Persistence of
            <i>Leishmania donovani</i>
            Antibodies in Past Visceral Leishmaniasis Cases in India

Gidwani, Kamlesh; Picado, Albert; Ostyn, Bart; Singh, Shri Prakash; Kumar, Rajiv; Khanal, Basudha; Lejon, Veerle; Chappuis, François; Boelaert, Marleen; Sundar, Shyam

doi:10.1128/cvi.00473-10

Cited by 65 publications

(62 citation statements)

References 14 publications

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“…Within the model, any privately treated patients are assumed to be unreported. In 2006-2009 a retrospective study indicated that the proportion of cases receiving treatment for VL in government health facilities was low (less than 30% for adults, and as low as 13% for 5 to 10 year olds (Gidwani et al, 2011)) indicating that there could be a large amount of under-reporting.…”

Section: Infection In Humansmentioning

confidence: 99%

“…Few to no new KA episodes have been reported amongst LST positives, and subsequent episodes are rare in others truly cured of KA (Burza et al, 2014;Hailu et al, 2009). Nonetheless, after clinical recovery, Leishmania antibodies persist for variable periods of up to 12 years (Gidwani et al, 2011;Bern et al, 2005), the variability partially determined by the degree of continued exposure and any persistent infection.…”

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confidence: 99%

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Progress in the Mathematical Modelling of Visceral Leishmaniasis

Rock¹,

Quinnell²,

Medley³

et al. 2016

Mathematical Models for Neglected Tropical Diseases - Essential Tools for Control and Elimination, Part B

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The leishmaniases comprise a complex of diseases characterised by clinical outcomes that range from self-limiting to chronic, disfiguring and stigmatising, to life-threatening. Diagnostic methods, treatments, and vector and reservoir control options exist, but deciding the most effective interventions requires a quantitative understanding of the population level infection and disease dynamics. The effectiveness of any set of interventions has to be determined within the context of operational conditions, including economic and political commitment. Mathematical models are the best available tools for studying quantitative systems crossing disciplinary spheres (biology, medicine, economics) within environmental and societal constraints.In 2005, the World Health Assembly and government health ministers of India, Nepal, and Bangladesh signed a Memorandum of Understanding to eliminate the life threatening form of leishmaniasis, visceral leishmaniasis (VL), on the Indian subcontinent by 2015 through a combination of early case detection, improved treatments, and vector control. The elimination target is <1/10,000 population at the district or subdistrict level compared to the current 20/10,000 in the regions of highest transmission.Towards this goal, this chapter focuses on mathematical models of VL, and the biology driving those models, to enable realistic predictions of the * Corresponding author Email address: orin.courtenay@warwick.ac.uk (Orin Courtenay)Preprint submitted to Advances in Parasitology July 18, 2016 best combination of interventions. Several key issues will be discussed which have affected previous modelling of VL and the direction future modelling may take. Current understanding of the natural history of disease, immunity (and loss of immunity), as well as stages of infection and their durations are considered particularly for humans, but also for dogs. Asymptomatic and clinical infection are discussed in the context of their relative roles in Leishmania transmission, as well as key components of the parasite-sandfly-vector interaction and intervention strategies including diagnosis, treatment and vector control. Gaps in current biological knowledge and potential avenues to improve model structures and mathematical predictions are identified. Underpinning the marriage between biology and mathematical modelling, the content of this chapter represents the first step towards developing the next generation of models for VL.

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Section: Infection In Humansmentioning

confidence: 99%

mentioning

confidence: 99%

Progress in the Mathematical Modelling of Visceral Leishmaniasis

Rock¹,

Quinnell²,

Medley³

et al. 2016

Mathematical Models for Neglected Tropical Diseases - Essential Tools for Control and Elimination, Part B

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“…8,9 These frequent relapses cannot be diagnosed using antibody detection tests because of long-term persistence of antibodies in those in whom they were initially present. 10 Thus, microscopy or culture of splenic and bone marrow aspirates is the principal test used to confirm VL in east Africa and have good specificity. However, complex clinical infrastructure and expertise are required to perform them safely, thus limiting their use.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Visceral Leishmaniasis Using Peripheral Blood Microscopy in Ethiopia: A Prospective Phase-III Study of the Diagnostic Performance of Different Concentration Techniques Compared to Tissue Aspiration

Diro¹,

Yansouni²,

Takele³

et al. 2016

Am J Trop Med Hyg

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Abstract. Visceral leishmaniasis (VL) is a fatal parasitic disease. Unfortunately, diagnosis of VL in east Africa currently relies on aspiration of tissue from the spleen or bone marrow, which is painful and potentially dangerous. We sought to determine whether peripheral blood could be used instead of invasive tissue aspirates to diagnose VL, using three parasite concentration techniques. Three hundred and one consecutive people suspected of having VL were recruited. Compared with microscopy of tissue aspirates, the diagnostic accuracy of peripheral blood microscopy was as follows: whole blood thin smear sensitivity 1.5% (95% confidence interval [CI] 0.0-8.3) and specificity 100% (95% CI 76.8-100); buffy-coat smear sensitivity 19.5% (95% CI 14.3-25.6) and specificity 98.9% (95% CI 94.1-100); peripheral blood mononuclear cell (PBMC) smear sensitivity 33.7% (95% CI 27.3-40.5) and specificity 95.7% (95% CI 89.6-98.6). Sensitivity of PBMC smears was significantly higher in human immunodeficiency virus (HIV)-coinfected patients (N = 48/301); two-sample test of proportions, P = 0.0097; sensitivity 55.9% (95% CI 37.9-72.8) and specificity 92.9% (95% CI 66.1-99.8), and correlated with the degree of parasite load in the tissue. Combining the results from smears of both PBMC and buffy coat yielded a sensitivity and specificity of 67.6% (95% CI 49.1-82.6) and 92.9% (95% CI 66

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“…The sensitivity of amastigote detection in splenic smear is 96% to 98% (11,12); however, splenic aspiration is associated with the risk of lifethreatening hemorrhage. Additionally, serological tests cannot discriminate between subclinical, current, and past infections (13,14). Various DNA-based molecular methods (PCR) have been used for the diagnosis of VL using blood, buccal swabs, or urine samples; however, their inability to discriminate between symptomatic or asymptomatic VL is a major drawback (7,15,16).…”

mentioning

confidence: 99%

A Correlative Study of Splenic Parasite Score and Peripheral Blood Parasite Load Estimation by Quantitative PCR in Visceral Leishmaniasis

et al. 2015

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Parasitological diagnosis of visceral leishmaniasis (VL) by splenic smear is highly sensitive, but it is associated with the risk of severe hemorrhage. In this study, the diagnosis of VL using quantitative PCR (qPCR) in peripheral blood was evaluated in 100 patients with VL. Blood parasitemia ranged from 5 to 93,688 leishmania parasite genomes/ml of blood and positively correlated with splenic score (P < 0.0001; r 2 ‫؍‬ 0.58). Therefore, quantification of parasite genomes by qPCR can replace invasive procedures for diagnostic and prognostic evaluations. Visceral leishmaniasis (VL), also known as kala-azar, is a systemic protozoan disease that is caused by the parasite Leishmania donovani complex and is transmitted through the bite of an infected phlebotomine sand fly. VL is characterized by prolonged fever, splenomegaly, weight loss, and pancytopenia, and it is complicated by serious infection (1). These clinical features can easily be mistaken for other common febrile illnesses, such as malaria, enteric fever, tuberculosis, etc. If untreated, VL is fatal (2). There are an estimated 200,000 to 400,000 new cases of VL each year worldwide, and over 60% of these occur in the Northern Indian state of Bihar and the bordering regions of Nepal and Bangladesh (3). Therefore, it is necessary to use a diagnostic test that is highly sensitive and specific. At present, diagnosis is either confirmed parasitologically by the demonstration of amastigotes in bone marrow or spleen smears or by the demonstration of antibodies using the rapid immunochromatographic test, the direct agglutination test (DAT), or molecular tests (4-10). The sensitivity of amastigote detection in splenic smear is 96% to 98% (11, 12); however, splenic aspiration is associated with the risk of lifethreatening hemorrhage. Additionally, serological tests cannot discriminate between subclinical, current, and past infections (13,14). Various DNA-based molecular methods (PCR) have been used for the diagnosis of VL using blood, buccal swabs, or urine samples; however, their inability to discriminate between symptomatic or asymptomatic VL is a major drawback (7,15,16). Hence, more appropriate tools are urgently needed. Real-time quantitative PCR (qPCR) is a promising tool that can be employed in the diagnosis of VL (17, 18). qPCR distinguishes symptomatic from asymptomatic VL and has the ability to diagnose VL early (19,20). We recently reported the usefulness of real-time PCR (RT-PCR) for estimation of parasite load during the treatment of VL (21). In the present study, we looked for a correlation between the splenic smear score (5) and the number of circulating parasites in patients with active VL.The study was carried out at the Infectious Diseases Research Laboratory (Department of Medicine, Banaras Hindu University, Varanasi, India) and at its field site Kala-Azar Medical Research Centre (Muzaffarpur, Bihar, India). The study was approved by the Ethics Committee of the Institute of Medical Sciences, Banaras Hindu University, and all subjects provided writt...

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Persistence of Leishmania donovani Antibodies in Past Visceral Leishmaniasis Cases in India

Cited by 65 publications

References 14 publications

Progress in the Mathematical Modelling of Visceral Leishmaniasis

Progress in the Mathematical Modelling of Visceral Leishmaniasis

Diagnosis of Visceral Leishmaniasis Using Peripheral Blood Microscopy in Ethiopia: A Prospective Phase-III Study of the Diagnostic Performance of Different Concentration Techniques Compared to Tissue Aspiration

A Correlative Study of Splenic Parasite Score and Peripheral Blood Parasite Load Estimation by Quantitative PCR in Visceral Leishmaniasis

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