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Molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of Nepal
BACKGROUND: Visceral Leishmaniasis (VL) is caused by a protozoan parasite Leishmania donovani that is transmitted to humans by an infected female sandfly, Phlebotomus argentipes. VL is common in the Indian sub-continent including Nepal and efforts for its elimination are ongoing. However, expansion...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528229/ https://www.ncbi.nlm.nih.gov/pubmed/31113385 http://dx.doi.org/10.1186/s12879-019-4083-3 |
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author | Shrestha, Mitesh Khatri-Chhetri, Medha Poudel, Ram Chandra Maharjan, Jyoti Dumre, Shyam Prakash Manandhar, Krishna Das Pandey, Basu Dev Pun, Sher Bahadur Pandey, Kishor |
author_facet | Shrestha, Mitesh Khatri-Chhetri, Medha Poudel, Ram Chandra Maharjan, Jyoti Dumre, Shyam Prakash Manandhar, Krishna Das Pandey, Basu Dev Pun, Sher Bahadur Pandey, Kishor |
author_sort | Shrestha, Mitesh |
collection | PubMed |
description | BACKGROUND: Visceral Leishmaniasis (VL) is caused by a protozoan parasite Leishmania donovani that is transmitted to humans by an infected female sandfly, Phlebotomus argentipes. VL is common in the Indian sub-continent including Nepal and efforts for its elimination are ongoing. However, expansion of disease towards the higher altitude areas, previously considered as VL free in Nepal, may impact the ability to achieve the elimination target by 2020. METHODS: This was an exploratory study, where VL suspected patients living exclusively in the non-program districts of Nepal and presenting with fever > 2 weeks and splenomegaly was included. The patients’ blood samples were collected, and DNA was extracted. DNA was subjected to PCR amplification and subsequent sequencing. Additionally, past 10 years data of VL cases from the national databases were analysed to see the trends of the disease in program and non program districts. RESULTS: Analysis of the past 10 years data revealed that trend of VL cases significantly decreased in the program districts (p = 0.001) while it increased in the non-program districts (p = 0.002). The national trend for overall incidence of VL also significantly decreased over this time period. Limited number of patients’ samples (n = 14) were subjected to molecular investigation, and four patients were found to be positive for Leishmania species by PCR. Interestingly, these cases in non-program districts were indeed also L. donovoni complex. All four patients were male with age ranges from 10 to 68 years. GenBank BLAST of the obtained DNA sequences confirmed identified specimens as L. donovani complex. We identified additional VL cases from non-program districts (including the high lands) of Nepal, indicating that the infection could be an emerging threat for the non-program areas of Nepal. CONCLUSION: The demonstration of VL cases in areas initially considered non-endemic has raised concern about on-going transmission in those regions and may trigger subsequent government plan and action to include those areas in the elimination program. Thus, the government should consider revising the disease control programs to accommodate non-program districts for achieving the VL elimination goal set for 2020. |
format | Online Article Text |
id | pubmed-6528229 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-65282292019-05-28 Molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of Nepal Shrestha, Mitesh Khatri-Chhetri, Medha Poudel, Ram Chandra Maharjan, Jyoti Dumre, Shyam Prakash Manandhar, Krishna Das Pandey, Basu Dev Pun, Sher Bahadur Pandey, Kishor BMC Infect Dis Research Article BACKGROUND: Visceral Leishmaniasis (VL) is caused by a protozoan parasite Leishmania donovani that is transmitted to humans by an infected female sandfly, Phlebotomus argentipes. VL is common in the Indian sub-continent including Nepal and efforts for its elimination are ongoing. However, expansion of disease towards the higher altitude areas, previously considered as VL free in Nepal, may impact the ability to achieve the elimination target by 2020. METHODS: This was an exploratory study, where VL suspected patients living exclusively in the non-program districts of Nepal and presenting with fever > 2 weeks and splenomegaly was included. The patients’ blood samples were collected, and DNA was extracted. DNA was subjected to PCR amplification and subsequent sequencing. Additionally, past 10 years data of VL cases from the national databases were analysed to see the trends of the disease in program and non program districts. RESULTS: Analysis of the past 10 years data revealed that trend of VL cases significantly decreased in the program districts (p = 0.001) while it increased in the non-program districts (p = 0.002). The national trend for overall incidence of VL also significantly decreased over this time period. Limited number of patients’ samples (n = 14) were subjected to molecular investigation, and four patients were found to be positive for Leishmania species by PCR. Interestingly, these cases in non-program districts were indeed also L. donovoni complex. All four patients were male with age ranges from 10 to 68 years. GenBank BLAST of the obtained DNA sequences confirmed identified specimens as L. donovani complex. We identified additional VL cases from non-program districts (including the high lands) of Nepal, indicating that the infection could be an emerging threat for the non-program areas of Nepal. CONCLUSION: The demonstration of VL cases in areas initially considered non-endemic has raised concern about on-going transmission in those regions and may trigger subsequent government plan and action to include those areas in the elimination program. Thus, the government should consider revising the disease control programs to accommodate non-program districts for achieving the VL elimination goal set for 2020. BioMed Central 2019-05-21 /pmc/articles/PMC6528229/ /pubmed/31113385 http://dx.doi.org/10.1186/s12879-019-4083-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Shrestha, Mitesh Khatri-Chhetri, Medha Poudel, Ram Chandra Maharjan, Jyoti Dumre, Shyam Prakash Manandhar, Krishna Das Pandey, Basu Dev Pun, Sher Bahadur Pandey, Kishor Molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of Nepal |
title | Molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of Nepal |
title_full | Molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of Nepal |
title_fullStr | Molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of Nepal |
title_full_unstemmed | Molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of Nepal |
title_short | Molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of Nepal |
title_sort | molecular evidence supports the expansion of visceral leishmaniasis towards non-program districts of nepal |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528229/ https://www.ncbi.nlm.nih.gov/pubmed/31113385 http://dx.doi.org/10.1186/s12879-019-4083-3 |
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