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Papers by Andrea Boggild

SummaryBackgroundThere are currently no effective treatments for outpatients with coronavirus dis... more SummaryBackgroundThere are currently no effective treatments for outpatients with coronavirus disease 2019 (COVID-19). Interferon-lambda-1 is a Type III interferon involved in the innate antiviral response with activity against respiratory pathogens.MethodsIn this double-blind, placebo-controlled trial, outpatients with laboratory-confirmed COVID-19 were randomized to a single subcutaneous injection of peginterferon-lambda 180μg or placebo within 7 days of symptom onset or first positive swab if asymptomatic. The primary endpoint was proportion negative for SARS-CoV-2 RNA on Day 7 post-injection.FindingsThere were 30 patients per arm, with median baseline SARS-CoV-2 viral load of 6.71 (IQR 1.3-8.0) log copies/mL. The decline in SARS-CoV-2 RNA was greater in those treated with peginterferon-lambda than placebo (p=0.04). On Day 7, 24 participants (80%) in the peginterferon-lambda group had an undetectable viral load compared to 19 (63%) in the placebo arm (p=0.15). After controlling f...

Canada Communicable Disease Report, 2016

Background: In light of the 2016 summer Olympic games it is anticipated that Canadian practitione... more Background: In light of the 2016 summer Olympic games it is anticipated that Canadian practitioners will require information about common illnesses that may affect travellers returning from Brazil. Objective: To identify the demographic and travel correlates of illness among recent Canadian travellers and migrants from Brazil attending a network of travel health clinics across Canada. Methods: Data was analyzed on returned Canadian travellers and migrants presenting to a CanTravNet site for care of an illness between June 2013 and June 2016. Results: During the study period, 7,707 ill travellers and migrants presented to a CanTravNet site and 89 (0.01%) acquired their illness in Brazil. Tourists were most well represented (n=45, 50.6%), followed by those travelling to "visit friends and relatives" (n=14, 15.7%). The median age was 37 years (range <1-78 years), 49 travellers were men (55.1%) and 40 were women (44.9%). Of the 40 women, 26 (65%) were of childbearing age. Nine percent (n=8) of travellers were diagnosed with arboviruses including dengue (n=6), chikungunya (n=1) and Zika virus (n=1), while another 14.6% (n=13) presented for care of non-specific viral syndrome (n=7), non-specific febrile illness (n=1), peripheral neuropathy (n=1) and non-specific rash (n=4), which are four syndromes that may be indicative of Zika virus infection. Ill returned travellers to Brazil were more likely to present for care of arboviral or Zika-like illness than other ill returned travellers to South America (23.6 per 100 travellers versus 10.5 per 100 travellers, respectively [p=0.0024]). Interpretation: An epidemiologic approach to illness among returned Canadian travellers to Brazil can inform Canadian practitioners encountering both prospective and returned travellers to the Olympic games. Analysis showed that vector-borne illnesses such as dengue are common and even in this small group of travellers, both chikungunya and Zika virus were represented. It is extremely important to educate travellers about mosquito-avoidance measures in advance of travel to Brazil.

Parasitology Research, 2002

Glutamylated and tyrosinated tubulin were localized in Giardia intestinalis and selected trichomo... more Glutamylated and tyrosinated tubulin were localized in Giardia intestinalis and selected trichomonads of the Tritrichomonadinae subfamily, using speci®c monoclonal antibodies directed at each of the posttranslational modi®cations. Analysis was carried out using indirect immuno¯uorescence microscopy. Although trichomonad tubulins remained unlabeled by anti-tyrosine tubulin (TUB-1A2), the presence of the glutamylation motif (GT 335) was con®rmed and found to dier in distribution among tritrichomonads. Tritrichomonas muris was most heavily labeled with GT 335, while T. foetus was the least so. Like trichomonads, Giardia was unreactive to anti-tyrosine tubulin; however, the GT 335 antibody produced marked¯uorescence in Giardia trophozoites. This study is the ®rst to report immuno¯uorescent localization of tubulin glutamylation in Giardia and con®rms previously reported mass spectrometry data.

Canada Communicable Disease Report, 2016

Background: Strongyloides stercoralis is a parasitic nematode found in humans, with a higher prev... more Background: Strongyloides stercoralis is a parasitic nematode found in humans, with a higher prevalence in tropical and subtropical regions worldwide. If untreated, the infection can progress to disseminated strongyloidiasis, a critical illness which may be fatal. Objective: To provide clinical guidance on the prevention, assessment and management of disseminated strongyloidiasis. Methods: A literature review was conducted to evaluate the current evidence and to identify any systematic reviews, case reports, guidelines and peer reviewed and non-peer reviewed medical literature. The Committee to Advise on Tropical Medicine and Travel (CATMAT) assembled a working group to develop this statement, which was then critically reviewed and approved by all CATMAT members. Recommendations: CATMAT recommends that screening for strongyloidiasis should be considered for individuals with epidemiologic risk and/or co-morbidities that place them at risk for Strongyloides hyperinfection and dissemination. Those at highest risk of hyperinfection and dissemination are individuals born in a Strongyloides-endemic area who undergo iatrogenic immunosuppression or have intercurrent human T-lymphotropic virus (HTLV-1) infection. Diagnosis of strongyloidiasis is based on serologic testing and/or examination of stools and other clinical specimens for larvae. Referral to a tropical medicine specialist with expertise in the management of strongyloidiasis is recommended for suspected and confirmed cases. A diagnosis and treatment algorithm for strongyloidiasis has been developed as a reference tool. Conclusion: Strongyloidiasis is relatively widespread in the global migrant population and screening for the disease should be based on an individual risk assessment. A practical tool for the clinician to use in the prevention, assessment and management of disseminated strongyloidiasis in Canada is now available.

Zoonoses and Public Health, 2016

Impacts • Echinococcus multilocularis is a parasite capable of causing serious and potentially fa... more Impacts • Echinococcus multilocularis is a parasite capable of causing serious and potentially fatal illness (alveolar echinococcosis) in humans. • The parasite is an emerging zoonosis in Ontario. • This article describes a local public health department's investigation of the potential exposure of several people who had had contact with a case of alveolar echinococcosis in a dog, and summarizes a comprehensive decision process that can be used by public health departments to assist in the follow-up of such exposures.

American Journal of Tropical Medicine and Hygiene, 2016

Mucosal leishmaniasis (ML) is a disfiguring manifestation of Leishmania (Viannia) infection. We e... more Mucosal leishmaniasis (ML) is a disfiguring manifestation of Leishmania (Viannia) infection. We evaluated parasite load (PL) over time as a potential biomarker of treatment outcome in ML. PL was assessed with kinetoplast DNA quantitative real-time polymerase chain reaction (kDNA-qPCR) at enrollment, days 14 and 21-28 of therapy and 3, 6, 12-18, and 18-24 months after treatment of ML and correlated to demographic, clinical, and parasitologic factors. Forty-four patients were enrolled: 30 men and 14 women. Enrollment PL differed significantly by causative species (P < 0.001), and was higher in patients with severe ML (nasal and laryngeal involvement) compared with those with only isolated nasal involvement (median = 1,285 versus 51.5 parasites/μg tissue DNA; P = 0.005). Two patterns of PL emerged: pattern 1 (N = 23) was characterized by a sequential decline in PL during and after therapy until kDNA was undetectable. Pattern 2 (N = 18) was characterized by clearance of detectable kDNA during treatment, followed by an increased PL thereafter. All patients who failed treatment (N = 4) demonstrated pattern 1. Leishmania (Viannia) braziliensis was overrepresented among those with pattern 2 (P = 0.019). PL can be quantified by cytology brush qPCR during and after treatment in ML. We demonstrate that treatment failure was associated with undetectable PL, and L. (V.) braziliensis infection was overrepresented in those with rebounding PL.

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 5, 2015

Journal of Clinical Microbiology, 2009

Molecular methods such as PCR have become attractive tools for diagnosis of cutaneous leishmanias... more Molecular methods such as PCR have become attractive tools for diagnosis of cutaneous leishmaniasis (CL), both for their high sensitivity and for their specificity. However, their practical use in routine diagnosis is limited due to the infrastructural requirements and the lack of any standardization. Recently, a simplified and standardized PCR format for molecular detection of Leishmania was developed. The Leishmania OligoC-TesT is based on simple and rapid detection using a dipstick with PCR-amplified Leishmania DNA. In this study, we estimated the diagnostic accuracy of the Leishmania OligoC-TesT for 61 specimens from 44 CL-suspected patients presenting at the leishmaniasis clinic of the Instituto de Medicina Tropical Alexander von Humboldt, Peru. On the basis of parasitological detection and the leishmanin skin test (LST), patients were classified as (i) confirmed CL cases, (ii) LST-positive cases, and (iii) LST-negative cases. The sensitivities of the Leishmania OligoC-TesT was...

Journal of Clinical Microbiology, 2007

Traditional culture of Leishmania spp. is labor intensive and has poor sensitivity. We evaluated ... more Traditional culture of Leishmania spp. is labor intensive and has poor sensitivity. We evaluated a microculture method for the diagnosis of cutaneous leishmaniasis in consecutive patients presenting to the Leishmaniasis Clinic at the Instituto de Medicina Tropical Alexander von Humboldt, Peru, for evaluation of skin lesions. Lesion aspirates were cultured in duplicate and parallel in traditional culture tubes containing modified Novy-MacNeal-Nicolle (NNN) medium or Roswell Park Memorial Institute medium 1640 with 10% fetal bovine serum (10% RPMI) and in 70-μl capillary tubes containing a mixture of lesion aspirate and 10% RPMI. For sensitivity analysis, the consensus standard was considered to be a positive result in any two of the following four tests: Giemsa-stained lesion smear, culture, kinetoplast DNA PCR, or leishmanin skin test. The outcome measures were sensitivity and time to culture positivity. Forty-five patients with 62 skin lesions were enrolled in the study, of which 5...

Journal of Clinical Microbiology, 2010

We compared traditional cutaneous leishmaniasis diagnostic methods to filter paper lesion impress... more We compared traditional cutaneous leishmaniasis diagnostic methods to filter paper lesion impression (FPLI) PCR for secondarily infected ulcers and nonulcerative lesions. The sensitivity and specificity of FPLI PCR for secondarily infected lesions ( n = 8) were 100%. In primarily nonulcerative lesions ( n = 15), the sensitivity of FPLI PCR was inferior to that of pooled-invasive-specimen PCR (72.7% versus 100%) ( P = 0.10). FPLI PCR is sensitive, specific, and unlike invasive procedures, can be used in secondarily infected ulcers. Invasive specimen collection is superior in nonulcerative lesions.

Journal of Clinical Microbiology, 2011

We present an algorithm based on three PCR assays for Leishmania ( Viannia ) species identificati... more We present an algorithm based on three PCR assays for Leishmania ( Viannia ) species identification and assessed its performance using 70 specimens from Peruvian patients. The succession of the assayed targets can be ordered according to species prevalence. Sequential progression through the algorithm reduced the number of samples here studied by approximately 30% after each step.

Journal of Clinical Microbiology, 2009

Amoebic keratitis causes significant ocular morbidity in contact lens wearers. Current diagnostic... more Amoebic keratitis causes significant ocular morbidity in contact lens wearers. Current diagnostic methods for amoebic keratitis are insensitive and labor-intensive and have poor turnaround time. We evaluated four laboratory methods for detection of acanthamoebae in clinical specimens. Deidentified, delinked consecutive specimens from patients with suspected amoebic keratitis were assayed for acanthamoebae by direct smear analysis, culture, and PCR using two different primer sets specific for Acanthamoeba ribosomal DNA. The consensus reference standard was considered fulfilled when the results for any two of the four tests were positive, and the outcome measures were sensitivity and specificity. Of 107 specimens assayed over an 18-month period, 20 were positive for acanthamoebae. The sensitivity and specificity of each assay were as follows, respectively: for smear analysis, 55% (95% confidence interval [CI], 33.2 to 76.8%) and 100%; for culture, 73.7% (95% CI, 54.4 to 93.0%) and 100...

Canadian Medical Association Journal, 2013

American Journal of Tropical Medicine and Hygiene, 2011

We hypothesized that Leishmania kDNA may be present in urine of patients with cutaneous leishmani... more We hypothesized that Leishmania kDNA may be present in urine of patients with cutaneous leishmaniasis (CL). Urine samples and standard diagnostic specimens were collected from patients with skin lesions. kDNA polymerase chain reaction (PCR) was performed on samples from patients and 10 healthy volunteers from non-endemic areas. Eighty-six of 108 patients were diagnosed with CL and 18 (21%) had detectable Leishmania Viannia kDNA in the urine. Sensitivity and specificity were 20.9% (95% confidence interval [CI] 12.3-29.5%) and 100%. Six of 8 patients with mucocutaneous involvement had detectable kDNA in urine versus 12 of 78 patients with isolated cutaneous disease (P < 0.001). L. (V.) braziliensis (N = 3), L. (V.) guyanensis (N = 6), and L. (V.) peruviana (N = 3) were identified from urine. No healthy volunteer or patient with an alternate diagnosis had detectable kDNA in urine. Sensitivity of urine PCR is sub-optimal for diagnosis. On the basis of these preliminary data in a small number of patients, detectable kDNA in urine may identify less localized forms of infection and inform treatment decisions.

The American Journal of Tropical Medicine and Hygiene, 2010

during January-April of each year (2007-2009) after review and approval by the Institutional Revi... more during January-April of each year (2007-2009) after review and approval by the Institutional Review Board of the Universidad Peruana Cayetano Heredia. Study population. Consecutive patients who came to the Leishmania Clinic for evaluation of skin lesions were enrolled as described. 13, 14 We included patients who were referred to the clinic for suspected CL, had a clinical indication for skin scraping or aspirate, and were able to provide informed consent. We excluded patients with bacterial or fungal superinfection of the lesion, and those undergoing active treatment for CL. Diagnostic investigations. Skin scraping and aspirates were obtained for Giemsa-stained lesion smears, culture, and polymerase chain reaction (PCR) as described. 13, 14 Giemsastained smears were prepared by using material scraped from the ulcer base and border with a sterile lancet. 13, 14 Smear amastigote density was quantitated as described using the method of Chulay and Bryceson. 13, 14, 19 Aspirated fluid was divided evenly in a biosafety cabinet under sterile conditions and inoculated in parallel and duplicate for culture by using two methods. In the first method, 200 μL was placed in 16 × 110 mm flat-sided tissue culture tubes (Nalge Nunc International, Rochester, NY) containing 3.0 mL modified Novy-MacNeal-Nicolle (NNN) medium (blood agar base, cat. no. 245400; Difco, Detroit, MI) with 15% defibrinated rabbit blood. In the second method, 60 μL of a 1:1 mixture of aspirate and 10-20% RPMI 1640 medium (Invitrogen, Carlsbad, CA) supplemented with l-glutamine, 10-20% fetal

The American Journal of Tropical Medicine and Hygiene, 2013

Conventional understanding suggests that simultaneous infection with more than one species of Lei... more Conventional understanding suggests that simultaneous infection with more than one species of Leishmania is unlikely. In Peru, co-infections are clinically relevant because causative species dictates prognosis, treatment response, and follow-up. We describe a case of Leishmania (Viannia) braziliensis and L. (V.) lainsoni co-infection in a Peruvian patient with cutaneous leishmaniasis.

International Encyclopedia of Public Health, 2008

Malaria remains the most important parasitic disease of humans, with an estimated 500 million cas... more Malaria remains the most important parasitic disease of humans, with an estimated 500 million cases per year, and 1–3 million deaths annually. Severe and cerebral malaria carry mortality rates on the order of 10–30%, and are almost universally caused by Plasmodium falciparum. The greatest burden of illness is borne by children under the age of five residing in sub-Saharan Africa. We herein discuss the protean clinical manifestations, up-to-date management, and current preventive strategies for malaria.

Current Infectious Disease Reports, 2021

Coccidioidomycosis incidence has been increasing recently in endemic regions. The disease can man... more Coccidioidomycosis incidence has been increasing recently in endemic regions. The disease can manifest with variable pulmonary and cutaneous presentations, challenging the clinical diagnosis. Our case highlights the differential diagnosis that must be considered for presentations of erythema nodosum and cavitating lung lesions and the importance of synthesizing the entire patient history-including travel history-for construction of appropriate diagnostic and treatment plans.

Relevé des maladies transmissibles au Canada, 2015

Le chikungunya est devenu une préoccupation de santé publique importante, une situation attribuab... more Le chikungunya est devenu une préoccupation de santé publique importante, une situation attribuable en partie à l'augmentation des voyages internationaux. Les récentes éclosions observées dans les pays de la Caraïbe et le signalement d'un premier cas d'infection autochtone aux États-Unis, donnent à craindre une possible augmentation du nombre de cas au Canada. Le chikungunya ayant un grand nombre de symptômes cliniques en commun avec d'autres maladies transmises par les arthropodes, telles que la dengue, le diagnostic clinique de la maladie est compliqué. Dans cet article, nous présentons un tableau clinique atypique de chikungunya observé chez un homme au retour d'un voyage à Haïti. Le diagnostic microbiologique, le traitement, le pronostic et les implications pour la santé publique aideront à préparer les cliniciens à la prise en charge de cet agent pathogène émergent.

SummaryBackgroundThere are currently no effective treatments for outpatients with coronavirus dis... more SummaryBackgroundThere are currently no effective treatments for outpatients with coronavirus disease 2019 (COVID-19). Interferon-lambda-1 is a Type III interferon involved in the innate antiviral response with activity against respiratory pathogens.MethodsIn this double-blind, placebo-controlled trial, outpatients with laboratory-confirmed COVID-19 were randomized to a single subcutaneous injection of peginterferon-lambda 180μg or placebo within 7 days of symptom onset or first positive swab if asymptomatic. The primary endpoint was proportion negative for SARS-CoV-2 RNA on Day 7 post-injection.FindingsThere were 30 patients per arm, with median baseline SARS-CoV-2 viral load of 6.71 (IQR 1.3-8.0) log copies/mL. The decline in SARS-CoV-2 RNA was greater in those treated with peginterferon-lambda than placebo (p=0.04). On Day 7, 24 participants (80%) in the peginterferon-lambda group had an undetectable viral load compared to 19 (63%) in the placebo arm (p=0.15). After controlling f...

Canada Communicable Disease Report, 2016

Background: In light of the 2016 summer Olympic games it is anticipated that Canadian practitione... more Background: In light of the 2016 summer Olympic games it is anticipated that Canadian practitioners will require information about common illnesses that may affect travellers returning from Brazil. Objective: To identify the demographic and travel correlates of illness among recent Canadian travellers and migrants from Brazil attending a network of travel health clinics across Canada. Methods: Data was analyzed on returned Canadian travellers and migrants presenting to a CanTravNet site for care of an illness between June 2013 and June 2016. Results: During the study period, 7,707 ill travellers and migrants presented to a CanTravNet site and 89 (0.01%) acquired their illness in Brazil. Tourists were most well represented (n=45, 50.6%), followed by those travelling to "visit friends and relatives" (n=14, 15.7%). The median age was 37 years (range <1-78 years), 49 travellers were men (55.1%) and 40 were women (44.9%). Of the 40 women, 26 (65%) were of childbearing age. Nine percent (n=8) of travellers were diagnosed with arboviruses including dengue (n=6), chikungunya (n=1) and Zika virus (n=1), while another 14.6% (n=13) presented for care of non-specific viral syndrome (n=7), non-specific febrile illness (n=1), peripheral neuropathy (n=1) and non-specific rash (n=4), which are four syndromes that may be indicative of Zika virus infection. Ill returned travellers to Brazil were more likely to present for care of arboviral or Zika-like illness than other ill returned travellers to South America (23.6 per 100 travellers versus 10.5 per 100 travellers, respectively [p=0.0024]). Interpretation: An epidemiologic approach to illness among returned Canadian travellers to Brazil can inform Canadian practitioners encountering both prospective and returned travellers to the Olympic games. Analysis showed that vector-borne illnesses such as dengue are common and even in this small group of travellers, both chikungunya and Zika virus were represented. It is extremely important to educate travellers about mosquito-avoidance measures in advance of travel to Brazil.

Parasitology Research, 2002

Glutamylated and tyrosinated tubulin were localized in Giardia intestinalis and selected trichomo... more Glutamylated and tyrosinated tubulin were localized in Giardia intestinalis and selected trichomonads of the Tritrichomonadinae subfamily, using speci®c monoclonal antibodies directed at each of the posttranslational modi®cations. Analysis was carried out using indirect immuno¯uorescence microscopy. Although trichomonad tubulins remained unlabeled by anti-tyrosine tubulin (TUB-1A2), the presence of the glutamylation motif (GT 335) was con®rmed and found to dier in distribution among tritrichomonads. Tritrichomonas muris was most heavily labeled with GT 335, while T. foetus was the least so. Like trichomonads, Giardia was unreactive to anti-tyrosine tubulin; however, the GT 335 antibody produced marked¯uorescence in Giardia trophozoites. This study is the ®rst to report immuno¯uorescent localization of tubulin glutamylation in Giardia and con®rms previously reported mass spectrometry data.

Canada Communicable Disease Report, 2016

Background: Strongyloides stercoralis is a parasitic nematode found in humans, with a higher prev... more Background: Strongyloides stercoralis is a parasitic nematode found in humans, with a higher prevalence in tropical and subtropical regions worldwide. If untreated, the infection can progress to disseminated strongyloidiasis, a critical illness which may be fatal. Objective: To provide clinical guidance on the prevention, assessment and management of disseminated strongyloidiasis. Methods: A literature review was conducted to evaluate the current evidence and to identify any systematic reviews, case reports, guidelines and peer reviewed and non-peer reviewed medical literature. The Committee to Advise on Tropical Medicine and Travel (CATMAT) assembled a working group to develop this statement, which was then critically reviewed and approved by all CATMAT members. Recommendations: CATMAT recommends that screening for strongyloidiasis should be considered for individuals with epidemiologic risk and/or co-morbidities that place them at risk for Strongyloides hyperinfection and dissemination. Those at highest risk of hyperinfection and dissemination are individuals born in a Strongyloides-endemic area who undergo iatrogenic immunosuppression or have intercurrent human T-lymphotropic virus (HTLV-1) infection. Diagnosis of strongyloidiasis is based on serologic testing and/or examination of stools and other clinical specimens for larvae. Referral to a tropical medicine specialist with expertise in the management of strongyloidiasis is recommended for suspected and confirmed cases. A diagnosis and treatment algorithm for strongyloidiasis has been developed as a reference tool. Conclusion: Strongyloidiasis is relatively widespread in the global migrant population and screening for the disease should be based on an individual risk assessment. A practical tool for the clinician to use in the prevention, assessment and management of disseminated strongyloidiasis in Canada is now available.

Zoonoses and Public Health, 2016

Impacts • Echinococcus multilocularis is a parasite capable of causing serious and potentially fa... more Impacts • Echinococcus multilocularis is a parasite capable of causing serious and potentially fatal illness (alveolar echinococcosis) in humans. • The parasite is an emerging zoonosis in Ontario. • This article describes a local public health department's investigation of the potential exposure of several people who had had contact with a case of alveolar echinococcosis in a dog, and summarizes a comprehensive decision process that can be used by public health departments to assist in the follow-up of such exposures.

American Journal of Tropical Medicine and Hygiene, 2016

Mucosal leishmaniasis (ML) is a disfiguring manifestation of Leishmania (Viannia) infection. We e... more Mucosal leishmaniasis (ML) is a disfiguring manifestation of Leishmania (Viannia) infection. We evaluated parasite load (PL) over time as a potential biomarker of treatment outcome in ML. PL was assessed with kinetoplast DNA quantitative real-time polymerase chain reaction (kDNA-qPCR) at enrollment, days 14 and 21-28 of therapy and 3, 6, 12-18, and 18-24 months after treatment of ML and correlated to demographic, clinical, and parasitologic factors. Forty-four patients were enrolled: 30 men and 14 women. Enrollment PL differed significantly by causative species (P < 0.001), and was higher in patients with severe ML (nasal and laryngeal involvement) compared with those with only isolated nasal involvement (median = 1,285 versus 51.5 parasites/μg tissue DNA; P = 0.005). Two patterns of PL emerged: pattern 1 (N = 23) was characterized by a sequential decline in PL during and after therapy until kDNA was undetectable. Pattern 2 (N = 18) was characterized by clearance of detectable kDNA during treatment, followed by an increased PL thereafter. All patients who failed treatment (N = 4) demonstrated pattern 1. Leishmania (Viannia) braziliensis was overrepresented among those with pattern 2 (P = 0.019). PL can be quantified by cytology brush qPCR during and after treatment in ML. We demonstrate that treatment failure was associated with undetectable PL, and L. (V.) braziliensis infection was overrepresented in those with rebounding PL.

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 5, 2015

Journal of Clinical Microbiology, 2009

Molecular methods such as PCR have become attractive tools for diagnosis of cutaneous leishmanias... more Molecular methods such as PCR have become attractive tools for diagnosis of cutaneous leishmaniasis (CL), both for their high sensitivity and for their specificity. However, their practical use in routine diagnosis is limited due to the infrastructural requirements and the lack of any standardization. Recently, a simplified and standardized PCR format for molecular detection of Leishmania was developed. The Leishmania OligoC-TesT is based on simple and rapid detection using a dipstick with PCR-amplified Leishmania DNA. In this study, we estimated the diagnostic accuracy of the Leishmania OligoC-TesT for 61 specimens from 44 CL-suspected patients presenting at the leishmaniasis clinic of the Instituto de Medicina Tropical Alexander von Humboldt, Peru. On the basis of parasitological detection and the leishmanin skin test (LST), patients were classified as (i) confirmed CL cases, (ii) LST-positive cases, and (iii) LST-negative cases. The sensitivities of the Leishmania OligoC-TesT was...

Journal of Clinical Microbiology, 2007

Traditional culture of Leishmania spp. is labor intensive and has poor sensitivity. We evaluated ... more Traditional culture of Leishmania spp. is labor intensive and has poor sensitivity. We evaluated a microculture method for the diagnosis of cutaneous leishmaniasis in consecutive patients presenting to the Leishmaniasis Clinic at the Instituto de Medicina Tropical Alexander von Humboldt, Peru, for evaluation of skin lesions. Lesion aspirates were cultured in duplicate and parallel in traditional culture tubes containing modified Novy-MacNeal-Nicolle (NNN) medium or Roswell Park Memorial Institute medium 1640 with 10% fetal bovine serum (10% RPMI) and in 70-μl capillary tubes containing a mixture of lesion aspirate and 10% RPMI. For sensitivity analysis, the consensus standard was considered to be a positive result in any two of the following four tests: Giemsa-stained lesion smear, culture, kinetoplast DNA PCR, or leishmanin skin test. The outcome measures were sensitivity and time to culture positivity. Forty-five patients with 62 skin lesions were enrolled in the study, of which 5...

Journal of Clinical Microbiology, 2010

We compared traditional cutaneous leishmaniasis diagnostic methods to filter paper lesion impress... more We compared traditional cutaneous leishmaniasis diagnostic methods to filter paper lesion impression (FPLI) PCR for secondarily infected ulcers and nonulcerative lesions. The sensitivity and specificity of FPLI PCR for secondarily infected lesions ( n = 8) were 100%. In primarily nonulcerative lesions ( n = 15), the sensitivity of FPLI PCR was inferior to that of pooled-invasive-specimen PCR (72.7% versus 100%) ( P = 0.10). FPLI PCR is sensitive, specific, and unlike invasive procedures, can be used in secondarily infected ulcers. Invasive specimen collection is superior in nonulcerative lesions.

Journal of Clinical Microbiology, 2011

We present an algorithm based on three PCR assays for Leishmania ( Viannia ) species identificati... more We present an algorithm based on three PCR assays for Leishmania ( Viannia ) species identification and assessed its performance using 70 specimens from Peruvian patients. The succession of the assayed targets can be ordered according to species prevalence. Sequential progression through the algorithm reduced the number of samples here studied by approximately 30% after each step.

Journal of Clinical Microbiology, 2009

Amoebic keratitis causes significant ocular morbidity in contact lens wearers. Current diagnostic... more Amoebic keratitis causes significant ocular morbidity in contact lens wearers. Current diagnostic methods for amoebic keratitis are insensitive and labor-intensive and have poor turnaround time. We evaluated four laboratory methods for detection of acanthamoebae in clinical specimens. Deidentified, delinked consecutive specimens from patients with suspected amoebic keratitis were assayed for acanthamoebae by direct smear analysis, culture, and PCR using two different primer sets specific for Acanthamoeba ribosomal DNA. The consensus reference standard was considered fulfilled when the results for any two of the four tests were positive, and the outcome measures were sensitivity and specificity. Of 107 specimens assayed over an 18-month period, 20 were positive for acanthamoebae. The sensitivity and specificity of each assay were as follows, respectively: for smear analysis, 55% (95% confidence interval [CI], 33.2 to 76.8%) and 100%; for culture, 73.7% (95% CI, 54.4 to 93.0%) and 100...

Canadian Medical Association Journal, 2013

American Journal of Tropical Medicine and Hygiene, 2011

We hypothesized that Leishmania kDNA may be present in urine of patients with cutaneous leishmani... more We hypothesized that Leishmania kDNA may be present in urine of patients with cutaneous leishmaniasis (CL). Urine samples and standard diagnostic specimens were collected from patients with skin lesions. kDNA polymerase chain reaction (PCR) was performed on samples from patients and 10 healthy volunteers from non-endemic areas. Eighty-six of 108 patients were diagnosed with CL and 18 (21%) had detectable Leishmania Viannia kDNA in the urine. Sensitivity and specificity were 20.9% (95% confidence interval [CI] 12.3-29.5%) and 100%. Six of 8 patients with mucocutaneous involvement had detectable kDNA in urine versus 12 of 78 patients with isolated cutaneous disease (P < 0.001). L. (V.) braziliensis (N = 3), L. (V.) guyanensis (N = 6), and L. (V.) peruviana (N = 3) were identified from urine. No healthy volunteer or patient with an alternate diagnosis had detectable kDNA in urine. Sensitivity of urine PCR is sub-optimal for diagnosis. On the basis of these preliminary data in a small number of patients, detectable kDNA in urine may identify less localized forms of infection and inform treatment decisions.

The American Journal of Tropical Medicine and Hygiene, 2010

during January-April of each year (2007-2009) after review and approval by the Institutional Revi... more during January-April of each year (2007-2009) after review and approval by the Institutional Review Board of the Universidad Peruana Cayetano Heredia. Study population. Consecutive patients who came to the Leishmania Clinic for evaluation of skin lesions were enrolled as described. 13, 14 We included patients who were referred to the clinic for suspected CL, had a clinical indication for skin scraping or aspirate, and were able to provide informed consent. We excluded patients with bacterial or fungal superinfection of the lesion, and those undergoing active treatment for CL. Diagnostic investigations. Skin scraping and aspirates were obtained for Giemsa-stained lesion smears, culture, and polymerase chain reaction (PCR) as described. 13, 14 Giemsastained smears were prepared by using material scraped from the ulcer base and border with a sterile lancet. 13, 14 Smear amastigote density was quantitated as described using the method of Chulay and Bryceson. 13, 14, 19 Aspirated fluid was divided evenly in a biosafety cabinet under sterile conditions and inoculated in parallel and duplicate for culture by using two methods. In the first method, 200 μL was placed in 16 × 110 mm flat-sided tissue culture tubes (Nalge Nunc International, Rochester, NY) containing 3.0 mL modified Novy-MacNeal-Nicolle (NNN) medium (blood agar base, cat. no. 245400; Difco, Detroit, MI) with 15% defibrinated rabbit blood. In the second method, 60 μL of a 1:1 mixture of aspirate and 10-20% RPMI 1640 medium (Invitrogen, Carlsbad, CA) supplemented with l-glutamine, 10-20% fetal

The American Journal of Tropical Medicine and Hygiene, 2013

Conventional understanding suggests that simultaneous infection with more than one species of Lei... more Conventional understanding suggests that simultaneous infection with more than one species of Leishmania is unlikely. In Peru, co-infections are clinically relevant because causative species dictates prognosis, treatment response, and follow-up. We describe a case of Leishmania (Viannia) braziliensis and L. (V.) lainsoni co-infection in a Peruvian patient with cutaneous leishmaniasis.

International Encyclopedia of Public Health, 2008

Malaria remains the most important parasitic disease of humans, with an estimated 500 million cas... more Malaria remains the most important parasitic disease of humans, with an estimated 500 million cases per year, and 1–3 million deaths annually. Severe and cerebral malaria carry mortality rates on the order of 10–30%, and are almost universally caused by Plasmodium falciparum. The greatest burden of illness is borne by children under the age of five residing in sub-Saharan Africa. We herein discuss the protean clinical manifestations, up-to-date management, and current preventive strategies for malaria.

Current Infectious Disease Reports, 2021

Coccidioidomycosis incidence has been increasing recently in endemic regions. The disease can man... more Coccidioidomycosis incidence has been increasing recently in endemic regions. The disease can manifest with variable pulmonary and cutaneous presentations, challenging the clinical diagnosis. Our case highlights the differential diagnosis that must be considered for presentations of erythema nodosum and cavitating lung lesions and the importance of synthesizing the entire patient history-including travel history-for construction of appropriate diagnostic and treatment plans.

Relevé des maladies transmissibles au Canada, 2015

Le chikungunya est devenu une préoccupation de santé publique importante, une situation attribuab... more Le chikungunya est devenu une préoccupation de santé publique importante, une situation attribuable en partie à l'augmentation des voyages internationaux. Les récentes éclosions observées dans les pays de la Caraïbe et le signalement d'un premier cas d'infection autochtone aux États-Unis, donnent à craindre une possible augmentation du nombre de cas au Canada. Le chikungunya ayant un grand nombre de symptômes cliniques en commun avec d'autres maladies transmises par les arthropodes, telles que la dengue, le diagnostic clinique de la maladie est compliqué. Dans cet article, nous présentons un tableau clinique atypique de chikungunya observé chez un homme au retour d'un voyage à Haïti. Le diagnostic microbiologique, le traitement, le pronostic et les implications pour la santé publique aideront à préparer les cliniciens à la prise en charge de cet agent pathogène émergent.