{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:38:14Z","timestamp":1760233094122,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T00:00:00Z","timestamp":1671148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008816","name":"University of Sri Jayewardenepura","doi-asserted-by":"publisher","award":["ASP\/01\/RE\/MED\/2015\/45"],"award-info":[{"award-number":["ASP\/01\/RE\/MED\/2015\/45"]}],"id":[{"id":"10.13039\/501100008816","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Leishmania donovani causes both cutaneous and visceral leishmaniasis (CL and VL) in Sri Lanka, where chronic kidney disease (CKD) and kidney transplant recipients\u2019 (KTR) geographical areas overlap. This study aimed to determine the risk of exposure to Leishmania infection among renal patients. This cross-sectional study in a renal unit assessed clinical symptoms and signs of CL and VL in recipients of blood\/kidney or immunosuppressives. Sera were tested with Leishmania-specific DAT and rK-39 ELISA. There were 170 participants. A total of 84.1% (n = 143) were males (CKD: 101, KTR; 42, mean age 45) and 27 were females (females: CKD: 23, KTR: 4, mean age 39 years). Recipients of blood transfusion\/s within last 2 years: 75.9% (CKD: 115, KTR: 14), on immunosuppressive therapy: 34.1% (CKD: 13, KTR: 45). Two CKD patients repeatedly showed clear positive titres (1: 12,800 and 1: 3200) with Leishmania-DAT and another two (CKD) became marginally positive with rK39-ELISA. Prevalence of anti-Leishmania antibodies: 2.4% (4\/170). All four patients were clinically asymptomatic and were recipients of recent blood transfusions. Attributable risk of exposure to Leishmania infection through blood transfusions was 0.032, OR 2.99 (95% CI = 0.16 to 56.45, p = 0.47). Therefore, routine screening of kidney\/blood donors and CKD and KTR patients in Sri Lanka may not be necessary.<\/jats:p>","DOI":"10.3390\/pathogens11121553","type":"journal-article","created":{"date-parts":[[2022,12,19]],"date-time":"2022-12-19T04:54:13Z","timestamp":1671425653000},"page":"1553","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessment of Risk of Exposure to Leishmania Parasites among Renal Disease Patients from a Renal Unit in a Sri Lankan Endemic Leishmaniasis Focus"],"prefix":"10.3390","volume":"11","author":[{"given":"Chandrani","family":"Menike","sequence":"first","affiliation":[{"name":"Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10280, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeewa","family":"Dassanayake","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Teaching Hospital, Anuradhapura 50000, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renu","family":"Wickremasinghe","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10280, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4182-284X","authenticated-orcid":false,"given":"Maheeka","family":"Seneviwickrama","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10280, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indika","family":"De Alwis","sequence":"additional","affiliation":[{"name":"Provincial General Hospital, Blood Bank, Ratnapuara 70000, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3347-6075","authenticated-orcid":false,"given":"Ahmed","family":"Abd El Wahed","sequence":"additional","affiliation":[{"name":"Institute for Animal Hygiene and Veterinary Public Health, Leipzig University, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shalindra","family":"Ranasinghe","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10280, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Redmon, J.H., Elledge, M.F., Womack, D.S., Wickremashinghe, R., Wanigasuriya, K.P., Peiris-John, R.J., Lunyera, J., Smith, K., Raymer, J.H., and Levine, K.E. (2014). Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka-lessons learned from the WHO CKDu population prevalence study. BMC Nephrol., 15.","DOI":"10.1186\/1471-2369-15-125"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ranasinghe, A.V., Kumara, G.W.G.P., Karunarathna, R.H., De Silva, A.P., Sachintani, K.G.D., Gunawardena, J.M.C.N., Kumari, S.K.C.R., Sarjana, M.S.F., Chandraguptha, J.S., and De Silva, M.V.C. (2019). The incidence, prevalence and trends of Chronic Kidney Disease and Chronic Kidney Disease of uncertain aetiology (CKDu) in the North Central Province of Sri Lanka: An analysis of 30,566 patients. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1501-0"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1016\/j.vaccine.2012.11.065","article-title":"Leishmanization revisited: Immunization with a naturally attenuated cutaneous Leishmania donovani isolate from Sri Lanka protects against visceral leishmaniasis","volume":"31","author":"McCall","year":"2013","journal-title":"Vaccine"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Zhang, W.W., Ramasamy, G., McCall, L.I., Haydock, A., Ranasinghe, S., Abeygunasekara, P., Sirimanna, G., Wickremasinghe, R., Myler, P., and Matlashewski, G. (2014). Genetic analysis of Leishmania donovani tropism using a naturally attenuated cutaneous strain. PLoS Pathog., 10.","DOI":"10.1371\/journal.ppat.1004244"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1017\/S003118201700169X","article-title":"Dermotropic Leishmania donovani in Sri Lanka: Visceralizing potential in clinical and preclinical studies","volume":"145","author":"Kariyawasam","year":"2018","journal-title":"Parasitology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4038\/cmj.v52i1.1047","article-title":"Locally acquired visceral leishmaniasis in Sri Lanka","volume":"52","author":"Abeygunasekara","year":"2007","journal-title":"Ceylon Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1179\/2047773212Y.0000000054","article-title":"Leishmania donovani zymodeme MON-37 isolated from an autochthonous visceral leishmaniasis patient in Sri Lanka","volume":"106","author":"Ranasinghe","year":"2012","journal-title":"Pathog. Glob. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"300","DOI":"10.2478\/s11686-020-00174-6","article-title":"A Comprehensive Review of Cutaneous Leishmaniasis in Sri Lanka and Identification of Existing Knowledge Gaps","volume":"65","author":"Amarasinghe","year":"2020","journal-title":"Acta Parasit."},{"key":"ref_9","unstructured":"Epidemiology Unit Ministry of Health Sri Lanka (2020, August 20). Newly Introduced Notifiable Diseases, Available online: http:\/\/www.epid.gov.lk\/wer.htm."},{"key":"ref_10","unstructured":"World Health Organization (2020, August 20). Leishmaniasis Fact Sheet 2020. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/leishmaniasis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1080\/20477724.2017.1361564","article-title":"Emergence of visceral leishmaniasis in Sri Lanka: A newly established health threat","volume":"111","author":"Siriwardana","year":"2017","journal-title":"Pathog. Glob. Health"},{"key":"ref_12","unstructured":"World Health Organization (2010). Control of the Leishmaniases, World Health Organization."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"742","DOI":"10.4269\/ajtmh.12-0640","article-title":"Cross-sectional study to assess risk factors for leishmaniasis in an endemic region in Sri Lanka","volume":"89","author":"Ranasinghe","year":"2013","journal-title":"Am. J. Trop. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Siriwardana, Y.D., Deepachandi, B., Ranasinghe, S., Soysa, P., and Karunaweera, N. (2018). Evidence for Seroprevalence in Human Localized Cutaneous Leishmaniasis Caused by Leishmania donovani in Sri Lanka. Biomed Res. Int., 9320367.","DOI":"10.1155\/2018\/9320367"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9932","DOI":"10.1038\/s41598-019-46283-9","article-title":"A multicentric evaluation of dipstick test for serodiagnosis of visceral leishmaniasis in India, Nepal, Sri Lanka, Brazil, Ethiopia and Spain","volume":"9","author":"Ejazi","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.ijid.2020.07.006","article-title":"Presence of anti-Leishmania antibodies in candidates for kidney transplantation","volume":"98","author":"Oliveira","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Fran\u00e7a, A.O., Pompilio, M.A., Pontes, E.R.J.C., de Oliveira, M.P., Pereira, L.O.R., Lima, R.B., Goto, H., Sanchez, M.C.A., Fujimori, M., and Lima-J\u00fanior, M.S.D.C. (2018). Leishmania infection in blood donors: A new challenge in leishmaniasis transmission?. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198199"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"168","DOI":"10.4269\/ajtmh.1997.57.168","article-title":"Prevalence of anti-Leishmania donovani antibody among Brazilian blood donors and multiply transfused hemodialysis patients","volume":"57","author":"Luz","year":"1997","journal-title":"Am. J. Trop. Med."},{"key":"ref_19","first-page":"1486","article-title":"Visceral leishmaniasis in a kidney transplant recipient: Parasitic interstitial nephritis, a cause of renal dysfunction","volume":"10","author":"Dettwiler","year":"2010","journal-title":"Am. J. Trop. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.trre.2013.10.007","article-title":"Visceral leishmaniasis after kidney transplantation: Report of a new case and a review of the literature","volume":"28","author":"Bouchekoua","year":"2014","journal-title":"Transplant. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Akuffo, H., Costa, C., Griensven, J.-V., Burza, S., Moreno, J., and Herrero, M. (2018). New insights into leishmaniasis in the immunosuppressed. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006375"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s12639-020-01283-9","article-title":"A critical review of the applicability of serological screening for Leishmaniasis in blood banks in Brazil","volume":"45","author":"Rodrigues","year":"2021","journal-title":"J. Parasit. Dis."},{"key":"ref_23","first-page":"296","article-title":"Leishmaniasis in patients with chronic renal failure: A diagnostic and therapeutic challenge for the clinician","volume":"17","author":"Maggi","year":"2004","journal-title":"J. Nephrol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4103\/1319-2442.198159","article-title":"Visceral leishmaniasis in adults with nephropathy","volume":"28","author":"Harzallah","year":"2017","journal-title":"Saudi J. Kidney Dis. Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.bjid.2013.11.013","article-title":"Kidney involvement in leishmaniasis\u2014A review","volume":"18","author":"Barros","year":"2014","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s12199-015-0464-4","article-title":"Fluoride in drinking water and diet: The causative factor of chronic kidney diseases in the North Central Province of Sri Lanka","volume":"20","author":"Dharmaratne","year":"2015","journal-title":"Environ. Health Prev. Med."},{"key":"ref_27","unstructured":"Geology.com (2020, August 20). Sri Lanka Map and Satellite Image. Available online: https:\/\/geology.com\/world\/sri-lanka-satellite-image.shtml."},{"key":"ref_28","unstructured":"International Society of Nephrology (2013, March 02). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Available online: https:\/\/kdigo.org\/wp-content\/uploads\/2017\/02\/KDIGO_2012_CKD_GL.pdf."},{"key":"ref_29","first-page":"331","article-title":"Immunodiagnosis of Visceral Leishmaniasis: Current Status and Challenges: A Review Article","volume":"13","author":"Sarkari","year":"2018","journal-title":"Iran J. Parasitol."},{"key":"ref_30","unstructured":"InBios (2012). KalazarDetect\u2122 ELISA System Fact Sheet. Available with the ELISA Kits Package, InBios International, Inc."},{"key":"ref_31","unstructured":"Royal Tropical Institute KIT Biomedical Research (2002). DAT Fact Sheet 2002, Available with DAT Kits Package, KIT Royal Tropical Institute."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.trstmh.2010.09.006","article-title":"Diagnosis of visceral leishmaniasis","volume":"105","author":"Srivastava","year":"2011","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_33","unstructured":"World Health Organization (2013, March 02). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Available online: https:\/\/www.who.int\/vmnis\/indicators\/haemoglobin.pdf."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Adams ERJacquet, D., Schoone, G., Gidwani, K., Boelaert, M., and Cunningham, J. (2012). Leishmaniasis Direct Agglutination Test: Using Pictorials as Training Materials to Reduce Inter-Reader Variability and Improve Accuracy. PLoS Negl. Trop. Dis., 6.","DOI":"10.1371\/journal.pntd.0001946"},{"key":"ref_35","first-page":"130","article-title":"Strategies for reducing the risk of transfusion-transmitted leishmaniasis in an area endemic for Leishmania infantum: A patient- and donor-targeted approach","volume":"16","author":"Riera","year":"2018","journal-title":"Blood Transfus."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1111\/j.1365-3156.2010.02631.x","article-title":"Serological markers for Leishmania donovani infection in Nepal: Agreement between direct agglutination test and rK 39. ELISA","volume":"15","author":"Khanal","year":"2010","journal-title":"Trop. Med. Int. Health"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hasker, E., Malaviya, P., Gidwani, K., Picado, A., Ostyn, B., Kansal, S., Singh, R.P., Singh, O.P., Chourasia, A., and Singh, A.K. (2014). Strong association between serological status and probability of progression to clinical visceral leishmaniasis in prospective cohort studies in India and Nepal. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0002657"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"72","DOI":"10.4269\/ajtmh.2004.70.72","article-title":"A comparative study of the effectiveness of diagnostic tests for visceral leishmaniasis","volume":"70","author":"Boelaert","year":"2004","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Silvia, F., Simona, F., and Fabrizio, B. (2018). Solid Organ Transplant and Parasitic Diseases: A Review of the Clinical Cases in the Last Two Decades. Pathogens, 7.","DOI":"10.3390\/pathogens7030065"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/12\/1553\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:43:01Z","timestamp":1760146981000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/12\/1553"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,16]]},"references-count":39,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["pathogens11121553"],"URL":"https:\/\/doi.org\/10.3390\/pathogens11121553","relation":{},"ISSN":["2076-0817"],"issn-type":[{"type":"electronic","value":"2076-0817"}],"subject":[],"published":{"date-parts":[[2022,12,16]]}}}