Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia

Abstract

Background Tegumentary leishmaniasis (TL) is a parasitic disease that can present a cutaneous or mucocutaneous clinical form (CL and MCL, respectively). The disease is caused by different Leishmania species and transmitted by phlebotomine sand flies. Bolivia has one of the highest incidences of the disease in South America and the diagnosis is done by parasitological techniques. Our aim was to describe the clinical and immunological characteristics of CL and MCL patients attending the leishmaniasis reference center in Cochabamba, Bolivia, in order to gain updated clinical and epidemiological information, to evaluate the diagnostic methods used and to identify biomarkers related to clinical disease and its evolution. Methodology/Principal findings The study was conducted from September 2014 to November 2015 and 135 patients with lesions compatible with CL or MCL were included. Epidemiological and clinical data were collected using a semi-structured questionnaire. Two parasitological diagnostic methods were used: Giemsa-stained smears and culture of lesion aspirates. Blood samples obtained from participants were used to measure the concentrations of different cytokines. 59.2% (80/135) were leishmaniasis confirmed cases (CL: 71.3%; MCL: 28.7%). Sixty percent of the confirmed cases were positive by smears and 90.6% were positive by culture. 53.8% were primo-infections. Eotaxin and monokine induced by IFN-γ presented higher serum concentrations in the MCL clinical presentation compared to CL cases and no-cases. None of the cytokines presented different concentrations between primo-infections and secondary infections due to treatment failure. Conclusions/Significance In Bolivia, parasitological diagnosis remains the reference standard in diagnosis of leishmaniasis because of its high specificity, whereas the sensitivity varies over a wide range leading to loss of cases. Until more accurate tools are implemented, all patients should be tested by both smears and culture of lesion aspirates to minimize the risk of false negatives. Our results showed higher concentrations of several cytokines in MCL compared to CL, but no differences were observed between CL and no-cases. In addition, none of the cytokines differed between primary and secondary infections. These results highlight the need of further research to identify biomarkers of susceptibility and disease progression, in addition to looking at the local cellular immune responses in the lesions.

Usefulness of Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry in the Characterization of Leishmania Strains Causing Tegumentary Leishmaniasis in Bolivia versus hsp70 Gene Sequencing

“…In our context, 55 Leishmania strains that were isolated from patients in Bolivia were analyzed via both MALDI-TOF MS and hsp70 sequencing (the latter as a reference) to assess the usefulness of mass spectrometry in this context. The strains were isolated from TL patients in a Cochabamba laboratory that routinely performs culture-based diagnosis ( 37 ). Once the strains are obtained, the application of the MALDI-TOF technique is straightforward ( 35 ).…”

Tegumentary leishmaniasis by Leishmania braziliensis complex in Cochabamba, Bolivia including the presence of L. braziliensis outlier

“…Treatment failure : Patients who had a relapse due to treatment failure were identified from historical clinical data (Ballart et al., 2021). Treatment failures were considered as CL and MCL patients who had previously received a complete antileishmanial treatment in the past, regardless of its duration, and were not cured.…”

In Vitro and In Vivo Effects of Conventional and Chitosan Nanoparticle-Encapsulated Miltefosine Drug for Treatment of Cutaneous Leishmaniasis

“…Leishmaniasis is a vector-born infectious disease transmitted by protozoan parasites and is both anthroponotic and zoonotic. After malaria, leishmaniasis is considered the second leading parasitic cause of death [1]. Female sandflies are intermittently infected by the parasite that feeds on the blood of infected animals or humans and acquires the parasites from their blood [2].…”