Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies

Background: On the Indian subcontinent, visceral leishmaniasis (VL) incidence is on track to reach elimination goals by 2020 in nearly all endemic districts. Although not included in official targets, previous data suggest post-kala-azar dermal leishmaniasis (PKDL) patients can act as an infection r...

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Autores: Mondal, Dinesh, Bern, Caryn, Ghosh, Debashis, Rashid, Masud, Molina, Ricardo, Chowdhury, Rajashree, Nath, Rupen, Ghosh, Prakash, Chapman, Lloyd A C, Alim, Abdul, Bilbe, Graeme, Alvar, Jorge
Tipo de documento: artigo
Data de publicação:2019
País:España
Recursos:Instituto de Salud Carlos III (ISCIII)
Repositório:Repisalud
Idioma:inglês
OAI Identifier:oai:repisalud.isciii.es:20.500.12105/13826
Acesso em linha:http://hdl.handle.net/20.500.12105/13826
Access Level:Acceso aberto
Palavra-chave:Disease Reservoirs
Disease Transmission, Infectious
Adult
Animals
Female
Humans
Insect Vectors
Leishmania donovani
Leishmaniasis, Cutaneous
Leishmaniasis, Visceral
Male
Middle Aged
Psychodidae
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spelling Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand FliesMondal, DineshBern, CarynGhosh, DebashisRashid, MasudMolina, RicardoChowdhury, RajashreeNath, RupenGhosh, PrakashChapman, Lloyd A CAlim, AbdulBilbe, GraemeAlvar, JorgeDisease ReservoirsDisease Transmission, InfectiousAdultAnimalsFemaleHumansInsect VectorsLeishmania donovaniLeishmaniasis, CutaneousLeishmaniasis, VisceralMaleMiddle AgedPsychodidaeBackground: On the Indian subcontinent, visceral leishmaniasis (VL) incidence is on track to reach elimination goals by 2020 in nearly all endemic districts. Although not included in official targets, previous data suggest post-kala-azar dermal leishmaniasis (PKDL) patients can act as an infection reservoir. Methods: We conducted xenodiagnosis on 47 PKDL patients and 15 VL patients using laboratory-reared Phlebotomus argentipes. In direct xenodiagnosis, flies were allowed to feed on the patient's skin for 15 minutes. For indirect xenodiagnosis, flies were fed through a membrane on the patient's blood. Five days later, blood-fed flies were dissected and examined by microscopy and/or polymerase chain reaction (PCR). A 3-mm skin snip biopsy (PKDL) or venous blood (VL) was processed by quantitative PCR. Results: Twenty-seven PKDL patients (57.4%) had positive results by direct and/or indirect xenodiagnosis. Direct was significantly more sensitive than indirect xenodiagnosis (55.3% vs 6.4%, P < .0001). Those with positive xenodiagnosis had median skin parasite loads >1 log10 unit higher than those with negative results (2.88 vs 1.66, P < .0001). In a multivariable model, parasite load, nodular lesions, and positive skin microscopy were significantly associated with positive xenodiagnosis. Blood parasite load was the strongest predictor for VL. Compared to VL, nodular PKDL was more likely and macular PKDL less likely to result in positive xenodiagnosis, but neither difference reached statistical significance. Conclusions: Nodular and macular PKDL, and VL, can be infectious to sand flies. Active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs.Oxford University PressAgencia Española de Cooperación Internacional para el DesarrolloInternational Centre for Diarrhoeal Disease Research, Bangladesh (India)World Health Organization (WHO/OMS)20222022-03-2520192019-07-0120192019-07-01journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/20.500.12105/13826reponame:Repisaludinstname:Instituto de Salud Carlos III (ISCIII)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:repisalud.isciii.es:20.500.12105/138262026-06-12T12:43:37Z
dc.title.none.fl_str_mv Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
title Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
spellingShingle Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
Mondal, Dinesh
Disease Reservoirs
Disease Transmission, Infectious
Adult
Animals
Female
Humans
Insect Vectors
Leishmania donovani
Leishmaniasis, Cutaneous
Leishmaniasis, Visceral
Male
Middle Aged
Psychodidae
title_short Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
title_full Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
title_fullStr Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
title_full_unstemmed Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
title_sort Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
dc.creator.none.fl_str_mv Mondal, Dinesh
Bern, Caryn
Ghosh, Debashis
Rashid, Masud
Molina, Ricardo
Chowdhury, Rajashree
Nath, Rupen
Ghosh, Prakash
Chapman, Lloyd A C
Alim, Abdul
Bilbe, Graeme
Alvar, Jorge
author Mondal, Dinesh
author_facet Mondal, Dinesh
Bern, Caryn
Ghosh, Debashis
Rashid, Masud
Molina, Ricardo
Chowdhury, Rajashree
Nath, Rupen
Ghosh, Prakash
Chapman, Lloyd A C
Alim, Abdul
Bilbe, Graeme
Alvar, Jorge
author_role author
author2 Bern, Caryn
Ghosh, Debashis
Rashid, Masud
Molina, Ricardo
Chowdhury, Rajashree
Nath, Rupen
Ghosh, Prakash
Chapman, Lloyd A C
Alim, Abdul
Bilbe, Graeme
Alvar, Jorge
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Agencia Española de Cooperación Internacional para el Desarrollo
International Centre for Diarrhoeal Disease Research, Bangladesh (India)
World Health Organization (WHO/OMS)
dc.subject.none.fl_str_mv Disease Reservoirs
Disease Transmission, Infectious
Adult
Animals
Female
Humans
Insect Vectors
Leishmania donovani
Leishmaniasis, Cutaneous
Leishmaniasis, Visceral
Male
Middle Aged
Psychodidae
topic Disease Reservoirs
Disease Transmission, Infectious
Adult
Animals
Female
Humans
Insect Vectors
Leishmania donovani
Leishmaniasis, Cutaneous
Leishmaniasis, Visceral
Male
Middle Aged
Psychodidae
description Background: On the Indian subcontinent, visceral leishmaniasis (VL) incidence is on track to reach elimination goals by 2020 in nearly all endemic districts. Although not included in official targets, previous data suggest post-kala-azar dermal leishmaniasis (PKDL) patients can act as an infection reservoir. Methods: We conducted xenodiagnosis on 47 PKDL patients and 15 VL patients using laboratory-reared Phlebotomus argentipes. In direct xenodiagnosis, flies were allowed to feed on the patient's skin for 15 minutes. For indirect xenodiagnosis, flies were fed through a membrane on the patient's blood. Five days later, blood-fed flies were dissected and examined by microscopy and/or polymerase chain reaction (PCR). A 3-mm skin snip biopsy (PKDL) or venous blood (VL) was processed by quantitative PCR. Results: Twenty-seven PKDL patients (57.4%) had positive results by direct and/or indirect xenodiagnosis. Direct was significantly more sensitive than indirect xenodiagnosis (55.3% vs 6.4%, P < .0001). Those with positive xenodiagnosis had median skin parasite loads >1 log10 unit higher than those with negative results (2.88 vs 1.66, P < .0001). In a multivariable model, parasite load, nodular lesions, and positive skin microscopy were significantly associated with positive xenodiagnosis. Blood parasite load was the strongest predictor for VL. Compared to VL, nodular PKDL was more likely and macular PKDL less likely to result in positive xenodiagnosis, but neither difference reached statistical significance. Conclusions: Nodular and macular PKDL, and VL, can be infectious to sand flies. Active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs.
publishDate 2019
dc.date.none.fl_str_mv 2019
2019-07-01
2019
2019-07-01
2022
2022-03-25
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/20.500.12105/13826
url http://hdl.handle.net/20.500.12105/13826
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Oxford University Press
publisher.none.fl_str_mv Oxford University Press
dc.source.none.fl_str_mv reponame:Repisalud
instname:Instituto de Salud Carlos III (ISCIII)
instname_str Instituto de Salud Carlos III (ISCIII)
reponame_str Repisalud
collection Repisalud
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.198674

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