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Title: Determinants for progression from asymptomatic infection to symptomatic visceral leishmaniasis: A cohort study
Author: Chakravarty, Jaya
Hasker, Epco C.
Kansal, Sangeeta
Singh, Om Prakash
Malaviya, Paritosh
Singh, Abhishek Kumar
Chourasia, Ankita
Singh, Toolika
Sudarshan, Medhavi
Singh, Akhil Pratap
Singh, Bhawana
Singh, Rudra Pratap
Ostyn, Bart
Fakiola, Michaela
Picado de Puig, Albert
Menten, Joris
Blackwell, Jenefer M.
Wilson, Mary Elisabeth
Sacks, David
Boelaert, Marleen
Sundar, Shyam
Keywords: Leishmaniosi
Genètica molecular
Molecular genetics
Issue Date: 27-Mar-2019
Publisher: Public Library of Science (PLoS)
Abstract: Background: Asymptomatic Leishmania donovani infections outnumber clinical presentations, however the predictors for development of active disease are not well known. We aimed to identify serological, immunological and genetic markers for progression from L. donovani infection to clinical Visceral Leishmaniasis (VL). Methods: We enrolled all residents >2 years of age in 27 VL endemic villages in Bihar (India). Blood samples collected on filter paper on two occasions 6–12 months apart, were tested for antibodies against L. donovani with rK39-ELISA and DAT. Sero converters, (negative for both tests in the first round but positive on either of the two during the second round) and controls (negative on both tests on both occasions) were followed for three years. At the start of follow-up venous blood was collected for the following tests: DAT, rK39- ELISA, Quantiferon assay, SNP/HLA genotyping and L.donovani specific quantitative PCR. Results: Among 1,606 subjects enrolled,17 (8/476 seroconverters and 9/1,130 controls) developed VL (OR 3.1; 95% CI 1.1–8.3). High DAT and rK39 ELISA antibody titers as well as positive qPCR were strongly and significantly associated with progression from seroconversion to VL with odds ratios of 19.1, 30.3 and 20.9 respectively. Most VL cases arose early (median 5 months) during follow-up. Conclusion: We confirmed the strong association between high DAT and/or rK39 titers and progression to disease among asymptomatic subjects and identified qPCR as an additional predictor. Low predictive values do not warrant prophylactic treatment but as most progressed to VL early during follow-up, careful oberservation of these subjects for at least 6 months is indicated.
Note: Reproducció del document publicat a:
It is part of: PLoS Neglected Tropical Diseases, 2019, vol. 13, num. 3, p. e0007216
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ISSN: 1935-2735
Appears in Collections:Articles publicats en revistes (ISGlobal)

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