: Commonly found characteristics included cutaneous involvement, regardless of Leishmania species; appearance of lesions unrelated to time of probable Leishmania infection; rapid recovery of CD4 count following HAART; and rapid progression

Algorithm for selection of studies.

<p>Algorithm for selection of studies.</p

Comparison of the sensitivity, specificity and likelihood ratio of tests.

<p>p-ELISA = enzyme immunoassay with antigens of promastigotes of <i>Leishmania</i> sp. DAT = direct agglutination test, IFAT = indirect immunofluorescence; rK39-ELISA = enzyme immunoassay with rK39 antigen, n = number of studies included in the analysis, S = sensitivity, Sp = specificity; LR+ = positive likelihood ratio, LR− = negative likelihood ratio. CI = confidence interval.</p><p>*Analysis in which the study by Romero et al. was excluded because of discrepancies noted in the published data.</p

ROC plot comparing the performance of the rK39 strip test to serologic techniques utilizing promastigote antigens for diagnosis of Visceral Leishmaniasis.

<p>ROC plot comparing the performance of the rK39 strip test to serologic techniques utilizing promastigote antigens for diagnosis of Visceral Leishmaniasis.</p

ROC plot comparing the performance of the rK39-ELISA to the p-ELISA and IFAT for the diagnosis of Visceral Leishmaniasis.

<p>(<b>A</b>) Analysis including all studies that met our selection criteria. (<b>B</b>) Analysis after removal of the outlier study.</p

ROC plot showing the heterogeneity of strip test by continent.

<p>ROC plot showing the heterogeneity of strip test by continent.</p

Return of the founder Chikungunya virus to its place of introduction into Brazil is revealed by genomic characterization of exanthematic disease cases

Submitted by Sandra Infurna ([email protected]) on 2020-03-10T15:58:07Z No. of bitstreams: 1 MartaGiovanetti_LCAlcantara_etal_IOC_2020.pdf: 1148514 bytes, checksum: 32d98df74817f86ea43988acd886f4e0 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2020-03-10T16:31:16Z (GMT) No. of bitstreams: 1 MartaGiovanetti_LCAlcantara_etal_IOC_2020.pdf: 1148514 bytes, checksum: 32d98df74817f86ea43988acd886f4e0 (MD5)Made available in DSpace on 2020-03-10T16:31:16Z (GMT). No. of bitstreams: 1 MartaGiovanetti_LCAlcantara_etal_IOC_2020.pdf: 1148514 bytes, checksum: 32d98df74817f86ea43988acd886f4e0 (MD5) Previous issue date: 2019Laboratório Central de Saúde Pública. Departamento de Virologia, Salvador, BA, Brasil.Laboratório Central de Saúde Pública. Departamento de Virologia, Salvador, BA, Brasil.Ministério da Saúde. Coordenação Geral de Vigilância de Arboviroses (CGARB). Brasília, DF, BrasilUniversidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Laboratório de Genética Celular e Molecular. Belo Horizonte, MG, Brasil / University of KwaZulu- Natal, Durban. College of Health Sciences. KwaZulu-Natal Research Innovation and Sequencing Platform. Durban, South Africa.Fundação Oswaldo Cruz. Instituto Gonçalo Muniz. Laboratório de Patologia Experimental. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brasil.Laboratório Central de Saúde Pública. Departamento de Virologia, Salvador, BA, Brasil.Universidade Estadual de Feira de Santana. Feira de Santana, BA, Brasil / Secretaria de Saúde de Feira de Santana. Feira de Santana, BA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Coordenação Geral dos Laboratórios de Saúde Pública. Brasília, DF, Brasil.Organização Pan-Americana da Saúde/Organização Mundial da Saúde. Brasília, DF, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças Transmissíveis. Brasília, DF, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brasil.Universidade Federal do Mato Grosso do Sul. MS, Brasil / Fundação Oswaldo Cruz. Coordenação de Saúde Laboratórios de Vigilância e Referência. Rio de Janeiro, RJ, Brasil.University of Oxford. Oxford, UK.University of KwaZulu- Natal, Durban. College of Health Sciences. KwaZulu-Natal Research Innovation and Sequencing Platform. Durban, South Africa.University of Oxford. Oxford, UK.University of KwaZulu- Natal, Durban. College of Health Sciences. KwaZulu-Natal Research Innovation and Sequencing Platform. Durban, South Africa / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brasil.University of Oxford. Department of Zoology. Oxford, UK.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Laboratório de Genética Celular e Molecular. Belo Horizonte, MG, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, BrasilMinistério da Saúde. Coordenação Geral de Vigilância de Arboviroses (CGARB). Brasília, DF, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, BrasilBetween June 2017 and August 2018, several municipalities located in Bahia state (Brazil) reported a large increase in the number of patients presenting with febrile illness similar to that of arboviral infections. Using a combination of portable whole genome sequencing, molecular clock and epidemiological analyses, we revealed the return of the CHIKV-ECSA genotype into Bahia. Our results show local persistence of lineages in some municipalities and the re-introduction of new epidemiological strains from different Brazilian regions, highlighting a complex dynamic of transmission between epidemic seasons and sampled locations. Estimated climate-driven transmission potential of CHIKV remained at similar levels throughout the years, such that large reductions in the total number of confirmed cases suggests a slow, but gradual accumulation of herd-immunity over the 4 years of the epidemic in Bahia after its introduction in 2014. Bahia remains a reservoir of the genetic diversity of CHIKV in the Americas, and genomic surveillance strategies are essential to assist in monitoring and understanding arboviral transmission and persistence both locally and over large distances