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Significantly lower anti-Leishmania IgG responses in Sudanese versus Indian visceral leishmaniasis.
PLoS Negl Trop Dis. 2014 Feb; 8(2):e2675.PN

Abstract

BACKGROUND

Visceral leishmaniasis (VL), a widely distributed systemic disease caused by infection with the Leishmania donovani complex (L. donovani and L. infantum), is almost always fatal if symptomatic and untreated. A rapid point-of-care diagnostic test for anti-Leishmania antibodies, the rK39-immunochromatographic test (rK39-ICT), has high sensitivity and specificity in South Asia but is less sensitive in East Africa. One of the underlying reasons may be continent-specific molecular diversity in the rK39 antigen within the L. donovani complex. However, a second reason may be differences in specific IgG anti-Leishmania levels in patients from different geographical regions, either due to variable antigenicity or immunological response.

METHODOLOGY/PRINCIPAL FINDINGS

We determined IgG titres of Indian and Sudanese VL patients against whole cell lysates of Indian and Sudanese L. donovani strains. Indian VL patients had significantly higher IgG titres against both L. donovani strains compared to Sudanese VL patients (p<0.0001). Mean reciprocal log10 50% end-point titres (1/log10t50) were i) 3.80 and 3.88 for Indian plasma and ii) 2.13 and 2.09 for Sudanese plasma against Indian and Sudanese antigen respectively (p<0.0001). Overall, the Indian VL patients therefore showed a 46.8-61.7 -fold higher mean ELISA titre than the Sudanese VL patients. The higher IgG titres occurred in children (<16 years old) and adults of either sex from India (mean 1/log10t50: 3.60-4.15) versus Sudan (mean 1/log10t50: 1.88-2.54). The greatest difference in IgG responses was between male Indian and Sudanese VL patients of ≥ 16 years old (mean 1/log10t50: 4.15 versus 1.99 = 144-fold (p<0.0001).

CONCLUSIONS/SIGNIFICANCE

Anti-Leishmania IgG responses among VL patients in Sudan were significantly lower than in India; this may be due to chronic malnutrition with Zn(2+) deficiency, or variable antigenicity and capacity to generate IgG responses to Leishmania antigens. Such differential anti-Leishmania IgG levels may contribute to lower sensitivity of the rK39-ICT in East Africa.

Authors+Show Affiliations

Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.Faculty of Medicine, University of Khartoum, Khartoum, Sudan.Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.Departamento de Medicina, Universidad del Norte, Barranquilla, Colombia.Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India ; Immunology and Infection Laboratory, Queensland Institute of Medical Research, Herston, Queensland, Australia.Faculty of Medicine, University of Khartoum, Khartoum, Sudan ; Department of Laboratory Medicine, Karolinska Insitutet, Stockholm, Sweden.Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24587456

Citation

Bhattacharyya, Tapan, et al. "Significantly Lower anti-Leishmania IgG Responses in Sudanese Versus Indian Visceral Leishmaniasis." PLoS Neglected Tropical Diseases, vol. 8, no. 2, 2014, pp. e2675.
Bhattacharyya T, Bowes DE, El-Safi S, et al. Significantly lower anti-Leishmania IgG responses in Sudanese versus Indian visceral leishmaniasis. PLoS Negl Trop Dis. 2014;8(2):e2675.
Bhattacharyya, T., Bowes, D. E., El-Safi, S., Sundar, S., Falconar, A. K., Singh, O. P., Kumar, R., Ahmed, O., Boelaert, M., & Miles, M. A. (2014). Significantly lower anti-Leishmania IgG responses in Sudanese versus Indian visceral leishmaniasis. PLoS Neglected Tropical Diseases, 8(2), e2675. https://doi.org/10.1371/journal.pntd.0002675
Bhattacharyya T, et al. Significantly Lower anti-Leishmania IgG Responses in Sudanese Versus Indian Visceral Leishmaniasis. PLoS Negl Trop Dis. 2014;8(2):e2675. PubMed PMID: 24587456.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Significantly lower anti-Leishmania IgG responses in Sudanese versus Indian visceral leishmaniasis. AU - Bhattacharyya,Tapan, AU - Bowes,Duncan E, AU - El-Safi,Sayda, AU - Sundar,Shyam, AU - Falconar,Andrew K, AU - Singh,Om Prakash, AU - Kumar,Rajiv, AU - Ahmed,Osman, AU - Boelaert,Marleen, AU - Miles,Michael A, Y1 - 2014/02/20/ PY - 2013/08/28/received PY - 2013/12/17/accepted PY - 2014/3/4/entrez PY - 2014/3/4/pubmed PY - 2014/11/5/medline SP - e2675 EP - e2675 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 8 IS - 2 N2 - BACKGROUND: Visceral leishmaniasis (VL), a widely distributed systemic disease caused by infection with the Leishmania donovani complex (L. donovani and L. infantum), is almost always fatal if symptomatic and untreated. A rapid point-of-care diagnostic test for anti-Leishmania antibodies, the rK39-immunochromatographic test (rK39-ICT), has high sensitivity and specificity in South Asia but is less sensitive in East Africa. One of the underlying reasons may be continent-specific molecular diversity in the rK39 antigen within the L. donovani complex. However, a second reason may be differences in specific IgG anti-Leishmania levels in patients from different geographical regions, either due to variable antigenicity or immunological response. METHODOLOGY/PRINCIPAL FINDINGS: We determined IgG titres of Indian and Sudanese VL patients against whole cell lysates of Indian and Sudanese L. donovani strains. Indian VL patients had significantly higher IgG titres against both L. donovani strains compared to Sudanese VL patients (p<0.0001). Mean reciprocal log10 50% end-point titres (1/log10t50) were i) 3.80 and 3.88 for Indian plasma and ii) 2.13 and 2.09 for Sudanese plasma against Indian and Sudanese antigen respectively (p<0.0001). Overall, the Indian VL patients therefore showed a 46.8-61.7 -fold higher mean ELISA titre than the Sudanese VL patients. The higher IgG titres occurred in children (<16 years old) and adults of either sex from India (mean 1/log10t50: 3.60-4.15) versus Sudan (mean 1/log10t50: 1.88-2.54). The greatest difference in IgG responses was between male Indian and Sudanese VL patients of ≥ 16 years old (mean 1/log10t50: 4.15 versus 1.99 = 144-fold (p<0.0001). CONCLUSIONS/SIGNIFICANCE: Anti-Leishmania IgG responses among VL patients in Sudan were significantly lower than in India; this may be due to chronic malnutrition with Zn(2+) deficiency, or variable antigenicity and capacity to generate IgG responses to Leishmania antigens. Such differential anti-Leishmania IgG levels may contribute to lower sensitivity of the rK39-ICT in East Africa. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/24587456/Significantly_lower_anti_Leishmania_IgG_responses_in_Sudanese_versus_Indian_visceral_leishmaniasis_ L2 - https://dx.plos.org/10.1371/journal.pntd.0002675 DB - PRIME DP - Unbound Medicine ER -