A 22-Year Survey of Leishmaniasis Cases in a Tertiary-Care Hospital in an Endemic Setting
Abstract
:1. Background
2. Methods
2.1. Study Area and Population
2.2. Samples and Patients
Patients | Samples | |
---|---|---|
Number | Type | |
88 | 96 | Bone marrow |
29 | 31 | Skin biopsy |
5 | 5 | Skin lesion aspirate |
2 | 2 | Lymph node aspirate |
1 | 2 | Peripheral blood |
1 | 1 | Lymph node biopsy |
3 | 3 | Skin lesion aspirate |
5 | Skin biopsy | |
2 | 2 | Bone marrow |
2 | Lymph node biopsy | |
1 | 2 | Bone marrow |
1 | Peripheral blood | |
1 | 1 | Bone marrow |
1 | Spleen biopsy | |
1 | 1 | Bone marrow |
1 | Skin biopsy | |
134 | 156 | Total |
2.3. Conventional Parasitologic Assays
2.3.1. Microscopic Examination
2.3.2. Cultivation of Leishmania Promastigotes
2.4. Molecular Methods
2.4.1. Isoenzyme Characterization
2.4.2. FRET Real-time PCR Assay
3. Results
4. Discussion
Patient | Origin | Sex | Age | Year of Sampling | Clinical and Epidemiological Notes | Sample type (No. of Samples) | Isoenzymes Characterization (No. of Samples) |
---|---|---|---|---|---|---|---|
Visceral Leishmaniasis | |||||||
1 | IT | M | 49 | 1994 | No travel history; transplanted kidney patient; night fever | Bone marrow (1) | L. infantum MON 1 (1) |
2 | IT | M | 30 | 1994 | Frequent travels through Crete Island in the last 2 months; worsening asthenia for 20 days, fever | Bone marrow (1) | L. infantum MON 1 (1) |
3 | IT | M | 39 | 1996–2000 | No travel history; transplanted kidney patient; fever, asthenia, splenomegaly, leukopenia, thrombocytopenia, ipergammaglobulinemia | Bone marrow (5) | L. infantum MON 1 (4) |
4 | U * | F | U ** | 2000 | Suspected lymphoma/myeloma/VL | Bone marrow (1) | n.p. |
5 | Albania | M | 2 | 2005 | In Italy for 1 year; chronic anemia, progressive bone marrow aplasia | Bone marrow (2) Peripheral blood (1) | n.p. |
6 | Macedonia | M | U ** | 2005 | Suspected lymphoma/myeloma/VL | Bone marrow (1) | n.p. |
7 | IT | M | 67 | 2009 | No travel history; fever, splenomegaly | Bone marrow (1) Splenic biopsy (1) | n.p. |
Cutaneous Leishmaniasis | |||||||
8 | IT | M | 65 | 2012 | No travel history; cutaneous nodules in the legs | Skin biopsy (1) | n.p. |
9 | IT | M | U ** | 1992 | Missionary in Chad; skin lesion in the right flank 2x1 cm | Skin biopsy (2) | L. major MON 196 (1) |
10 | IT | M | U ** | 2000 | No travel history; skin lesions in the scalp | Skin lesion aspirate (1) Skin biopsy (3) | n.p. |
11 | Tunisia | M | 29 | 2000 | Skin lesions in the limbs | Skin biopsy (1) | L. major MON 25 (1) |
12 | Marocco | M | U ** | 2001 | Cutaneous granuloma | Skin biopsy (1) | L. major MON 25 (1) |
13 | Tunisia | F | 33 | 2001 | Skin lesions in the limbs | Skin biopsy (1) | n.p. |
14 | IT | M | 68 | 2007 | No travel history; facial skin lesion | Skin biopsy (2) | n.p. |
15 | IT | F | 49 | 2011 | No travel history; skin lesion | Skin lesion aspirate (1) | n.p. |
Patient | Sample Type | No. of Samples | Microscopy a | Culture | Real-time PCR b |
---|---|---|---|---|---|
1 | Bone marrow | 1 | Positive | Positive | n.p. |
2 | Bone marrow | 1 | Positive | Positive | n.p. |
3 | Bone marrow | 5 c | Positive | Positive | n.p. |
Positive | Positive | n.p. | |||
Positive | Positive | n.p. | |||
Positive | Positive | n.p. | |||
n.p. | Positive | n.p. | |||
4 | Bone marrow | 1 | n.p. | Positive | n.p. |
5 | Bone marrow | 2 d | Positive | Positive | n.p |
Peripheral blood | 1 | n.p. | Negative | n.p | |
6 | Bone marrow | 1 | Negative | Positive | Positive |
7 | Bone marrow | 1 d | Negative | Negative | Negative |
Splenic biopsy | 1 d | n.p. | Positive | Positive | |
8 | Skin biopsy | 1 | Negative | Positive | Positive |
9 | Skin biopsy | 2 | Positive | Positive | n.p. |
10 | Skin lesion aspirate | 1 | n.p. | Positive | n.p. |
Skin biopsy | 3 | Positive | Positive | n.p. | |
11 | Skin biopsy | 1 | n.p. | Positive | n.p. |
12 | Skin biopsy | 1 | Negative | Positive | n.p. |
13 | Skin biopsy | 1 | Negative | Positive | n.p. |
14 | Skin biopsy | 2 e | n.p. n.p. | Positive Negative | Positive Positive |
15 | Skin biopsy | 1 | n.p. | Negative | Positive |
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interests
References
- Antinori, S.; Schifanella, L.; Corbellino, M. Leishmaniasis: New insights from an old and neglected disease. Eur. J. Clin. Microbiol. Infect. Dis. 2012, 31, 109–118. [Google Scholar] [CrossRef]
- Bern, C.; Maguire, J.H.; Alvar, J. Complexities of assessing the disease burden attributable to leishmaniasis. PLoS Negl. Trop. Dis. 2008, 2. [Google Scholar] [CrossRef]
- World Health Organization (WHO). Control of the Leishmaniases. In Proceedings of WHO Technical Report Series on the Control of Leishmaniases, Geneva, Switzerland, 22–26 March 2010.
- Maroli, M.; Rossi, L.; Balzelli, R.; Capelli, G.; Ferroglio, E.; Genchi, C.; Gramiccia, M.; Mortasino, M.; Pietrobelli, M.; Gradoni, L. The northward spread of leishmaniasis in Italy: Evidence from retrospective and ongoing studies on the canine reservoir and phlebotomine vectors. Trop. Med. Int. Health 2008, 13, 256–264. [Google Scholar] [CrossRef]
- Gouzelou, E.; Haralambous, C.; Antoniou, M.; Christodoulou, V.; Martinkovic, F.; Zivicnjak, T.; Smirlis, D.; Pratlong, F.; Dedet, J.P.; Ozbel, Y.; et al. Genetic diversity and structure in Leishmania infantum populations from southeastern Europe revealed by microsatellite analysis. Parasit. Vectors 2013, 6. [Google Scholar] [CrossRef]
- Dujardin, J.C.; Campino, L.; Canavate, C.; Dedet, J.P.; Gradoni, L.; Soteriadou, K.; Mazeris, A.; Ozbel, Y.; Boelaert, M. Spread of vector-borne diseases and neglect of leishmaniasis, Europe. Emerg. Infect. Dis. 2008, 14, 1013–1018. [Google Scholar] [CrossRef]
- Biglino, A.; Bolla, C.; Concialdi, E.; Trisciuoglio, A.; Romano, A.; Ferroglio, E. Asymptomatic Leishmania infantum infection in an area of Northwestern Italy (Piedmont region) where such infections are traditionally nonendemic. J. Clin. Microbiol. 2010, 48, 131–136. [Google Scholar] [CrossRef]
- Alvar, J.; Velez, I.D.; Bern, C.; Herrero, M.; Desjeux, P.; Cano, J.; Jannin, J.; den Boer, M.; the WHO Leishmaniasis Control Team. Leishmaniasis worldwide and global estimates of its incidence. PLoS ONE 2012, 7. [Google Scholar] [CrossRef]
- Varani, S.; Cagarelli, R.; Melchionda, F.; Attard, L.; Salvatori, C.; Finarelli, A.C.; Gentilomi, G.A.; Tigani, R.; Rangoni, R.; Todeschini, R.; Scalone, A.; Di Muccio, T.; Gramiccia, M.; Gradoni, L.; Viale, P.; Landini, M.P. Ongoing Outbreak of Visceral Leishmaniasis in Bologna Province, Italy, November 2012 to May 2013. Euro Surveill. 2013, 18, 20530. [Google Scholar]
- Azienda Ospedaliero-Universitaria Di Parma: L’ospedale. Available online: http://www.ao.pr.it/chi-siamo/lospedale/ (accessed on 17 December 2013).
- Cresce la popolazione dell’Emilia-Romagna. I dati per provincia, 2012. Available online: http://www.regione.emilia-romagna.it/notizie/2012/giugno/Cresce-la-popolazione-dellEmilia-Romagna/dati%20province%201.pdf. (accessed on 17 December 2013).
- Conferenza territoriale sociale e sanitaria della provincia di Parma—Ufficio di Presidenza. La comunità in cui viviamo (2008). Profilo di comunità. Available online: http://www.ao.pr.it/wp-content/uploads/2012/04/Ctss_profilo-comunita.pdf (accessed on 17 December 2013) .
- Calderaro, A.; Piccolo, G.; Gorrini, C.; Rossi, S.; Montecchini, S.; Dell’Anna, M.L.; de Conto, F.; Medici, M.C.; Chezzi, C.; Arcangeletti, M.C. Accurate identification of the six human Plasmodium spp. causing imported malaria, including Plasmodium ovale wallikeri and Plasmodium knowlesi. Malaria J. 2013, 13. [Google Scholar] [CrossRef]
- Garcia, L.S.; Bruckner, D.A. Diagnostic Medical Parasitology, 3rd edition; Garcia, L.S., Bruckner, D.A., Eds.; ASM Press: Washington, DC, USA, 1997; pp. 165–190. [Google Scholar]
- Garcia, L.S.; Bruckner, D.A. Diagnostic Medical Parasitology, 3rd edition; Garcia, L.S., Bruckner, D.A., Eds.; ASM Press: Washington, DC, USA, 1997; pp. 676–697. [Google Scholar]
- World Health Organization (WHO). Preparation of Culture Media. In Basic Laboratory Methods in Medical Parasitology; WHO: Geneva, Switzerland, 1991; pp. 107–108. [Google Scholar]
- Nimri, L.; Soubani, R.; Gramiccia, M. Leishmania species and zymodemes isolated from endemic areas of cutaneous leishmaniasis in Jordan. Kinetoplastid Biol. Dis. 2002, 1. [Google Scholar] [CrossRef]
- Schulz, A.; Mellenthin, K.; Schonian, G.; Fleischer, B.; Drosten, C. Detection, differentiation, and quantitation of pathogenic Leishmania organisms by a fluorescence resonance energy transfer-based Real-time PCR assay. J. Clin. Microbiol. 2003, 41, 1529–1535. [Google Scholar] [CrossRef]
- Simon, I.; Wissing, K.M.; del Marmol, V.; Antinori, S.; Remmelink, M.; Nilufer Broeders, E.; Nortier, J.L.; Corbellino, M.; Abramowicz, D.; Cascio, A. Recurrent leishmaniasis in kidney transplant recipients: Report of 2 cases and systematic review of the literature. Transpl. Infect. Dis. 2011, 13, 397–406. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention Homepage. Available online: www.dpd.cdc.gov (accessed on 17 December 2013).
- Haouas, N.; Gorcii, M.; Chargui, N.; Aoun, K.; Bouratbine, A.; Messaadi Akrout, F.; Masmoudi, A.; Zili, J.; Ben Said, M.; Pratlong, F.; et al. Leishmaniasis in central and southern Tunisia: current geographical distribution of zymodemes. Parasite 2007, 14, 239–246. [Google Scholar] [CrossRef]
- Pratlong, F.; Dereure, J.; Ravel, C.; Lami, P.; Balard, Y.; Serres, G.; Lanotte, G.; Rioux, J.A.; Dedet, J.P. Geographical distribution and epidemiological features of Old World cutaneous leishmaniasis foci, based on the isoenzyme analysis of 1048 strains. Trop. Med. Int. Health 2009, 14, 1071–1085. [Google Scholar] [CrossRef]
- Kuhls, K.; Chicharro, C.; Canavate, C.; Cortes, S.; Campino, L.; Haralambous, C.; Soteriadou, K.; Pratlong, F.; Dedet, J.P.; Mauricio, I.; et al. Differentiation and gene flow among european populations of Leishmania infantum MON-1. PLoS Negl. Trop. Dis. 2008, 2. [Google Scholar] [CrossRef]
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Calderaro, A.; Montecchini, S.; Rossi, S.; Gorrini, C.; Dell'Anna, M.L.; Piccolo, G.; Medici, M.C.; Arcangeletti, M.C.; Chezzi, C.; Conto, F.D. A 22-Year Survey of Leishmaniasis Cases in a Tertiary-Care Hospital in an Endemic Setting. Int. J. Environ. Res. Public Health 2014, 11, 2834-2845. https://doi.org/10.3390/ijerph110302834
Calderaro A, Montecchini S, Rossi S, Gorrini C, Dell'Anna ML, Piccolo G, Medici MC, Arcangeletti MC, Chezzi C, Conto FD. A 22-Year Survey of Leishmaniasis Cases in a Tertiary-Care Hospital in an Endemic Setting. International Journal of Environmental Research and Public Health. 2014; 11(3):2834-2845. https://doi.org/10.3390/ijerph110302834
Chicago/Turabian StyleCalderaro, Adriana, Sara Montecchini, Sabina Rossi, Chiara Gorrini, Maria Loretana Dell'Anna, Giovanna Piccolo, Maria Cristina Medici, Maria Cristina Arcangeletti, Carlo Chezzi, and Flora De Conto. 2014. "A 22-Year Survey of Leishmaniasis Cases in a Tertiary-Care Hospital in an Endemic Setting" International Journal of Environmental Research and Public Health 11, no. 3: 2834-2845. https://doi.org/10.3390/ijerph110302834