Abstract
Visceral leishmaniasis (VL) caused by Leishmania infantum is endemic in the Mediterranean basin with most of the infected human patients remaining asymptomatic. Recently, the saurian-associated Leishmania tarentolae was detected in human blood donors and in sheltered dogs. The circulation of L. infantum and L. tarentolae was investigated in humans, dogs and cats living in the Pelagie islands (Sicily, Italy) by multiple serological and molecular testing. Human serum samples (n = 346) were tested to assess the exposure to L. infantum by immunofluorescence antibody test (IFAT), enzyme-linked immunosorbent assay (ELISA) and Western blot (WB) and to L. tarentolae by IFAT. Meanwhile, sera from dogs (n = 149) and cats (n = 32) were tested for both Leishmania species by IFAT and all blood samples, including those of humans, by specific sets of real time-PCR for L. infantum and L. tarentolae. The agreement between serological tests performed for human samples, and between serological and molecular diagnostic techniques for both human and animal samples were also assessed. Overall, 41 human samples (11.8%, 95% CI: 8.9-15.7) were positive to L. infantum (5.2%, 95% CI: 3.3-8.1), L. tarentolae (5.2%, 95% CI: 3.3-8.1) and to both species (1.4%, 95% CI: 0.6-3.3) by serology and/or molecular tests. A good agreement among the serological tests was determined. Both Leishmania spp. were serologically and/or molecularly detected in 39.6% dogs and 43.7% cats. In addition to L. infantum, also L. tarentolae circulates in human and animal populations, raising relevant public health implications. Further studies should investigate the potential beneficial effects of L. tarentolae in the protection against L. infantum infection.
Highlights
With over 20 Leishmania spp. as causative agents, the leishmaniases are neglected tropical diseases inducing cutaneous, mucocutaneous and, the most severe, visceral form
Out of 23 patients positive to L. infantum, 17 (4.9%, 95% confidence intervals (CI): 3.1–7.7) tested positive by immunofluorescence antibody test (IFAT) with antibodies titres of 1:80 (n = 10), 1:160 (n = 4), 1:320 (n = 1) and 1:1280 (n = 2), 21 (6.1%, 95% CI: 4.0–9.1) by enzyme-linked immunosorbent assay (ELISA) and 16 (4.6%, 95% CI: 2.9–7.4) by Western blot (WB) (Table 1)
Circulating L. infantum kDNA was detected in blood of 2 patients (0.6%, 95% CI: 0.2–2.1) seropositive to both L. infantum and L. tarentolae with IgG titers of 1:1280 and 1:320, respectively
Summary
With over 20 Leishmania spp. as causative agents, the leishmaniases are neglected tropical diseases inducing cutaneous, mucocutaneous and, the most severe, visceral form. Large outbreaks of VL are uncommon, especially in European countries [4], an epidemic of leishmaniasis started in June 2009, occurred in an urban area of Madrid (Spain) with more than 700 cases recorded [5]. In this scenario, hares (Lepus granatensis) were the sylvatic reservoir of L. infantum, with a minor role played by dogs [6], and humans presented mainly cutaneous forms, with visceral manifestations in immunocompromised patients [7]
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