Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)

Aronson, Naomi; Herwaldt, Barbara L.; Libman, Michael; Pearson, Richard D.; López‐Vélez, Rogelio; Weina, Peter J.; Carvalho, Edgar M.; Ephros, Moshe; Jerônimo, Selma M. B.; Magill, Alan J.

doi:10.4269/ajtmh.16-84256

Cited by 207 publications

(171 citation statements)

References 4 publications

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“…Our data demonstrate 4 major points: (1) cutaneous leishmaniasis appears to be endemic in humans in the southern United States; (2) in the southern United States, cutaneous leishmani- Note that the United States is not included on these maps. 14,18,19 L indicates Leishmania genus. Reproduced with permission from the American Journal of Tropical Medicine and Hygiene.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

2018

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IMPORTANCE Leishmaniasis is recognized as an endemic human disease in Africa, the Middle East, Asia, and South America. Yet despite case reports of endemic human leishmaniasis in the United States, and well-documented occurrences of disease in various animal vectors and reservoirs, the endemicity of leishmaniasis in North America has not yet been established. Moreover, leishmaniasis is not a federally reportable disease in the United States. Clinical awareness of endemic disease therefore remains low, with North American physicians considering leishmaniasis a tropical disease. OBJECTIVE To assess the endemicity of human leishmaniasis in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional multicenter observational study reviewed cases of human leishmaniasis occurring in the United States from 2007 through 2017. Previously diagnosed, deidentified cases of leishmaniasis were reported by the institutions of the authors and acknowledged contributors, as well as the Texas Department of State Health Services. Cases of leishmaniasis were identified by searching by disease name (leishmaniasis) or International Classification of Diseases, 9th and 10th Revisions diagnosis codes in the respective laboratory information systems. EXPOSURES Via examination of deidentified demographics, cases of leishmaniasis were classified as one of the following: (1) documentation of no history of travel outside of the United States within 10 years; (2) positive history of travel outside of the United States within 10 years; or (3) unknown or no documentation of travel history. MAIN OUTCOMES AND MEASURES Cases of leishmaniasis were considered endemic if identified in patients with documentation of no travel history outside of the United States within 10 years. RESULTS Of the 69 novel cases of human cutaneous leishmaniasis identified in this study, 41 (59%) were endemic; the median age at diagnosis was 61 years (range, 3-89 years), and 28 (68%) of the endemic cases occurred in female patients. Twenty-two (32%) cases had documentation of Leishmania speciation performed by polymerase chain reaction, and in 100% of these cases the infectious organism was identified as Leishmania mexicana. CONCLUSIONS AND RELEVANCE Human cutaneous leishmaniasis is endemic in the United States, and, at least regionally, is acquired endemically more frequently than it is via travel. Our data argue in favor of making leishmaniasis a federally reportable disease and may have substantial implications on North American public health initiatives, with climate models predicting the number of citizens exposed to leishmaniasis will double by 2080.

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Section: Discussionmentioning

confidence: 99%

Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

2018

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“…Most drugs used globally to treat leishmaniasis are not approved by the Food and Drug Administration for use in the USA and may not be easily available. In light of these challenges, detailed clinical practice guidelines for the diagnosis and management of leishmaniasis in North America were recently published [14, 15] after an inaugural collaboration between the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH).…”

Section: Discussionmentioning

confidence: 99%

Addressing a clinical challenge: guidelines for the diagnosis and treatment of leishmaniasis

Aronson

2017

BMC Med

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Leishmaniasis is a chronic intracellular parasitic infection that travelers, immigrants, deployed military personnel, and refugees from endemic global areas acquire from the bite of infected sand flies and carry with them, including to non-endemic countries where leishmaniasis may be an unfamiliar illness to medical providers. This commentary discusses the first clinical practice guidelines produced by the Infectious Diseases Society of America and American Society of Tropical Medicine and Hygiene for the diagnosis and management of leishmaniasis, targeted for clinicians in North America.

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“…However, scarring can cause disfiguration, and while infected, individuals remain a reservoir for continued transmission (19). Although medications are available to help decrease the risk of transmission, treatment can be complicated by drug resistance and toxicity (19,(21)(22)(23).…”

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confidence: 99%

Leishmania-Derived Trimannose Modulates the Inflammatory Response To Significantly Reduce Leishmania major-Induced Lesions

et al. 2018

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Leishmania lipophosphoglycan (LPG) is a key virulence factor, initiating inflammation resulting in cutaneous lesions. LPG is capped by various oligosaccharides. How these glycans are recognized and how they alter the course of Leishmania infection are poorly understood. Previous studies synthesized ␣-1,2-trimannose cap sugars on latex beads and demonstrated that C57BL/6 mice coinoculated with Leishmania major and trimannose-coated beads produced significantly higher levels of interleukin-12p40 (IL-12p40) and other proinflammatory, type 1 cytokines than mice inoculated with L. major alone within the first 48 h of infection. However, as L. major infection typically progress over weeks to months, the role of trimannose in altering disease progression over the course of infection was unknown. Wild-type mice were inoculated with either trimannose-coated or carrier (uncoated) beads, infected with L. major alone, coinoculated with carrier beads and L. major, or coinoculated with trimannose-coated beads and L. major. Trimannose treatment of L. majorinfected mice decreased the parasite load and significantly decreased the lesion size at 14 days postinfection (p.i.) compared to results for nontreated, infected mice. Infected, trimannose-treated mice had decreased IL-12p40 and IL-10 secretion and increased interferon gamma secretion at 14 days p.i. Mannose receptor knockout (MR Ϫ/Ϫ ) mice lack the ability to detect trimannose. When MR Ϫ/Ϫ mice were infected with L. major and treated with trimannose beads, they did not have decreased lesion size. Leishmania-derived trimannose represents a novel immunomodulator that provides early type 1-skewed cytokine production to control the parasite load and alter the course of cutaneous leishmaniasis.KEYWORDS Leishmania, carbohydrate, cutaneous leishmaniasis, mannose receptor G lycoconjugate cell surface molecules of many pathogens are often key virulence factors that promote pathogen survival (1-5). Antigen glycosylation has become increasingly recognized as a critical component of immune modulation by pathogens (6-9). However, the glycan portion of the glycoconjugate was mainly considered a modulatory component with little to no antigenic properties independent of the lipid or protein that it was conjugated to. Tzianabos et al. (10) and Cobb et al. (11) were the first to describe CD4 ϩ T cell proliferation mediated by zwitterionic polysaccharides of Bacteroides fragilis, which indicated that some carbohydrates can function as antigens without attachment to a lipid or protein. This property of carbohydrates has led to interest in the mechanisms of how pathogen-derived carbohydrates modulate host immune responses, resistance to treatment (12), and their potential role in novel

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Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)

Cited by 207 publications

References 4 publications

Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

Addressing a clinical challenge: guidelines for the diagnosis and treatment of leishmaniasis

Leishmania-Derived Trimannose Modulates the Inflammatory Response To Significantly Reduce Leishmania major-Induced Lesions

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