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  1. Article ; Online: Cytokine and phenotypic cell profiles in human cutaneous leishmaniasis caused by Leishmania donovani.

    Wijesooriya, Hiruni / Samaranayake, Nilakshi / Karunaweera, Nadira D

    PloS one

    2023  Volume 18, Issue 1, Page(s) e0270722

    Abstract: Background: The innate immune mediators are likely to influence the clinical phenotype of leishmaniasis by primary responses which limit or facilitate the spread of the parasite, as well as by modulating adaptive immunity. This study investigated the ... ...

    Abstract Background: The innate immune mediators are likely to influence the clinical phenotype of leishmaniasis by primary responses which limit or facilitate the spread of the parasite, as well as by modulating adaptive immunity. This study investigated the response of key innate immune cells in a focus which regularly reports localised cutaneous leishmaniasis (LCL) caused by Leishmania donovani, a species which typically causes visceral disease.
    Methods: Peripheral blood mononuclear cell (PBMC) derived macrophages and dendritic cells from patients with LCL and healthy controls from endemic and non-endemic areas, were stimulated with soluble Leishmania antigen (SLA). Inflammatory mediators produced by macrophages (TNF-α/TGF-β/IL-10, ELISA; NO, Griess method) and dendritic cells (IL-12p70, IL-10, flowcytometry) and macrophage expression of surface markers of polarization, activation and maturation (flowcytometry) were determined at 24h, 48h and 72h and compared. Study was conducted prospectively from 2015-2019.
    Results: Patient derived macrophages and dendritic cells produced higher levels of both pro and anti-inflammatory mediators compared to controls (p<0.05) with the best discrimination for active disease observed at 72h. Data demonstrated an early activation of macrophages and a subsequent pro-inflammatory bias, as indicated by temporal profiles of TNF-α/TGF-β and TNF-α/IL-10 ratios and higher proportions of classical (M1) macrophages. Higher TGF-β levels were observed in cells from patients with ulcerated or persistent lesions. Immune responses by cells derived from controls in endemic and non-endemic regions did not differ significantly from each other.
    Conclusions: The overall immunophenotypic profile suggests that LCL observed in the country is the result of a balancing immune response between pro-inflammatory and regulatory mediators. The mediators which showed distinct profiles in patients warrant further investigation as potential candidates for immunotherapeutic approaches. A comparison with visceral leishmaniasis caused by the same species, would provide further evidence on the differential role of these mediators in the resulting clinical phenotype.
    MeSH term(s) Humans ; Cytokines/metabolism ; Leishmania donovani ; Interleukin-10/genetics ; Leukocytes, Mononuclear/metabolism ; Tumor Necrosis Factor-alpha/genetics ; Leishmaniasis, Visceral/parasitology ; Leishmaniasis, Cutaneous ; Transforming Growth Factor beta/genetics ; Phenotype
    Chemical Substances Cytokines ; Interleukin-10 (130068-27-8) ; Tumor Necrosis Factor-alpha ; Transforming Growth Factor beta
    Language English
    Publishing date 2023-01-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0270722
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Unfolded protein response pathway in leishmaniasis: A review.

    Edirisinghe, Nimesha Madhushani / Manamperi, Nuwani Harshamali / Wanasinghe, Vishmi Samudika / Karunaweera, Nadira

    Parasite immunology

    2023  Volume 45, Issue 11, Page(s) e13009

    Abstract: Alteration in the physiological state of the endoplasmic reticulum (ER) leads to the specific response known as unfolded protein response (UPR) or ER stress response. The UPR is driven by three sensor proteins, namely: Inositol-Requiring Enzyme 1, ... ...

    Abstract Alteration in the physiological state of the endoplasmic reticulum (ER) leads to the specific response known as unfolded protein response (UPR) or ER stress response. The UPR is driven by three sensor proteins, namely: Inositol-Requiring Enzyme 1, Protein Kinase RNA-like ER kinase and Activating Transcription Factor 6 to restore ER homeostasis. Pathogenic infection can initiate UPR activation; some pathogens can subvert the UPR to promote their survival and replication. Many intracellular pathogens, including Leishmania, can interact and hijack ER for their survival and replication, triggering ER stress and subsequently ER stress response. This review aims to provide a comprehensive overview of the ER stress response in infections with the Leishmania species.
    MeSH term(s) Animals ; Unfolded Protein Response ; Endoplasmic Reticulum Stress/physiology ; Leishmaniasis/pathology ; Endoplasmic Reticulum/metabolism ; Endoplasmic Reticulum/pathology ; Leishmania
    Language English
    Publishing date 2023-08-11
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 424444-8
    ISSN 1365-3024 ; 0141-9838
    ISSN (online) 1365-3024
    ISSN 0141-9838
    DOI 10.1111/pim.13009
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  3. Article: Diagnostic Tools for Cutaneous Leishmaniasis Caused by

    Piyasiri, Sachee Bhanu / Dewasurendra, Rajika / Samaranayake, Nilakshi / Karunaweera, Nadira

    Diagnostics (Basel, Switzerland)

    2023  Volume 13, Issue 18

    Abstract: Leishmaniasis, a neglected tropical disease, encompasses a spectrum of clinical conditions and poses a significant risk of infection to over one billion people worldwide. Visceral leishmaniasis (VL) in the Indian sub-continent (ISC), where the causative ... ...

    Abstract Leishmaniasis, a neglected tropical disease, encompasses a spectrum of clinical conditions and poses a significant risk of infection to over one billion people worldwide. Visceral leishmaniasis (VL) in the Indian sub-continent (ISC), where the causative parasite is
    Language English
    Publishing date 2023-09-18
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics13182989
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  4. Article ; Online: Antimony resistance and gene expression in

    Madusanka, Rajamanthrilage Kasun / Karunaweera, Nadira D / Silva, Hermali / Selvapandiyan, Angamuthu

    Parasitology

    2023  Volume 151, Issue 1, Page(s) 1–14

    Abstract: Leishmaniasis is a vector-borne parasitic disease caused ... ...

    Abstract Leishmaniasis is a vector-borne parasitic disease caused by
    MeSH term(s) Leishmania/genetics ; Antimony/pharmacology ; Antimony/therapeutic use ; Proteomics ; Antiprotozoal Agents/pharmacology ; Antiprotozoal Agents/therapeutic use ; Drug Resistance/genetics ; Gene Expression
    Chemical Substances Antimony (9IT35J3UV3) ; Antiprotozoal Agents
    Language English
    Publishing date 2023-11-28
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 207627-5
    ISSN 1469-8161 ; 0031-1820
    ISSN (online) 1469-8161
    ISSN 0031-1820
    DOI 10.1017/S0031182023001129
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Treatment of Cutaneous Leishmaniasis and Insights into Species-Specific Responses: A Narrative Review.

    Madusanka, Rajamanthrilage Kasun / Silva, Hermali / Karunaweera, Nadira D

    Infectious diseases and therapy

    2022  Volume 11, Issue 2, Page(s) 695–711

    Abstract: Cutaneous leishmaniasis (CL) is a complex skin infection that has imposed a heavy burden on many developing countries and is caused by more than 20 Leishmania species. This disease is predominantly associated with disfiguring scars and major social ... ...

    Abstract Cutaneous leishmaniasis (CL) is a complex skin infection that has imposed a heavy burden on many developing countries and is caused by more than 20 Leishmania species. This disease is predominantly associated with disfiguring scars and major social stigma upon infection. The severity of the disease seemingly depends on many factors including the species of parasite, the host, region of endemicity, socio-economic status and the accessibility to health facilities. Despite myriad studies that have been performed on current and novel therapies, the treatment outcomes of CL remain contentious, possibly because of the knowledge gaps that still exist. The differential responses to the current CL therapies have become a major drawback in disease control, and the dearth of information on critical analyses of outcomes of such studies is a hindrance to the overall understanding. On the basis of currently available literature on treatment outcomes, we discuss the most effective doses, drug susceptibilities/resistance and treatment failures of the Leishmania genus for both monotherapy and combination therapy. This review focuses on the available treatment modalities for CL caused by different Leishmania species, with insights into their species-specific efficacies, which would inform the selection of appropriate drugs for the treatment and control of leishmaniasis.
    Language English
    Publishing date 2022-02-22
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 2701611-0
    ISSN 2193-6382 ; 2193-8229
    ISSN (online) 2193-6382
    ISSN 2193-8229
    DOI 10.1007/s40121-022-00602-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: The role of improved housing and living environments in malaria control and elimination.

    Carter, Richard / Karunaweera, Nadira D

    Malaria journal

    2020  Volume 19, Issue 1, Page(s) 385

    Abstract: Malaria risk and endemicity is often associated with the nature of human habitation and living environment. The disappearance of malaria from regions where it had been endemic for centuries, such as coastal areas of southern England, has been attributed, ...

    Abstract Malaria risk and endemicity is often associated with the nature of human habitation and living environment. The disappearance of malaria from regions where it had been endemic for centuries, such as coastal areas of southern England, has been attributed, at least in part, to improvement in the quality of housing. Moreover, indigenous malaria transmission ceased throughout England without the necessity to eliminate the vector mosquitoes. The principles of malaria transmission, as formulated following the thinking of the pioneers of malaria epidemiology, Ronald Ross and George Macdonald, show how this may happen. Malaria ceases to be sustainable where its reproduction number, R0, the number of new cases generated on average for each existing case of malaria, falls below 1. In the terms of a Ross/Macdonald analysis the reduced contact between humans and blood-feeding mosquitoes that is achieved through housing that is secure against mosquito entry can have a powerful effect in reducing malaria R0. The island of Sri Lanka, where malaria had been endemic probably for centuries previously, has reported no indigenous cases of malaria since 2012. The disappearance of malaria from Sri Lanka followed an effective attack upon malaria transmission by the Sri Lanka Anti Malaria Campaign. The targeted and enhanced efforts of this campaign launched in 1999, drove the malaria R0 below 1 for most of the period up to 2012, leading to a nearly continuous decline in malaria cases until their extinction. The decades leading up to the launch of these efforts were ones of general improvement of living environment and notably in the quality of housing stock. Studies in the late 1980s had shown that quality of housing in a highly malarious district of Sri Lanka was a strong determinant of malaria risk. Through its effects on malaria R0, improved housing is likely to have facilitated the malaria control and cessation of indigenous malaria transmission in Sri Lanka and that it will help reduce the risk of the re-introduction of malaria to the island.
    MeSH term(s) Communicable Disease Control/statistics & numerical data ; Disease Eradication/statistics & numerical data ; Environment ; Housing ; Humans ; Malaria/prevention & control ; Sri Lanka
    Language English
    Publishing date 2020-10-31
    Publishing country England
    Document type Letter
    ISSN 1475-2875
    ISSN (online) 1475-2875
    DOI 10.1186/s12936-020-03450-y
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  7. Article: Leishmaniasis: Path toward elimination from the Indian subcontinent.

    Karunaweera, Nadira D

    Tropical parasitology

    2016  Volume 6, Issue 1, Page(s) 2–4

    Language English
    Publishing date 2016-01-19
    Publishing country India
    Document type Journal Article
    ISSN 2229-5070
    ISSN 2229-5070
    DOI 10.4103/2229-5070.175023
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  8. Article ; Online: Histological findings associated with treatment response in cutaneous leishmaniasis: a clinicopathological correlation study.

    Riyal, Hasna / Samaranayake, Nilakshi / Amarathunga, Priyani / Munidasa, Deepani / Karunaweera, Nadira D

    International journal of dermatology

    2023  Volume 62, Issue 10, Page(s) 1237–1247

    Abstract: Background: Treatment responses to cutaneous leishmaniasis (CL) observed in Sri Lanka show variability, ranging from quick healing to delayed or failed responses to routine medication. The determinants of these differences in treatment response are not ... ...

    Abstract Background: Treatment responses to cutaneous leishmaniasis (CL) observed in Sri Lanka show variability, ranging from quick healing to delayed or failed responses to routine medication. The determinants of these differences in treatment response are not well defined. This study aimed to identify predictive features of treatment response and outcome in localized CL caused by Leishmania donovani, focusing on both clinical and histopathological findings in the patients.
    Methods: Tissue sections (n = 103) derived from 3 mm punch biopsies of parasitologically confirmed patients were assessed. Patients were followed up weekly until complete healing of skin lesions and were reviewed at the end of 6 months and 1 year.
    Results: Healing required 7-21 weekly doses of intralesional sodium stibogluconate (IL-SSG) (mean = 12.2 ± 0.622). Twenty-nine (28.1%) patients were identified as delayed responders. None had recurred at the end of 1 year. The demographic or clinical features (age, gender, lesion type, size, location, and lesion duration) did not significantly influence the treatment response. A heavy parasite load and acanthosis were significant predictors of a delayed response to treatment (P < 0.001). Higher parasite loads were associated with inflammation of the entire dermis (P = 0.008), more intense infiltration of macrophages (p = 0.001), and epidermal atrophy (P = 0.033). Well-formed granulomas were inversely proportional to parasite loads.
    Conclusions: Histology findings proved to be better prognostic markers than clinical features for delayed responders to treatment and will aid in targeted patient management when tissue biopsies are performed in the initial diagnosis of CL.
    MeSH term(s) Humans ; Correlation of Data ; Leishmaniasis, Cutaneous/drug therapy ; Antimony Sodium Gluconate/therapeutic use ; Biopsy ; Inflammation
    Chemical Substances Antimony Sodium Gluconate (V083S0159D)
    Language English
    Publishing date 2023-09-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 412254-9
    ISSN 1365-4632 ; 0011-9059 ; 1461-1244
    ISSN (online) 1365-4632
    ISSN 0011-9059 ; 1461-1244
    DOI 10.1111/ijd.16826
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  9. Article ; Online: Image Processing for mHealth-Based Approach to Detect the Local Tissue Inflammation in Cutaneous Leishmaniasis: A Proof of Concept Study.

    Silva, Hermali / Chellappan, Kalaivani / Karunaweera, Nadira

    Computational and mathematical methods in medicine

    2021  Volume 2021, Page(s) 4208254

    Abstract: Skin lesions are a feature of many diseases including cutaneous leishmaniasis (CL). Ulcerative lesions are a common manifestation of CL. Response to treatment in such lesions is judged through the assessment of the healing process by regular clinical ... ...

    Abstract Skin lesions are a feature of many diseases including cutaneous leishmaniasis (CL). Ulcerative lesions are a common manifestation of CL. Response to treatment in such lesions is judged through the assessment of the healing process by regular clinical observations, which remains a challenge for the clinician, health system, and the patient in leishmaniasis endemic countries. In this study, image processing was initially done using 40 CL lesion color images that were captured using a mobile phone camera, to establish a technique to extract features from the image which could be related to the clinical status of the lesion. The identified techniques were further developed, and ten ulcer images were analyzed to detect the extent of inflammatory response and/or signs of healing using pattern recognition of inflammatory tissue captured in the image. The images were preprocessed at the outset, and the quality was improved using the CIE
    MeSH term(s) Algorithms ; Computational Biology ; Humans ; Image Interpretation, Computer-Assisted/methods ; Image Interpretation, Computer-Assisted/statistics & numerical data ; Inflammation/diagnostic imaging ; Leishmaniasis, Cutaneous/diagnostic imaging ; Photography ; Principal Component Analysis ; Proof of Concept Study ; Skin Ulcer/diagnostic imaging ; Smartphone ; Sri Lanka ; Telemedicine/methods ; Telemedicine/statistics & numerical data
    Language English
    Publishing date 2021-11-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2252430-7
    ISSN 1748-6718 ; 1748-670X ; 1027-3662
    ISSN (online) 1748-6718
    ISSN 1748-670X ; 1027-3662
    DOI 10.1155/2021/4208254
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  10. Article ; Online: Efforts toward the Elimination of Visceral Leishmaniasis in South Asia: A Review of Progress in Bhutan.

    Dorji, Thinley / Dorjee, Sithar / Wangdi, Tenzin / Tshokey, Tshokey / Pradhan, Ambika Rani / Penjor, Kinley / Namgay, Rinzin / Togbye, Togbye / Karunaweera, Nadira

    The American journal of tropical medicine and hygiene

    2024  Volume 110, Issue 4, Page(s) 633–638

    Abstract: Leishmaniases are a group of diseases under the category of neglected tropical diseases targeted for global elimination. However, they continue to pose major clinical and public health problems, especially among those living in poor socioeconomic ... ...

    Abstract Leishmaniases are a group of diseases under the category of neglected tropical diseases targeted for global elimination. However, they continue to pose major clinical and public health problems, especially among those living in poor socioeconomic conditions. Here, we summarize leishmaniasis elimination efforts in Bhutan. Between 1994 and 2022, Bhutan recorded 54 cases of leishmaniasis across 14 of its 20 districts. There are seven species of Phlebotomus and three species of Sergentomyia sand flies documented in the country. At a subnational level, all endemic districts recorded a visceral leishmaniasis annual incidence <1 per 10,000 population, meeting the regional elimination targets. Serological testing with ELISA and molecular testing with polymerase chain reaction were established at the Royal Center for Disease Control in 2022. A leishmaniasis prevention and management guideline was adopted in 2023 to aid clinicians in diagnosis and management. Active and passive case surveillance was integrated with the national infectious disease early warning and response system. Risk-based entomological surveillance and control have also been prioritized. Climate change may play a major role in rendering districts in the temperate zone favorable for vector proliferation. The country's medical university introduced a diploma course in medical entomology in 2023 to augment the human resources needed for vector surveillance efforts. However, leishmaniasis elimination lacks dedicated programmatic management amid competing priorities for resources against other infectious diseases. Leishmaniasis elimination requires a targeted and programmatic approach in Bhutan, including cross-border collaborative efforts with neighboring Indian states. Bhutan remains highly committed to achieving leishmaniasis elimination targets.
    MeSH term(s) Animals ; Humans ; Leishmaniasis, Visceral/diagnosis ; Leishmaniasis, Visceral/epidemiology ; Leishmaniasis, Visceral/prevention & control ; Bhutan/epidemiology ; Phlebotomus ; Psychodidae ; Leishmaniasis/epidemiology ; Leishmaniasis/prevention & control ; Asia, Southern
    Language English
    Publishing date 2024-03-12
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 2942-7
    ISSN 1476-1645 ; 0002-9637
    ISSN (online) 1476-1645
    ISSN 0002-9637
    DOI 10.4269/ajtmh.23-0642
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