Reevaluating leishmanin skin test as a marker for immunity against cutaneous leishmaniasis

Boroujeni, Amir Momeni; Aminjavaheri, Malih; Moshtaghian, Bahador; Momeni, Arash; Momeni, Ali

doi:10.1111/j.1365-4632.2012.05850.x

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…When incidence rates were analysed according to age, there was a higher rate of LST conversion in older people over age 25, while the rate of LST reactivity loss and the risk of symptomatic infection were higher among younger ages. These interesting findings are consistent with many prior reports which indicate that older persons with a longer average duration of stay in endemic areas might have had longer exposure to infective sandfly bites which continuously boost their immune response, compared to younger people [12,20,21]. Thus, most (re)infections in adults remain symptomless and positive LST at this age might persist lifelong.…”

Section: Plos Neglected Tropical Diseasessupporting

confidence: 91%

“…Our data support that LST positivity might indicate a sensitisation to Leishmania antigens possibly triggered by a previous infection but it does not support that it is a marker of protection against disease recurrence. Hence LST positivity should not be considered as a surrogate marker of protective immunity [20,40,41].…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

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A prospective cohort study of Cutaneous Leishmaniasis due to Leishmania major: Dynamics of the Leishmanin skin test and its predictive value for protection against infection and disease

et al. 2020

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Background Leishmanin Skin Test (LST) is considered as a useful indicator of past infection by Leishmania parasites. However, the temporal dynamics of a positive LST under different epidemiologic scenarios and whether it relates to the protection against the recurrence of an overt disease are not fully documented. Methodology/Principal findings We report here on a population based prospective study conducted on 2686 individuals living in two foci located in Central Tunisia, to assess over a one-year epidemiologic season, the incidence of Leishmania (L.) major infection and disease and changes in LST reactivity. The two foci were both endemic for Cutaneous Leishmaniasis (CL) due to L. major, but contrasted in their history for this disease (ie: an old focus versus a recent focus). We found that most infections occurred in the new focus (290/1000; 95% CI: 265-315 person-years) with an incidence rate of CL lesions 2.4 times higher than in the old focus. Likewise, the rates of LST reactivity reversion and loss, in the new focus, were 99/1000[38-116] person-years and 14/1000[8-21] person-years, respectively. Loss of LST reactivity was not noticed in the old focus. Interestingly, the incidence rates of symptomatic infection did not differ significantly according to the LST status at enrolment (negative versus positive) between the combined foci and the new one.

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Section: Plos Neglected Tropical Diseasessupporting

confidence: 91%

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

A prospective cohort study of Cutaneous Leishmaniasis due to Leishmania major: Dynamics of the Leishmanin skin test and its predictive value for protection against infection and disease

et al. 2020

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“…Through intradermal injection of Leishmania antigens, the induration is being read 48–72 hours later as a demonstration of a delayed type hypersensitivity reaction, much like a tuberculin skin test [ 11 ]. LST does not differentiate between past and present infection and not species specific, yet it is often used as a marker for cellular immunity against CL [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

Uncharted territory of the epidemiological burden of cutaneous leishmaniasis in sub-Saharan Africa—A systematic review

et al. 2018

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IntroductionCutaneous leishmaniasis (CL) is the most frequent form of leishmaniasis, with 0.7 to 1.2 million cases per year globally. However, the burden of CL is poorly documented in some regions. We carried out this review to synthesize knowledge on the epidemiological burden of CL in sub-Saharan Africa.MethodsWe systematically searched PubMed, CABI Global health, Africa Index Medicus databases for publications on CL and its burden. There were no restrictions on language/publication date. Case series with less than ten patients, species identification studies, reviews, non-human, and non-CL focused studies were excluded. Findings were extracted and described. The review was conducted following PRISMA guidelines; the protocol was registered in PROSPERO (42016036272).ResultsFrom 289 identified records, 54 met eligibility criteria and were included in the synthesis. CL was reported from 13 of the 48 sub-Saharan African countries (3 eastern, nine western and one from southern Africa). More than half of the records (30/54; 56%) were from western Africa, notably Senegal, Burkina Faso and Mali. All studies were observational: 29 were descriptive case series (total 13,257 cases), and 24 followed a cross-sectional design. The majority (78%) of the studies were carried out before the year 2000. Forty-two studies mentioned the parasite species, but was either assumed or attributed on the historical account. Regional differences in clinical manifestations were reported. We found high variability across methodologies, leading to difficulties to compare or combine data. The prevalence in hospital settings among suspected cases ranged between 0.1 and 14.2%. At the community level, CL prevalence varied widely between studies. Outbreaks of thousands of cases occurred in Ethiopia, Ghana, and Sudan. Polymorphism of CL in HIV-infected people is a concern. Key information gaps in CL burden here include population-based CL prevalence/incidence, risk factors, and its socio-economic burden.ConclusionThe evidence on CL epidemiology in sub-Saharan Africa is scanty. The CL frequency and severity are poorly identified. There is a need for population-based studies to define the CL burden better. Endemic countries should consider research and action to improve burden estimation and essential control measures including diagnosis and treatment capacity.

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“…Obviously, the positive LST reactivity observed after vaccination with killed parasite is generally not predictive of protection against ZCL, despite a lower prevalence of disease in individuals with positive LST. Thus, although LST conversion might be an indicator of Leishmania -specific immunity, it may not, however, be considered as an accurate correlate of protection against the disease (Momeni Boroujeni et al, 2013 ), hence the need to define the immunological basis of resistance to infection with Leishmania parasites. Besides the key role of CD4 + Th1 cells, which is closely associated with LST reactivity, several studies pointed to the involvement of CD8 + T cells in acquiring immunity against leishmaniasis in mice model (Belkaid et al, 2002 ; Rhee et al, 2002 ).…”

Section: Introductionmentioning

confidence: 99%

Immunity Against Leishmania major Infection: Parasite-Specific Granzyme B Induction as a Correlate of Protection

Boussoffara

Chelif

Ahmed

et al. 2018

Front. Cell. Infect. Microbiol.

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Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania (L.) major infection is characterized by different clinical presentations which depend in part on the host factors. In attempt to investigate the impact of the host's immune response in the outcome of the disease, we conducted a prospective study of 453 individuals living in endemic foci of L. major transmission in Central Tunisia. Several factors were assessed at the baseline including (i) the presence of typical scars of ZCL, (ii) in vivo hypersensitivity reaction to leishmanin, and (iii) the in vitro release of granzyme B (Grz B) by peripheral blood mononuclear cells (PBMC) in response to stimulation with live L. major promastigotes. After one season of parasite's transmission, repeated clinical examinations allowed us to diagnose the new emerging ZCL cases. Heterogeneity was observed in terms of number of lesions developed by each individual as well as their size and spontaneous outcome, which led us to establish the parameter “severity of the disease.” The efficacy of the presence of typical ZCL scar, the leishmanin skin test (LST) positive reactivity and the high levels of Grz B (≥2 ng/ml), in the protection against the development of ZCL were 29, 15, and 22%, respectively. However, these factors were more efficient against development of intermediate or severe forms of ZCL. Levels of Grz B >2 ng/ml showed the best efficacy of protection (equals to 72.8%) against development of these forms of ZCL. The association of such parameter with the positivity of the LST exhibited a better efficacy (equals to 83.6%). In conclusion, our results support the involvement of Leishmania-specific cytotoxic cellular immune response in host protection against Leishmania-infection. This factor could be of great interest in monitoring the success of vaccination against human leishmaniasis.

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Reevaluating leishmanin skin test as a marker for immunity against cutaneous leishmaniasis

Cited by 9 publications

References 15 publications

A prospective cohort study of Cutaneous Leishmaniasis due to Leishmania major: Dynamics of the Leishmanin skin test and its predictive value for protection against infection and disease

A prospective cohort study of Cutaneous Leishmaniasis due to Leishmania major: Dynamics of the Leishmanin skin test and its predictive value for protection against infection and disease

Uncharted territory of the epidemiological burden of cutaneous leishmaniasis in sub-Saharan Africa—A systematic review

Immunity Against Leishmania major Infection: Parasite-Specific Granzyme B Induction as a Correlate of Protection

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