55 research outputs found
Comparison of Leishmania typing results obtained from 16 European clinical laboratories in 2014
Leishmaniasis is a vector-borne disease which is endemic in 98 countries
worldwide [1]. It is caused by protozoan parasites of the genus Leishmania,
which are transmitted by female sand flies of the genera Lutzomyia and
Phlebotomus. Many infected individuals never develop symptoms, but those who
do can exhibit various disease manifestations [2]. Visceral leishmaniasis (VL)
or kala-azar is the severe form, whereby parasites infect internal organs and
the bone marrow, a lethal condition if left untreated. Other disease types are
restricted to the skin (cutaneous leishmaniasis, CL) or the mucosae of the
nose and mouth (mucosal leishmaniasis, ML). Finally, a particular cutaneous
disease sometimes develops in cured VL patients: post kala-azar dermal
leishmaniasis (PKDL). Typically, VL is caused by two species: Leishmania
donovani and Leishmania infantum. The latter can also cause CL, as can all
other pathogenic species. Some particular species (e.g. L. braziliensis and L.
aethiopica) can lead to overt ML. As many as 20 different Leishmania species
are able to infect humans, and globally there are over 1 million new disease
cases per annum [1,3]. Leishmaniasis is endemic in southern Europe, and in
other European countries cases are diagnosed in travellers who have visited
affected areas both within the continent and beyond. Although treatment in
practice is often guided only by clinical presentation and patient history, in
some cases determination of the aetiological subgenus, species complex or
species is recommended for providing optimal treatment [2,4,5]. For example, a
patient returning from South America with CL might be infected with Leishmania
braziliensis, which necessitates systemic drug therapy and counselling about
the risk of developing mucosal leishmaniasis in the future. The same patient
could also be infected with Leishmania mexicana, which is managed by less
intensive treatment and which is not associated with mucosal disease [6].
Determining the infecting species and its probable source permits selection of
the correct drug, route of administration (intralesional, oral systemic, or
parenteral) and duration [7]. Unfortunately, for CL it is impossible to
predict the species responsible for an ulcerating lesion clinically, and the
morphology of amastigotes does not differ between species. When the
geographical origin of infection is known, for instance when a patient in an
endemic region is treated at a local hospital, the species can be guessed
often from the known local epidemiology, as species distribution follows a
geographical pattern [8]. However, especially in infectious disease clinics
that treat patients who have stayed in various endemic countries, the
geographic origin of infections may be unknown. For instance, people residing
in Europe who have travelled outside Europe may come from, or have also
visited, Leishmania-endemic areas within Europe, especially the Mediterranean
basin. Even when the location of infection is known, several species can co-
circulate in a given endemic area, in which case the species can only be
determined by laboratory tests. Culture and subsequent isoenzyme analysis is
time consuming and available in very few specialised centres, so it is
impractical as a front-line diagnostic test in clinical laboratories. Hence,
well-performed reliable molecular methods are necessary for species
identification. Several Leishmania typing methods have been published
(reviewed in [9]), and as a result each laboratory uses its own preferred
assay. The most popular assays nowadays are those that can be applied directly
to clinical samples, thereby circumventing the need for parasite isolation and
culture. However, few tests have been standardised, and no commercial kits are
currently available. As a result, clinical and epidemiological studies make
use of various techniques, and in patient management other methods are often
deployed. In this study we compare the typing performance in 16 clinical
laboratories across Europe, which use a variety of methods for species
discrimination
Pontine extension of a tentorial schwannoma without cranial nerve involvement: a case report
<p>Abstract</p> <p>Introduction</p> <p>Intracranial schwannomas unrelated to the cranial nerves are uncommon. We report a new case of tentorial schwannoma unrelated to the cranial nerves, with extension into the pons. A literature review with discussion of the most relevant pathogenetic aspects is also performed.</p> <p>Case presentation</p> <p>A 42-year-old Caucasian man was admitted with right-sided paresthesias and weakness of his upper and lower extremities. The neurological examination revealed right hemiparesis and hemi-hypoesthesia. A brain magnetic resonance imaging scan revealed a cerebellopontine lesion, arising from the left free edge of the tentorium, and extending into his pons. A piecemeal removal was performed through a retrosigmoid approach. The lesion was not found to be associated with any cranial nerves. The histological examination revealed a schwannoma Antoni type A. His postoperative course was uneventful. At one year follow-up, the patient was neurologically intact and the magnetic resonance imaging of his brain performed at that time showed complete removal without signs of recurrence.</p> <p>Conclusion</p> <p>Tentorial schwannomas are rare clinical entities. Knowledge of their clinical, radiological and anatomical characteristics is very important for the correct diagnosis and management.</p
Limits of a rapid identification of common Mediterranean sandflies using polymerase chain reaction-restriction fragment length polymorphism
Identification of wild-caught phlebotomine sand flies from Crete and Cyprus using DNA barcoding
The burden of visceral leishmaniasis in Italy from 1982 to 2012: a retrospective analysis of the multi-annual epidemic that occurred from 1989 to 2009
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