Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia.
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
PLoS Negl Trop Dis. 2023 Mar 9;17(3):e0011142. doi: 10.1371/journal.pntd.0011142. eCollection 2023 Mar.
Visceral leishmaniasis (VL) is a disease caused by Leishmania parasites. While predominantly transmitted by sandflies, cases of VL transmitted through blood transfusion have been reported, particularly in immunocompromised recipients. Although Leishmania parasites have been found in blood donors in some VL endemic areas, this has never been studied in East-Africa, where HIV prevalence is relatively high. We established the prevalence of asymptomatic Leishmania infection and associated socio-demographic factors among blood donors presenting at two blood bank sites (Metema and Gondar) in northwest Ethiopia between June and December 2020. Metema is located in a VL-endemic area; Gondar has historically been considered VL non-endemic but as an outbreak of VL has occurred around Gondar, it was defined as previously VL non-endemic. Blood samples were tested by the rK39 rapid diagnostic test (RDT), rK39 ELISA, direct agglutination test (DAT) and qPCR targeting kinetoplast DNA (kDNA). Asymptomatic infection was defined as positive by any of these tests in a healthy person. A total of 426 voluntary blood donors were included. The median age was 22 years (IQR, 19-28 years); 59% were male and 81% resided in urban areas. Only one participant had a history of VL and three had a family history of VL. Asymptomatic infection was detected in 15.0% (n = 32/213) in Metema and 4.2% (n = 9/213) in Gondar. The rK39 ELISA was positive in 5.4% (n = 23/426), the rK39 RDT in 2.6% (11/426), PCR in 2.6% (11/420) and DAT in 0.5% (2/426). There were six individuals with two positive tests: one positive on rK39 RDT and PCR and five positive on rK39 RDT and ELISA. The prevalence of asymptomatic infection was higher in Metema (VL-endemic) and males but was not associated with age, a history of VL amongst family members or living in a rural area. Antibodies against Leishmania and parasite DNA was detected in a substantial number of blood donors. Future research should be directed at better defining the risk to recipients, including parasite viability studies and longitudinal studies amongst recipients.
内脏利什曼病（VL）是由利什曼原虫引起的疾病。虽然主要通过沙蝇传播，但也有通过输血传播 VL 的病例报告，特别是在免疫功能低下的受者中。尽管在一些内脏利什曼病流行地区的献血者中发现了利什曼原虫，但在东非，HIV 流行率相对较高的地区，尚未对此进行研究。我们在 2020 年 6 月至 12 月期间在埃塞俄比亚西北部的两个血库（梅特马和贡德尔）检测了 426 名献血者中无症状利什曼原虫感染的流行率及其相关社会人口学因素。梅特马位于内脏利什曼病流行地区；贡德尔历史上被认为是非内脏利什曼病流行地区，但由于贡德尔周围发生了内脏利什曼病疫情，因此被定义为以前的非内脏利什曼病流行地区。采用 rK39 快速诊断检测（RDT）、rK39 ELISA、直接凝集试验（DAT）和针对动基体 DNA（kDNA）的 qPCR 检测血液样本。无症状感染定义为任何一种健康人测试结果为阳性。共有 426 名自愿献血者入选。中位年龄为 22 岁（IQR，19-28 岁）；59%为男性，81%居住在城市地区。只有一名参与者有内脏利什曼病病史，三名有内脏利什曼病家族史。在梅特马检测到 15.0%（n = 32/213）和贡德尔 4.2%（n = 9/213）的无症状感染。rK39 ELISA 阳性率为 5.4%（n = 23/426），rK39 RDT 阳性率为 2.6%（n = 11/426），PCR 阳性率为 2.6%（n = 11/420），DAT 阳性率为 0.5%（n = 2/426）。有 6 名个体有两种阳性检测结果：一种是 rK39 RDT 和 PCR 阳性，五种是 rK39 RDT 和 ELISA 阳性。无症状感染的流行率在梅特马（内脏利什曼病流行地区）和男性中较高，但与年龄、家庭成员中的内脏利什曼病病史或居住在农村地区无关。在大量献血者中检测到针对利什曼原虫的抗体和寄生虫 DNA。未来的研究应旨在更好地确定受者的风险，包括寄生虫存活能力研究和受者的纵向研究。
