Showing papers on "Visceral leishmaniasis published in 1985"
TL;DR: It was found that both IL-2 and gamma interferon production, in response to leishmania antigen, was absent during the active disease, but was restored after successful chemotherapy.
Abstract: The lymphocytes from eight patients with active visceral leishmaniasis (VL), a disease associated with marked immunologic dysfunction, were examined for ability to produce interleukin 2 (IL-2) and gamma interferon during in vitro cultivation. It was found that both IL-2 and gamma interferon production, in response to leishmania antigen, was absent during the active disease, but was restored after successful chemotherapy. Untreated VL patients produced IL-2 and gamma interferon when stimulated with phytohemagglutinin (PHA). Six patients with either active cutaneous or mucosal leishmaniasis, a disease not associated with immunosuppression, showed high levels of gamma interferon in response to leishmania antigen and PHA. Since IL-2 and gamma interferon have been shown to have important roles in the immune response and in the killing of leishmania, their absence may represent a key defect in the immune response in VL.
320 citations
TL;DR: Renal involvement in visceral leishmaniasis was mild and seemed to revert with the cure of the leish maniasis, and there was a tendency to subsidence of abnormal laboratory findings within one month after specific therapy.
100 citations
TL;DR: All the Leishmania stocks isolated from dogs which came from Realengo, Bangu, Senador Camará (VL area), and from Campo Grande (VL + ACL area) were characterized as L. donovani (except in one case), according to their schizodeme, zymodeme and serodeme.
Abstract: Forty dogs from the periphery of the city of Rio de Janeiro were studied. All dogs where diagnosed as positive for leishmaniasis either parasitologically and/or serologically. Among them, 19 came from areas where only Visceral Leishmaniasis (VL) occurs (Realengo, Bangu, Senador Camara). Clinical signs of the disease were seen in 36.8% of the cases, including emaciation - 100%, lymphadenopathy and depilation - 85.7%. The other 21 dogs came from an area (Campo Grande) where both diseases (VL, and American Cutaneous Leishmaniasis - ACL) occur. Clinical signs of the disease, mainly cutaneous or mucocutaneous ulcers were seen in 76.2% of the cases. Leishmania parasites were found in 39 cases: 22% in viscera, 42.5% in viscera and normal skin and 35% in cutaneous or mucocutaneous ulcers. All the Leishmania stocks isolated from dogs which came from Realengo, Bangu, Senador Camara (VL area), and from Campo Grande (VL + ACL area) were characterized as L. donovani (except in one case) according to their schizodeme, zymodeme and serodeme. The only stock characterized as L. b. braziliensis, was isolated from the lymph node of a dog from Campo Grande with visceral disease and without skin lesions. Antimony therapy attempted in eight Leishmania donovani positive dogs was unsuccessful.
99 citations
TL;DR: Low-frequency, long-duration pentamidine was often useful in maintaining any improvement made during treatment with the less well tolerated high-dose, high frequency sodium stibogluconate.
Abstract: Ten Kenyan patients with visceral leishmaniasis unresponsive to sodium stibogluconate, at a dose of 16 to 20 mg Sb/kg body-weight/day given for 30 to 98 days, were treated with 20 mg Sb/kg bw given every eight hours. This regimen was modified or abandoned in six patients because of suspected toxicity, although toxicity was difficult to assess because of intercurrent illness. Toxic effects included lethargy, anorexia, vomiting, electrocardiographic changes, fall in haemoglobin and rise in liver enzymes. One patient died, probably from a cardiac arrhythmia. Two patients were cured, four responded partially and four showed no response. Pentamidine, at a dose of 4 mg/kg body-weight given one to 3 times per week for 5 to 39 weeks, was given as initial treatment in one patient and after failure of sodium stibogluconate in seven. Toxic effects included nephritis, hepatitis, transient diabetes and subcutaneous abscesses. Two patients were cured, two responded partially, three showed no response and one, after apparent cure, relapsed and was unresponsive to additional pentamidine treatment. Low-frequency, long-duration pentamidine was often useful in maintaining any improvement made during treatment with the less well tolerated high-dose, high frequency sodium stibogluconate. We observed the step-wise development of resistance to both sodium stibogluconate and pentamidine. The problems of managing patients with visceral leishmaniasis which is unresponsive to conventional doses of pentavalant antimonials are discussed and some tentative suggestions put forward.
91 citations
TL;DR: This combination of sodium stibogluconate at the same dose plus allopurinol at a dose of 20 mg/kg body-weight per day in three divided doses was safe and effective and none has relapsed in at least 12 months of follow-up.
Abstract: Five patients with long-standing visceral leishmaniasis who were unresponsive to sodium stibogluconate, 20 mg antimony/kg body-weight once or twice daily, were treated for 14 to 54 days with a combination of sodium stibogluconate at the same dose plus allopurinol at a dose of 20 mg/kg body-weight per day in three divided doses. This combination was safe and effective. Negative splenic aspirate smears were obtained from all patients within 19 days, and none has relapsed in at least 12 months of follow-up.
90 citations
TL;DR: Ten Kenyan patients with visceral leishmaniasis, unresponsive to sodium stibogluconate at a dose of 16 to 20 mg Sb/kg/day given for 30 to 98 days, have been studied clinically and immunologically and compared with 57 antimony-responsive patients.
Abstract: Ten Kenyan patients with visceral leishmaniasis, unresponsive to sodium stibogluconate at a dose of 16 to 20 mg Sb/kg/day given for 30 to 98 days, have been studied clinically and immunologically and compared with 57 antimony-responsive patients. Pulmonary tuberculosis and previous treatment with antimonial drugs were the only factors which were more common in unresponsive patients. The degree of immunosuppression and rate of recovery of immunoreactivity did not differ between antimony-responsive and -unresponsive patients. Only one patient had never been treated before (primary unresponsiveness). In the other nine patients secondary unresponsiveness occurred after one or more treatment courses, suggesting that the parasite developed resistance to antimony. Antimony-unresponsiveness in visceral leishmaniasis is a serious problem numerically, clinically and economically. A plea is made that the initial treatment of visceral leishmaniasis should be adequate in dose and duration.
74 citations
TL;DR: There are areas in the periphery of Rio de Janeiro city where human cases of Visceral and/or Cutaneous Leishmaniasis occur and the parasites have been identified as Leishmanniasis donovani and Leishmania braziliensis b Braziliensis respectively.
Abstract: There are areas in the periphery of Rio de Janeiro city where human cases of Visceral and/or Cutaneous Leishmaniasis occur. The parasites have been identified as Leishmania donovani and Leishmania braziliensis braziliensis respectively. A survey for Leishmaniasis was done among 1,342 dogs from those areas using an indirect immunofluorescent test. From the dogs, 616 came from areas where only human cases of Visceral Leishmaniasis occurred, 373 from an area where all human cases were of Cutaneous Leishmaniasis and 353 from a third area (Campo Grande) where both visceral and cutaneous human cases were detected. The prevalence of parasite antibody titers among dogs from areas of Cutaneous Leishmaniasis was significantly higher than that of Visceral Leishmaniasis (8.6% vs. 4.3%, p < 0.02). The highest prevalence was observed among dogs from the area where both diseases are present (12.7%).
66 citations
TL;DR: Evidence is presented incriminating the sandfly Lutzomyia longipalpis as the vector of Leishmania chagasi, the causative agent of American visceral leishmaniasis, in the Amazon Region of Brazil.
Abstract: Further evidence is presented incriminating the sandfly Lutzomyia longipalpis as the vector of Leishmania chagasi, the causative agent of American visceral leishmaniasis, in the Amazon Region of Brazil. During an outbreak of the disease in Santarem, Para State, this insect was shown to be the only species of sandfly consistently present in and around the patient's homes, where it often occurred in very large numbers. Of 491 specimens dissected, 35 (7.14%) proved to be infected, and isolates of L. chagasi were made from 16 of 27 of these sandflies following the inoculation of the promastigotes into hamsters. Finally, the parasite was transmitted to four other hamsters which had been subjected to the bites of large numbers of wild-caught Lu. longipalpis. Isolates of Leishmania from Lu. longipalpis captures in Santarem, and in another focus of visceral leishmaniasis on the Island of Marajo, Para, have been shown to be biologically and biochemically indistinguishable from the parasite infecting man, dogs and foxes in Para, and from stocks obtained from man elsewhere in Brazil (Bahia and Ceara States).
65 citations
TL;DR: The combined treatment was found to be more effective in the elimination of Leishmania donovani amastigotes from infected tissue macrophages than was either of the two treatments applied individually.
Abstract: A regimen of immunostimulation with 6-0-stearoyl-N-acetylmuramyl-L-alpha-aminobutyryl-D-isoglutamine, a lipophilic analog of muramyl dipeptide, combined with antimonial drug therapy was evaluated in the treatment of visceral leishmaniasis of mice and hamsters. The combined treatment was found to be more effective in the elimination of Leishmania donovani amastigotes from infected tissue macrophages than was either of the two treatments applied individually. In mice, it was found that immunostimulation of animals prophylactically, therapeutically, or both enhanced the effects of the antimonial drug (Glucantime) administered more than 1 week after a challenge of BALB/c and C57BL/6 mice. The superiority of the combined treatment of the parasite infection was demonstrable in both short-term (14 days) and long-term (40 to 45 days) infections of the two inbred strains of mice. The combined therapy was also effective in preventing the lethal course of leishmaniasis in hamsters which succumb to disseminated disease in the absence of therapeutic intervention. The efficacy of this dual approach to the therapy of disseminated leishmaniasis of experimental animals holds promise for similar application in the treatment of similarly afflicted human populations.
50 citations
Journal Article•
TL;DR: Results suggest that the hypergammaglobulinaemia present in visceral leishmaniasis may be the consequence of an inbalance of regulatory T cells, possibly associated with a direct stimulation of hamster B cells by L. donovani components.
Abstract: Studies were carried out on the mechanisms by which B lymphocytes are polyclonally activated to secrete antibodies during visceral leishmaniasis. Crude extracts of Leishmania donovani, the aetiological agent of this disease, of Leishmania mexicana amazonensis, the etiological agent of cutaneous leishmaniasis, and of Herpetomonas muscarum, a related non-pathogenic organism, all contain components which cause strong in vitro polyclonal activation of hamster spleen cells leading to the production of antibodies. However, in vivo, only hamsters infected with L. donovani develop hypergammaglobulinaemia due to B cell polyclonal activation. Hamsters injected with the crude extracts of leishmania or infected with L. mexicana amazonensis do not manifest these alterations in their B cell response. Furthermore spleen cells of hamsters infected with L. donovani became unresponsive to stimulation with the T cell mitogen phytohaemagglutinin (PHA) by day 10 of infection, whereas their response to concanavalin A (Con A) was preserved. The decreased lymphocyte response to PHA coincided with the augmentation of the PFC/spleen ratio. In contrast, spleen cells from hamsters infected with L. mexicana amazonensis, responded normally to both mitogens throughout the course of infection. These results suggest that the hypergammaglobulinaemia present in visceral leishmaniasis may be the consequence of an inbalance of regulatory T cells, possibly associated with a direct stimulation of hamster B cells by L. donovani components.
44 citations
TL;DR: Until now, the dermotropic zymodemes of Algeria and France have not been seen in cases of visceral leishmaniasis of the Mediterranean Basin.
Abstract: For the first time, the pathogenic agent of cutaneous leishmaniasis in the North of Algeria has been identified as Leishmania infantum s.1. The parasite was found to be a newly discovered enzymatic variant (zymodeme 24) differing by two electromorphs from a variant isolated in France (zymodeme 11) from the same type of lesion. Until now, the dermotropic zymodemes of Algeria and France have not been seen in cases of visceral leishmaniasis of the Mediterranean Basin.
TL;DR: Nineteen cases of "localized" leishmania lymphadenitis without any evidence of visceral leishmaniasis are reported, and differential diagnosis from toxoplasmosis and cat-scratch disease is discussed.
Abstract: Nineteen cases of "localized" leishmania lymphadenitis without any evidence of visceral leishmaniasis are reported. Fifteen males and 4 females aged 5 to 30 years have presented with localized lymphadenopathy of up to 3 months duration. The disease has a seasonal incidence of late summer to mid-winter. Cutaneous leishmaniasis even when present, usually was overlooked. Lesions of cutaneous leishmaniasis were absent in 3; healed in 1; small, similar to insect bites in 5; classic in 3; lupoid in 1 and unknown in 6 patients. Serum leishmanial antibody determination by IFAT performed on 12 cases were positive. Toxoplasma serology was negative. Histological picture of one lymph node biopsy showed an (anergic) intact histiocytic response characterized by thousands of intracellular amastigotes, no necrosis and inconspicuous plasma cells. In 17 biopsies the picture was that of histiocytic granulomata with varying degrees of necrosis, moderate numbers of amastigotes in several foci, fibrosis and varying numbers of plasma cells. One biopsy from a lupoid case shows numerous epitheloid granulomata, no organisms, no necrosis and inconspicuous plasma cells. Electron microscopy has been performed on 8 biopsies to confirm leishmania amastigotes. Differential diagnosis from toxoplasmosis and cat-scratch disease is discussed. Histological types of responses in the lymph nodes are comparable to those described in cutaneous leishmaniasis: an anergic response with intact macrophage granuloma, a histiocytic response with necrosis, and a lupoid type of response with epithelioid granulomas.
TL;DR: Between 1975 and 1983, 53 patients with parasitologically proven visceral leishmaniasis (VL) and 16 patients with suspected VL were diagnosed in Honduras and each gave a stronger reaction when tested against Trypanosoma cruzi antigen, suggesting that the reactions to L. donovani were false positives.
Abstract: Between 1975 and 1983, 53 patients with parasitologically proven visceral leishmaniasis (VL) and 16 patients with suspected VL were diagnosed in Honduras. The patients' ages ranged from 3 months to 10 years, but 95% were younger than 3 years old. Since 1978, when 16 patients were reported, the yearly incidence has declined, and in 1982 only 4 patients were reported. We located and interviewed the families of 57 of the 69 patients. At the onset of illness, all 57 patients lived in rural areas, and 55 lived in southern Honduras. All the patients who were discharged from the hospital alive were still living at the time of the interview. A case-control study, using age-matched neighbors as controls, showed that patients were significantly more likely to have lived in poorly constructed, wood-stick houses. We used an indirect immunofluorescence test to analyze blood samples for Leishmania antibodies from 218 family members of patients, 170 family members of controls, and 156 children living on the island of El Tigre, where 4 of the 5 most recently diagnosed patients lived. Although 15 specimens gave a positive reaction to L. donovani antigen, each gave a stronger reaction when tested against Trypanosoma cruzi antigen, suggesting that the reactions to L. donovani were false positives. A serosurvey of 279 dogs of cases and controls and from El Tigre showed that 24 had positive reactions to L. donovani antigen, but only 4 (1.4%) had higher titers to L. donovani than to T. cruzi.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: After spontaneous recovery or elimination of parasites by antimonial drug therapy, the response of spleen cells to T-cell mitogens or parasite antigens were restored to normal and the suppressor was identified as a macrophage population which appears to be responsible for a nonspecific immunosuppression of Lshs mice with significant parasite burdens of L. donovani.
Abstract: Visceral leishmaniasis is one of several parasitic diseases of humans characterized by immune suppression. A murine model of disseminated leishmaniasis utilizing inbred strains of specific genetic constitution was used to study the mechanisms of immunosuppression elicited during the course of infection. Resistant (Lshr) and susceptible (Lshs) strains of mice were challenged with amastigotes of Leishmania donovani and evaluated as to immune status at intervals between 2 and 40 weeks after challenge. The proliferative responses of splenic lymphocytes to T-cell mitogens, a B-cell mitogen, and parasite antigens were measured to evaluate the relative immune status of parasitized mice and noninfected control mice. Lymphocytes from resistant C3Heb/FeJ (C3H) mice responded normally to concanavalin A and phytohemagglutinin throughout the course of infection. Parasite antigen responses appeared 2 weeks after challenge of C3H mice and remained vigorous for periods up to 6 months. In contrast, immune suppression during infection was profound in both the curing (C57B1/10) and noncuring (B10.D2) phenotypes of Lshs congenic mice. Both Lshs strains developed severe infection as evidenced by high parasite burdens in the liver and spleen 4 to 5 weeks after challenge; splenic lymphocytes taken from these mice between 2 and 8 weeks became increasingly unresponsive to the T-cell mitogens as well as to parasite antigens. The noncuring B10.D2 mice which suffered chronic infection continued to be suppressed for as long as 40 weeks. C57B1/10 (curing) mice, in contrast, cleared infection between 12 and 16 weeks. After spontaneous recovery or elimination of parasites by antimonial drug therapy, the response of spleen cells to T-cell mitogens or parasite antigens were restored to normal. The spleen cells from the Lshs strains of mice obtained during the height of infection suppressed the proliferative responses of spleen cells from their uninfected counterparts upon cocultivation in vitro. Removal of adherent cells from the suppressive spleen cell populations restored normal mitogen responses. On the basis of adherence characteristics, phagocytosis, and morphology, the suppressor was identified as a macrophage population which appears to be responsible for a nonspecific immunosuppression of Lshs mice with significant parasite burdens of L. donovani.
TL;DR: A relatively high leishmanial infection rate was found in the phlebotomine sandfly Lutzomyia longipalpis collected from three villages of the Los Yungas region and biochemical characterization of the strains indicate that the parasite belongs to the Leishmania donovani complex.
Abstract: A relatively high leishmanial infection rate was found in the phlebotomine sandfly Lutzomyia longipalpis collected from three villages of the Los Yungas region (Department of La Paz, Bolivia). 2,578 female sandflies were dissected. In three houses surveyed in Santa Barbara promastigote infection rates of Lu. longipalpis were 4·2, 2·2 and 3·2% respectively. Anatomical localization of the infection in the insect, and biochemical characterization of the strains indicate that the parasite belongs to the Leishmania donovani complex. The geographical area and the biotopes of Lu. longipalpis are discussed in relation to the vector-parasite relationship.
TL;DR: Squirrel monkey visceral leishmaniasis has a sustained course and certain clinical, hematologic and pathologic characteristics which are similar to human visceralLeishmania donovani.
Abstract: Clinical signs, parasite densities, and hematologic and hepatic changes were studied in 7 squirrel monkeys (Saimiri sciureus) each of which was inoculated intravenously with amastigotes (5.0 X 10(7) per kg body weight) of a Khartoum strain (WR 378) of Leishmania donovani. One control monkey was inoculated with uninfected hamster spleen homogenate. Five of the infected monkeys recovered spontaneously from visceral leishmaniasis by 8 to 15 wk postinoculation (wk PI) and 2 of the infected monkeys died at 39 and 59 days PI, respectively. All monkeys inoculated with L. donovani experienced a slight body weight loss, mild but significant anemia, lymphocytosis and an inconsistent neutropenia. Liver parasite densities could be quantitated from liver imprints from 2 to 8 wk PI and reached a maximum mean of 6.3 X 10(7) amastigotes/g liver at 4 wk PI in Experiment 1 and 13.4 X 10(7) amastigotes/g liver at 6 wk PI in Experiment 2. None of the liver imprints contained parasites at 15 wk PI. The characteristic histopathologic findings in liver biopsy and necropsy samples were multiple granulomas consisting of macrophages (some of which contained parasites), lymphocytes and plasma cells. The squirrel monkey is a moderately susceptible host for L. donovani. Squirrel monkey visceral leishmaniasis has a sustained course and certain clinical, hematologic and pathologic characteristics which are similar to human visceral leishmaniasis.
TL;DR: It is apparent that parasitaemia with L. donovani occurs frequently in Kenyan patients with visceral leishmaniasis.
Abstract: Twenty Kenyan patients with visceral leishmaniasis were evaluated for the presence of Leishmania donovani in their peripheral blood. Smears, cultures and hamster inoculations detected parasitaemia in 11, 10 and six patients, respectively, and at least one method detected parasitaemia in 15 patients (75%). The likelihood of detecting parasitaemia correlated with the density of parasites in splenic aspirate smears. It is apparent that parasitaemia with L. donovani occurs frequently in Kenyan patients with visceral leishmaniasis.
TL;DR: There is no genetic inability of the host who acquire visceral leishmaniasis to develop a cellular immune response to leishmania antigen and the longterm persistence of high antibody titers following therapy suggests that the parasite may stay in the host for long time even after apparent clinical cure of the infection.
Abstract: Immunological studies were done in 48 subjects with a past history of visceral leishmaniasis and in 6 patients during the active phase of the disease and shortly after treatment. Antibody titers determined by immunofluorescence antibody test (IFA) or ELISA were positive in 32 (67%) of the 48 persons that had visceral leishmaniasis in the past. The mean antibody titer by the IFA in the 6 patients with active visceral leishmaniasis was 9536 ± 7169 and thymidine uptake in the lymphocyte blastogenesis assay was 323 ± 24. After treatment (3 and 6 months) antibody titers had fallen only in 3 of the 6 patients and a restoration of the lymphocyte proliferative response wasobserved (11909 ±5637). These data demonstrated that there is no genetic inability of the host who acquire visceral leishmaniasis to develop a cellular immune response to leishmania antigen. Moreover, the longterm persistence of high antibody titers following therapy suggests that the parasite may stay in the host for long time even after apparent clinical cure of the infection.
TL;DR: Comparison of the multiplication of the two lines of Leishmania indicated that the MAR line persisted longer in the livers than did the P line, and a slight decrease in body weight was observed at eight weeks post-infection.
Abstract: The relationship of the numbers of amastigotes in the liver to the duration of infection with two lines of a Khartoum strain of Leishmania donovani [designated the parent (P) line and the meglumine...
TL;DR: Application of enzyme-conjugated antisera specific for IgG improves the serodiagnostic value of the Dot-ELISA for individual patient evaluation and epidemiologic investigations.
Journal Article•
TL;DR: The clinical and laboratory manifestations of 29 patients admitted to hospital were assessed in an endemic area in northeastern Brazil, and visceral leishmaniasis remains an important disease among children living in endemic areas.
Abstract: Visceral leishmaniasis (kala-azar) is an important cause of morbidity and mortality in widely scattered areas of the world. To better characterize the South American form of the disease, the clinical and laboratory manifestations of 29 patients admitted to hospital (18 male and 11 female patients, mean age 4.9 years), were assessed in an endemic area in northeastern Brazil. Fever, weight loss, pronounced splenomegaly, hepatomegaly, anemia, thrombocytopenia, relative neutropenia, hypoalbuminemia and hypergammaglobulinemia were found in the majority of patients. Symptoms were often present for two or more months before diagnosis. Secondary infections complicated many cases; there were ten cases of pneumonia and half of the patients had one or more intestinal parasites. The average length of hospital stay was 27 days; all patients were treated with meglumine antimoniate (Glucantime). The mortality rate was 3%. American visceral leishmaniasis remains an important disease among children living in endemic areas.
TL;DR: The most consistent effects of treatment on the amastigotes were a reduction in average size, greater irregularity of the cell outline, and a moderate increase in the electron density of the cytoplasm associated with a greater concentration of ribosomes.
Abstract: Studies were made of the ultrastructure of amastigotes of Leishmania donovani before and during treatment of patients with sodium stibogluconate. The most consistent effects of treatment on the amastigotes were a reduction in average size, greater irregularity of the cell outline, and a moderate increase in the electron density of the cytoplasm associated with a greater concentration of ribosomes. It is suggested that the drug affects active transport functions or permeability of the plasma membrane.
Journal Article•
TL;DR: Les chiens sauvages jouent un role important dans l'epidemiologie de la maladie and des mesures de controle sont prises.
Abstract: La leishmaniose viscerale est maintenant presente en Iraq. Phlebotonus alexandri est le vecteur suspecte. Les chiens sont les reservoirs. Les chiens sauvages jouent un role important dans l'epidemiologie de la maladie et des mesures de controle sont prises
Journal Article•
TL;DR: The risk of bringing dogs in and out of the Mediterranean region is stressed, and veterinarians are advised to have leishmaniasis in mind when they are confronted with dogs taken ill with non-specific symptoms after a stay in that part of the world, even if as much as two years have elapsed between the return and the onset of clinical signs.
Abstract: The first case of imported visceral leishmaniasis in the dog in Denmark, and probably in Scandinavia, is described. The dog, a 5-year-old female wire-haired bird dog, became ill about 21 months after it had returned from a year's stay in Spain (Malaga). The clinical signs were fever, lameness, enlargement of the popliteal lymph nodes and weight loss. A tentative clinical diagnosis of leukaemia was discarded after the microscopic recognition of Leishmania organisms in a biopsy from a popliteal lymph node (Fig. 1). The diagnosis was confirmed by the demonstration of the kinetoplast in the organisms by electron microscopy (Fig. 3 a-b). The organisms measured about 2 micron in diameter indicating that the species in question was Leishmania donovani infantum, which is indigenous to Spain and other Mediterranian countries. The dog was killed, and Leishmania were found in sections of mesenteric and popliteal lymph nodes, spleen, liver, lung and kidneys. The most interesting histologic features were interstitial nephritis, dominated by numerous plasma cells and membranous glomerulonephritis (Fig. 2). It is suggested that the glomerulonephritis is immune complex-mediated as it is in human visceral leishmaniasis. The risk of bringing dogs in and out of the Mediterranean region is stressed, and veterinarians are advised to have leishmaniasis in mind when they are confronted with dogs taken ill with non-specific symptoms after a stay in that part of the world, even if as much as two years have elapsed between the return and the onset of clinical signs.
TL;DR: It is demonstrated that bacterial infection frequently occurs in patients with visceral leishmaniasis, and indicates an unfavourable prognosis, and the widespread range of infections and of infective agents suggests a multifactorial process.
Abstract: In an analysis of 63 hospitalized cases with visceral leishmaniasis, the clinical or post-mortem diagnosis of bacterial infection was performed in 33; 13 (39.3%) patients had respiratory infection, 4 (12.1%) had skin infection, 4 had urinary tract infection, 3 (9.0%) showed ear infection and 2 (6.6%) had infection of the oral cavity. It is worth mentioning that in 7 (21%) cases there was infection in multiple sites. Gram positive and/or Gram negative organisms were isolated from 10 patients. In only two (autopsied) cases, infection with less common organisms was recorded, one with disseminated candidiasis and another with disseminated tuberculosis. Death occurred in 9 of the 63 cases, and in 8 of these, concomitant bacterial infection of importance was documented. Patients who had serum globulins lower than 4 g% had significantly more infection (p less than 0.05) than patients with globulin levels higher than 4 g%; there was no significant difference when the number of leucocytes and neutrophils in patients with associated infection was compared with those in patients without bacterial infection. The present study demonstrates that bacterial infection frequently occurs in patients with visceral leishmaniasis, and indicates an unfavourable prognosis. Even though the mechanism of increased susceptibility to infection in this condition was unclear, the widespread range of infections and of infective agents, suggests a multifactorial process.
Journal Article•
01 Jan 1985
TL;DR: In the own laboratory, genes controlling visceral leishmaniasis caused by Leishmania donovani are most concerned, although some mention will also be made of work carried out in other laboratories on cutaneous forms of the disease.
Abstract: In recent years the use of inbred and other genetically manipulated strains of mice (1, 2) has revolutionised the study of genetically determined variations in the host’s response to infectious diseases. Studies of experimental leishmaniasis in mouse models have been particularly successful in identifying and mapping genes which have a major influence on the course of infection in vivo. Since Leishmania species are obligate intracellular protozoan parasites of the mononuclear phagocyte system, it seemed likely from the outset that some of these genes would be expressed at the macrophage level. In our own laboratory we have been most concerned with genes controlling visceral leishmaniasis caused by Leishmania donovani, although some mention will also be made of work carried out in other laboratories on cutaneous forms of the disease.