HIV co-infection with a currently non-pathogenic flagellate

Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
The Lancet (Impact Factor: 45.22). 02/1996; 347(8996):264-5. DOI: 10.1016/S0140-6736(96)90441-9
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Available from: Ricardo Molina, Sep 19, 2015
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    • "Included among the heteroxeneous trypanosomatids are species responsible for a broad spectrum of human and animal diseases, such as Trypanosoma cruzi and Leishmania sp., which are responsible for respectively Chagas disease , visceral and tegumentary leishmaniasis (Stuart et al., 2008). Although insect trypanosomatids are considered non-pathogenic to humans, several reports have shown that they can infect people , particularly those infected with human immunodeficiency virus (HIV), and the lesions may mimic diffuse cutaneous and visceral leishmaniasis (Chicharro and Alvar, 2003; Ghosh et al., 2012; Jiménez et al., 1996; Morio et al., 2008; Singh et al., 2013). "
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    ABSTRACT: We investigated whether ELISA using crude antigens from insect and plant trypanosomatids, which are non-pathogenic and easily cultivated in large scale, has the same positivity data as Leishmania (Leishmania) chagasi, the etiological agent of human visceral leishmaniasis (VL) or canine leishmaniasis (CanL), or as T. cruzi, the etiological agent of Chagas disease (CD). The antigens from Crithidia fasciculata, Crithidia luciliae, and Leptomonas seymouri showed 100% cross-reactivity with VL and CanL samples, with no statistically titers differences from L. (L.) chagasi, however, 34% (17/50) of VL samples revealed higher titers using the insect trypanosomatids than the homologous antigen. On the other hand, antigens from Strigomonas culicis, Angomonas deanei, and Phytomonas serpens showed low cross-reactivity with VL and CanL samples. The sera from patients with American tegumentary leishmaniasis showed low levels of cross-reactivity with all trypanosomatids investigated, even with L. (L) chagasi, without titers dissimilarity among them. These parasites were also worthless as antigen source for detection of CD cases, which required homologous antigens to reach 100% positivity. This study showed, by ELISA, that crude extract of Crithidia and Leptomonas have epitopes similar to L. (L.) chagasi, which supports the idea of using them as antigens source for the serodiagnosis of visceral leishmaniasis.
    Full-text · Article · Nov 2013 · Acta tropica
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    • "Monoxenous trypanosomatids can be pathogenic for human beings. Similar cases have also been reported [35], [36] where in HIV infected patients, Leptomonas parasites were detected with symptoms sometimes resembling those of visceral or cutaneous leishmaniasis. The present article also sustains the possibility of lower trypanosomatids infecting humans exists and should be considered by attending physicians. "
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    ABSTRACT: Known as 'neglected disease' because relatively little effort has been applied to finding cures, leishmaniasis kills more than 150,000 people every year and debilitates millions more. Visceral leishmaniasis (VL), also called Kala Azar (KA) or black fever in India, claims around 20,000 lives every year. Whole genome analysis presents an excellent means to identify new targets for drugs, vaccine and diagnostics development, and also provide an avenue into the biological basis of parasite virulence in the L. donovani complex prevalent in India. In our presently described study, the next generation SOLiD™ platform was successfully utilized for the first time to carry out whole genome sequencing of L. donovani clinical isolates from India. We report the exceptional occurrence of insect trypanosomatids in clinical cases of visceral leishmaniasis (Kala Azar) patients in India. We confirm with whole genome sequencing analysis data that isolates which were sequenced from Kala Azar (visceral leishmaniasis) cases were genetically related to Leptomonas. The co-infection in splenic aspirate of these patients with a species of Leptomonas and how likely is it that the infection might be pathogenic, are key questions which need to be investigated. We discuss our results in the context of some important probable hypothesis in this article. Our intriguing results of unusual cases of Kala Azar found to be most similar to Leptomonas species put forth important clinical implications for the treatment of Kala Azar in India. Leptomonas have been shown to be highly susceptible to several standard leishmaniacides in vitro. There is very little divergence among these two species viz. Leishmania sp. and L. seymouri, in terms of genomic sequence and organization. A more extensive perception of the phenomenon of co-infection needs to be addressed from molecular pathogenesis and eco-epidemiological standpoint.
    Full-text · Article · Feb 2013 · PLoS ONE
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    • "In addition, due to increasing international travel and population migration Leishmania parasites are imported into other regions of the world, including areas non-endemic for the disease (Harms et al. 2003; Schönian et al. 2003; Johnston et al. 2009). Furthermore, the fact that lower trypanosomatids related to the monoxenous parasites of insects of the genera Leptomonas or Herpetomonas, have been identified as causative agents of VL in southern Europe (Jimenez et al. 1996), South America (Pacheco et al. 1998) and in the Indian subcontinent (Bhattarai et al. 2009) points to the need for species identification even in areas where, so far, only one species had been thought to cause the disease. The advantage of molecular approaches based on PCR or other amplification techniques is that they combine high sensitivity for direct detection of the infecting parasites in various human, animal and sand fly tissues, with species specificity. "
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    ABSTRACT: Molecular approaches are being used increasingly for epidemiological studies of visceral and cutaneous leishmaniases. Several molecular markers resolving genetic differences between Leishmania parasites at species and strain levels have been developed to address key epidemiological and population genetic questions. The current gold standard, multilocus enzyme typing (MLEE), needs cultured parasites and lacks discriminatory power. PCR assays identifying species directly with clinical samples have proven useful in numerous field studies. Multilocus sequence typing (MLST) is potentially the most powerful phylogenetic approach and will, most probably, replace MLEE in the future. Multilocus microsatellite typing (MLMT) is able to discriminate below the zymodeme level and seems to be the best candidate for becoming the gold standard for distinction of strains. Population genetic studies by MLMT revealed geographical and hierarchic population structure in L. tropica, L. major and the L. donovani complex. The existence of hybrids and gene flow between Leishmania populations suggests that sexual recombination is more frequent than previously thought. However, typing and analytical tools need to be further improved. Accessible databases should be created and sustained for integrating data obtained by different researchers. This would allow for global analyses and help to avoid biases in analyses due to small sample sizes.
    Full-text · Article · Nov 2010 · Parasitology
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