Latent Infection with Leishmania donovani in Highly Endemic Villages in Bihar, India

被引:49
作者
Hasker, Epco [1 ]
Kansal, Sangeeta [2 ]
Malaviya, Paritosh [2 ]
Gidwani, Kamlesh [2 ]
Picado, Albert [1 ,3 ]
Singh, Rudra Pratap [2 ]
Chourasia, Ankita [2 ]
Singh, Abhishek Kumar [2 ]
Shankar, Ravi [2 ]
Menten, Joris [1 ]
Wilson, Mary Elizabeth [4 ,5 ]
Boelaert, Marleen [1 ]
Sundar, Shyam [2 ]
机构
[1] Inst Trop Med, B-2000 Antwerp, Belgium
[2] Banaras Hindu Univ, Varanasi 221005, Uttar Pradesh, India
[3] Univ Barcelona, Hosp Clin, CRESIB, Barcelona Ctr Int Hlth Res, Barcelona, Spain
[4] Univ Iowa, Iowa City, IA USA
[5] Vet Affairs Med Ctr, Iowa City, IA 52242 USA
来源
PLOS NEGLECTED TROPICAL DISEASES | 2013年 / 7卷 / 02期
关键词
DIRECT AGGLUTINATION-TEST; CLUSTER RANDOMIZED-TRIAL; HIGH-TRANSMISSION FOCI; VISCERAL LEISHMANIASIS; KALA-AZAR; EPIDEMIOLOGY; NEPAL; AGREEMENT; ETHIOPIA; CHAGASI;
D O I
10.1371/journal.pntd.0002053
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Introduction: Asymptomatic persons infected with the parasites causing visceral leishmaniasis (VL) usually outnumber clinically apparent cases by a ratio of 4-10 to 1. We describe patterns of markers of Leishmania donovani infection and clinical VL in relation to age in Bihar, India. Methods: We selected eleven villages highly endemic for Leishmania donovani. During a 1-year interval we conducted two house to house surveys during which we collected blood samples on filter paper from all consenting individuals aged 2 years and above. Samples were tested for anti-leishmania serology by Direct Agglutination Test (DAT) and rK39 ELISA. Data collected during the surveys included information on episodes of clinical VL among study participants. Results: We enrolled 13,163 persons; 6.2% were reactive to DAT and 5.9% to rK39. Agreement between the tests was weak (kappa = 0.30). Among those who were negative on both tests at baseline, 3.6% had converted to sero-positive on either of the two tests one year later. Proportions of sero-positives and sero-converters increased steadily with age. Clinical VL occurred mainly among children and young adults (median age 19 years). Discussion: Although infection with L. donovani is assumed to be permanent, serological markers revert to negative. Most VL cases occur at younger ages, yet we observed a steady increase with age in the frequency of sero-positivity and sero-conversion. Our findings can be explained by a boosting effect upon repeated exposure to the parasite or by intermittent release of parasites in infected subjects from safe target cells. A certain proportion of sero-negative subjects could have been infected but below the threshold of antibody abundance for our serologic testing.
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