Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies.
post-kala-azar dermal leishmaniasis
transmission
visceral leishmaniasis
xenodiagnosis
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
02 07 2019
02 07 2019
Historique:
received:
23
07
2018
accepted:
17
10
2018
pubmed:
26
10
2018
medline:
31
7
2020
entrez:
26
10
2018
Statut:
ppublish
Résumé
On the Indian subcontinent, visceral leishmaniasis (VL) incidence is on track to reach elimination goals by 2020 in nearly all endemic districts. Although not included in official targets, previous data suggest post-kala-azar dermal leishmaniasis (PKDL) patients can act as an infection reservoir. We conducted xenodiagnosis on 47 PKDL patients and 15 VL patients using laboratory-reared Phlebotomus argentipes. In direct xenodiagnosis, flies were allowed to feed on the patient's skin for 15 minutes. For indirect xenodiagnosis, flies were fed through a membrane on the patient's blood. Five days later, blood-fed flies were dissected and examined by microscopy and/or polymerase chain reaction (PCR). A 3-mm skin snip biopsy (PKDL) or venous blood (VL) was processed by quantitative PCR. Twenty-seven PKDL patients (57.4%) had positive results by direct and/or indirect xenodiagnosis. Direct was significantly more sensitive than indirect xenodiagnosis (55.3% vs 6.4%, P < .0001). Those with positive xenodiagnosis had median skin parasite loads >1 log10 unit higher than those with negative results (2.88 vs 1.66, P < .0001). In a multivariable model, parasite load, nodular lesions, and positive skin microscopy were significantly associated with positive xenodiagnosis. Blood parasite load was the strongest predictor for VL. Compared to VL, nodular PKDL was more likely and macular PKDL less likely to result in positive xenodiagnosis, but neither difference reached statistical significance. Nodular and macular PKDL, and VL, can be infectious to sand flies. Active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs.
Sections du résumé
BACKGROUND
On the Indian subcontinent, visceral leishmaniasis (VL) incidence is on track to reach elimination goals by 2020 in nearly all endemic districts. Although not included in official targets, previous data suggest post-kala-azar dermal leishmaniasis (PKDL) patients can act as an infection reservoir.
METHODS
We conducted xenodiagnosis on 47 PKDL patients and 15 VL patients using laboratory-reared Phlebotomus argentipes. In direct xenodiagnosis, flies were allowed to feed on the patient's skin for 15 minutes. For indirect xenodiagnosis, flies were fed through a membrane on the patient's blood. Five days later, blood-fed flies were dissected and examined by microscopy and/or polymerase chain reaction (PCR). A 3-mm skin snip biopsy (PKDL) or venous blood (VL) was processed by quantitative PCR.
RESULTS
Twenty-seven PKDL patients (57.4%) had positive results by direct and/or indirect xenodiagnosis. Direct was significantly more sensitive than indirect xenodiagnosis (55.3% vs 6.4%, P < .0001). Those with positive xenodiagnosis had median skin parasite loads >1 log10 unit higher than those with negative results (2.88 vs 1.66, P < .0001). In a multivariable model, parasite load, nodular lesions, and positive skin microscopy were significantly associated with positive xenodiagnosis. Blood parasite load was the strongest predictor for VL. Compared to VL, nodular PKDL was more likely and macular PKDL less likely to result in positive xenodiagnosis, but neither difference reached statistical significance.
CONCLUSIONS
Nodular and macular PKDL, and VL, can be infectious to sand flies. Active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs.
Identifiants
pubmed: 30357373
pii: 5144025
doi: 10.1093/cid/ciy891
pmc: PMC6603265
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
251-258Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.
Références
J Infect Dis. 2002 Nov 1;186(9):1314-20
pubmed: 12402201
Lancet Infect Dis. 2003 Feb;3(2):87-98
pubmed: 12560194
Bull World Health Organ. 1992;70(3):341-6
pubmed: 1638662
Indian J Med Res. 2006 Mar;123(3):195-6
pubmed: 16778303
Indian J Med Res. 2006 Mar;123(3):473-7
pubmed: 16789343
Am J Trop Med Hyg. 2007 May;76(5):909-14
pubmed: 17488915
Parasitology. 2009 Dec;136(14):1915-34
pubmed: 19835643
PLoS Negl Trop Dis. 2010 Oct 05;4(10):null
pubmed: 20957193
PLoS Negl Trop Dis. 2011 Aug;5(8):e1288
pubmed: 21886852
PLoS One. 2012;7(5):e35671
pubmed: 22693548
Trop Med Int Health. 2013 Mar;18(3):268-75
pubmed: 23279800
Am J Trop Med Hyg. 2013 Aug;89(2):345-53
pubmed: 23817330
PLoS Negl Trop Dis. 2014 Jan 09;8(1):e2583
pubmed: 24416460
Vet Res. 2015 Dec 09;46:138
pubmed: 26645907
BMJ Open. 2016 May 17;6(5):e010050
pubmed: 27188804
Wkly Epidemiol Rec. 2016 Jun 3;91(22):287-96
pubmed: 27263128
PLoS Negl Trop Dis. 2016 Dec 14;10(12):e0005196
pubmed: 27974858
Int J Parasitol. 2017 Sep;47(10-11):609-616
pubmed: 28455239
Clin Infect Dis. 2017 Jul 1;65(1):150-153
pubmed: 28520851
Nat Commun. 2017 Jul 5;8(1):57
pubmed: 28680146
PLoS One. 2017 Sep 28;12(9):e0185606
pubmed: 28957391
Ind Med Gaz. 1924 Dec;59(12):593-597
pubmed: 29007563
PLoS Pathog. 2017 Oct 19;13(10):e1006571
pubmed: 29049371
Parasite. 2017;24:42
pubmed: 29139377
PLoS Negl Trop Dis. 2017 Nov 16;11(11):e0005877
pubmed: 29145397
Nat Microbiol. 2018 May;3(5):548-555
pubmed: 29556108
AIDS. 1994 Feb;8(2):277-9
pubmed: 8043238
Am J Trop Med Hyg. 1999 Jan;60(1):51-3
pubmed: 9988321