Cutaneous asymptomatic carriage of Leishmania spp.

Abstract

Parasites establish dynamic relationships with their hosts that allow their persistence. Leishmania spp. are unicellular parasites that have two hosts: a haematophageous insect, the sand fly, and a vertebrate. Both in animals and humans, absence of clinical lesions does not imply absence of infection. This phenomenon has major implications in epidemiology, preventive medicine, and pharmacology. Parasitic load determination in mammalian tissues or organs is currently performed by culture‐based methods that are time consuming and require samples harbouring cultivable parasites. Recently, we developed a real‐time PCR assay to quantify the parasitic burden of several Leishmania spp. based on detection of kinetoplastic DNA (kDNA). The efficacy of this real‐time PCR assay was first evaluated in monitoring the fate of Leishmania major in C57Bl/6 mice following intradermal inoculation of the right ear pinna with low doses of infective metacyclics at 24 h, 96 h, and weekly for 7 weeks. Leishmania were established in the center of the inoculated pinna, to a lesser extent in the pinna border, and in the draining lymph node. The parasite was detected, but not quantified, in distant cutaneous sites (left ear pinna, thorax skin, tail base) and in the femoral bone marrow. Throughout the whole experiment, the parasite was detected in the glabrous tail base skin. We also investigated whether the parasites detected by our method were still viable or if we were also detecting DNA from dead parasites. Technical and biological constraints have been overcome by developing an in vitro model to monitor the persistence of Leishmania kDNA in cultured mouse macrophages after host leucocytes were exposed to L‐leucine‐methyl ester, a leishmanicidal molecule. The detection of kDNA by real‐time PCR was correlated with the viability of the parasites in macrophages. These results show that laboratory mice (experimental host) or in vitro‐grown mouse macrophages infected with Leishmania parasites can be considered useful systems in two areas. First, in pharmacology, preventive medicine and epidemiology, such a system would allow pharmacological evaluation of Leishmania‐targeted drugs or vaccines to a broader extent than merely monitoring the reduction of the lesion or the prevention of lesion onset. A similar system could be developed in other animal species, particularly the dog, in order to detect asymptomatic carriage at the borders or in quarantines, or to investigate the real prevalence of Leishmania spp. The growing importance of Leishmania infantum‐related disorders in humans makes such a method very interesting. A second use for this experimental system is the investigation of the prompt and renewed interactions that Leishmania parasites establish within their mammalian hosts. Establishment of a system to quantify the parasitic burden of Leishmania spp. is the perspective of this preliminary research. Recently published data show that the apparent lack of symptoms hides complex mechanisms involving very different factors such as keratinocytes, epidermal and dermal leucocytes, the extracellular matrix, and sand fly saliva. Funding: Institut Pasteur, Centre National de la Recherche Scientifique.