Subclinical Leishmania infection in patients with rheumatic diseases under biological drugs
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Climate changes and immunosuppression are influencing the spread of leishmaniasis and re-emergence in Northern Italy, respectively. We evaluated the prevalence of subclinical leishmaniasis in patients from a Northern Italian region with chronic inflammatory rheumatism (CIRD) receiving biological drugs (BD) and correlated it to the area of residence.
DNA from PBMC of patients affected by CIRD treated with either BD for at least 5 years (Group A) or other immunosuppressive drugs (Group B) was investigated by a qPCR for Leishmania infantum kDNA and compared to healthy subjects (Group C). Variables such as sex and age, rural areas, dog ownership, type of BD administered and association between BD and steroids, were evaluated by statistical analysis.
A higher proportion of L. infantum DNA positivity was found in Group A than in Group C (p < 0.05), while no parasite DNA was detected in Group B. In Group A, 18/50 patients (36%) had higher rates of parasite DNA (from 1 to 136 to 1.000.000 copies/ml) than Group C (from 1 to 10 copies/ml). 14/18 (77.7%) of positive patients from Group A lived in rural areas, but no statistical differences occurred in relation to dog ownership or BD type (p < 0.0003).
We can speculate that exposure to rural areas appears to be a factor closely linked with the risk of developing Leishmania subclinical infection. A screening with molecular methods in patients with CIRD treated with BD living in these areas and monitoring Leishmania DNA during such therapies, would be mandatory to prevent delay in diagnosis should VL symptoms appear.
KeywordsLeishmania infantum Subclinical leishmaniasis Biologic drugs Rural areas Northern Italy Real-time PCR
Chronic inflammatory rheumatic diseases
Quantitative real-time PCR
Mahmoud Rachid for his help in molecular methods; Gianluca Rugna for having provided Leishmania strains and Sara Bonazza for her help in collecting PBMC specimens.
MM and CC equally contributed to the design of the study and the writing of the manuscript. MM CC and AT analysed and interpreted the patient’s data. GM and AT performed the statistical analysis. PM, SA, SH and TB contributed to the revision of the article. MG contributed to the collection of patient’s data. All authors read and approved the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
The study was approved by the ethics committee of the University of Ferrara, Italy (protocol no. 150494).
Written informed consents were obtained from all participants before their enrolment.
Consent for publication
All the enrolled subjects had signed a written informed consent for publication.
All the data included in the manuscript are available from the authors upon reasonable request.
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