Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia.
<h4>Background</h4>Tegumentary leishmaniasis (TL) is a parasitic disease that can present a cutaneous or mucocutaneous clinical form (CL and MCL, respectively). The disease is caused by different Leishmania species and transmitted by phlebotomine sand flies. Bolivia has one of the highes...
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Public Library of Science (PLoS)
2021-03-01
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Series: | PLoS Neglected Tropical Diseases |
Online Access: | https://doi.org/10.1371/journal.pntd.0009223 |
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author | Cristina Ballart Mary Cruz Torrico Gisela Vidal Faustino Torrico Daniel Lozano Montserrat Gállego Lilian Pinto Ernesto Rojas Ruth Aguilar Carlota Dobaño Sonia Ares-Gomez Albert Picado |
author_facet | Cristina Ballart Mary Cruz Torrico Gisela Vidal Faustino Torrico Daniel Lozano Montserrat Gállego Lilian Pinto Ernesto Rojas Ruth Aguilar Carlota Dobaño Sonia Ares-Gomez Albert Picado |
author_sort | Cristina Ballart |
collection | DOAJ |
description | <h4>Background</h4>Tegumentary leishmaniasis (TL) is a parasitic disease that can present a cutaneous or mucocutaneous clinical form (CL and MCL, respectively). The disease is caused by different Leishmania species and transmitted by phlebotomine sand flies. Bolivia has one of the highest incidences of the disease in South America and the diagnosis is done by parasitological techniques. Our aim was to describe the clinical and immunological characteristics of CL and MCL patients attending the leishmaniasis reference center in Cochabamba, Bolivia, in order to gain updated clinical and epidemiological information, to evaluate the diagnostic methods used and to identify biomarkers related to clinical disease and its evolution.<h4>Methodology/principal findings</h4>The study was conducted from September 2014 to November 2015 and 135 patients with lesions compatible with CL or MCL were included. Epidemiological and clinical data were collected using a semi-structured questionnaire. Two parasitological diagnostic methods were used: Giemsa-stained smears and culture of lesion aspirates. Blood samples obtained from participants were used to measure the concentrations of different cytokines. 59.2% (80/135) were leishmaniasis confirmed cases (CL: 71.3%; MCL: 28.7%). Sixty percent of the confirmed cases were positive by smears and 90.6% were positive by culture. 53.8% were primo-infections. Eotaxin and monokine induced by IFN-γ presented higher serum concentrations in the MCL clinical presentation compared to CL cases and no-cases. None of the cytokines presented different concentrations between primo-infections and secondary infections due to treatment failure.<h4>Conclusions/significance</h4>In Bolivia, parasitological diagnosis remains the reference standard in diagnosis of leishmaniasis because of its high specificity, whereas the sensitivity varies over a wide range leading to loss of cases. Until more accurate tools are implemented, all patients should be tested by both smears and culture of lesion aspirates to minimize the risk of false negatives. Our results showed higher concentrations of several cytokines in MCL compared to CL, but no differences were observed between CL and no-cases. In addition, none of the cytokines differed between primary and secondary infections. These results highlight the need of further research to identify biomarkers of susceptibility and disease progression, in addition to looking at the local cellular immune responses in the lesions. |
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issn | 1935-2727 1935-2735 |
language | English |
last_indexed | 2024-12-14T08:04:26Z |
publishDate | 2021-03-01 |
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spelling | doaj.art-7a1425a9a5d74088b9c65a0b2e07fb8f2022-12-21T23:10:15ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352021-03-01153e000922310.1371/journal.pntd.0009223Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia.Cristina BallartMary Cruz TorricoGisela VidalFaustino TorricoDaniel LozanoMontserrat GállegoLilian PintoErnesto RojasRuth AguilarCarlota DobañoSonia Ares-GomezAlbert Picado<h4>Background</h4>Tegumentary leishmaniasis (TL) is a parasitic disease that can present a cutaneous or mucocutaneous clinical form (CL and MCL, respectively). The disease is caused by different Leishmania species and transmitted by phlebotomine sand flies. Bolivia has one of the highest incidences of the disease in South America and the diagnosis is done by parasitological techniques. Our aim was to describe the clinical and immunological characteristics of CL and MCL patients attending the leishmaniasis reference center in Cochabamba, Bolivia, in order to gain updated clinical and epidemiological information, to evaluate the diagnostic methods used and to identify biomarkers related to clinical disease and its evolution.<h4>Methodology/principal findings</h4>The study was conducted from September 2014 to November 2015 and 135 patients with lesions compatible with CL or MCL were included. Epidemiological and clinical data were collected using a semi-structured questionnaire. Two parasitological diagnostic methods were used: Giemsa-stained smears and culture of lesion aspirates. Blood samples obtained from participants were used to measure the concentrations of different cytokines. 59.2% (80/135) were leishmaniasis confirmed cases (CL: 71.3%; MCL: 28.7%). Sixty percent of the confirmed cases were positive by smears and 90.6% were positive by culture. 53.8% were primo-infections. Eotaxin and monokine induced by IFN-γ presented higher serum concentrations in the MCL clinical presentation compared to CL cases and no-cases. None of the cytokines presented different concentrations between primo-infections and secondary infections due to treatment failure.<h4>Conclusions/significance</h4>In Bolivia, parasitological diagnosis remains the reference standard in diagnosis of leishmaniasis because of its high specificity, whereas the sensitivity varies over a wide range leading to loss of cases. Until more accurate tools are implemented, all patients should be tested by both smears and culture of lesion aspirates to minimize the risk of false negatives. Our results showed higher concentrations of several cytokines in MCL compared to CL, but no differences were observed between CL and no-cases. In addition, none of the cytokines differed between primary and secondary infections. These results highlight the need of further research to identify biomarkers of susceptibility and disease progression, in addition to looking at the local cellular immune responses in the lesions.https://doi.org/10.1371/journal.pntd.0009223 |
spellingShingle | Cristina Ballart Mary Cruz Torrico Gisela Vidal Faustino Torrico Daniel Lozano Montserrat Gállego Lilian Pinto Ernesto Rojas Ruth Aguilar Carlota Dobaño Sonia Ares-Gomez Albert Picado Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia. PLoS Neglected Tropical Diseases |
title | Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia. |
title_full | Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia. |
title_fullStr | Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia. |
title_full_unstemmed | Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia. |
title_short | Clinical and immunological characteristics of tegumentary leishmaniasis cases in Bolivia. |
title_sort | clinical and immunological characteristics of tegumentary leishmaniasis cases in bolivia |
url | https://doi.org/10.1371/journal.pntd.0009223 |
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