Debre Markos University, Debre Markos, Ethiopia.
University of Gondar, Gondar, Ethiopia.
Parasit Vectors. 2023 Dec 16;16(1):457. doi: 10.1186/s13071-023-06057-9.
BACKGROUND: Leishmaniasis is a common neglected tropical disease in Ethiopia. Visceral leishmaniasis (VL) caused by Leishmania donovani presents in the lowlands, while cutaneous leishmaniasis (CL) affects people living in the highlands. Although CL is described as being caused by Leishmania aethiopica, there is also evidence of L. tropica and L. major isolated from a patient, sand flies and potential reservoirs. Information on species causing CL in Ethiopia is patchy, and no nation-wide study has ever been done. Understanding which species are causing CL in Ethiopia can have important implications for patient management and disease prevention. METHODS: We analyzed stored routine samples and biobanked DNA isolates from previously conducted studies of CL patients from different centers in the north, center and south of Ethiopia. Species typing was performed using ITS-1 PCR with high-resolution melt (HRM) analysis, followed by HSP70 amplicon sequencing on a selection of the samples. Additionally, sociodemographic, clinical and laboratory data of patients were analyzed. RESULTS: Of the 226 CL samples collected, the Leishmania species could be determined for 105 (45.5%). Leishmania aethiopica was identified in 101 (96.2%) samples from across the country. In four samples originating from Amhara region, northwestern Ethiopia, L. donovani was identified by ITS-1 HRM PCR, of which two were confirmed with HSP70 sequences. While none of these four patients had symptoms of VL, two originated from known VL endemic areas. CONCLUSIONS: The majority of CL was caused by L. aethiopica, but CL due to L. tropica and L. major cannot be ruled out. Our study is the first to our knowledge to demonstrate CL patients caused by L. donovani in Ethiopia. This should spark future research to investigate where, how and to which extent such transmission takes place, how it differs genetically from L. donovani causing VL and whether such patients can be diagnosed and treated successfully with the currently available tools and drugs.
背景:利什曼病是埃塞俄比亚常见的被忽视热带病。由杜氏利什曼原虫引起的内脏利什曼病(VL)发生在低地,而皮肤利什曼病(CL)影响高地的人。尽管 CL 被描述为由利什曼原虫引起,但也有证据表明,从患者、沙蝇和潜在的储主中分离出利什曼原虫、利什曼原虫和利什曼原虫。关于埃塞俄比亚引起 CL 的物种的信息参差不齐,而且从未进行过全国性研究。了解埃塞俄比亚引起 CL 的物种对患者管理和疾病预防具有重要意义。
方法:我们分析了来自埃塞俄比亚北部、中部和南部不同中心的先前进行的 CL 患者研究中存储的常规样本和生物银行 DNA 分离物。使用 ITS-1 PCR 进行高分辨率熔化(HRM)分析,并对选择的样本进行 HSP70 扩增子测序,以确定物种类型。此外,还分析了患者的社会人口统计学、临床和实验室数据。
结果:在所收集的 226 例 CL 样本中,105 例(45.5%)可确定利什曼原虫的种类。在来自全国各地的 101 例(96.2%)样本中鉴定出利什曼原虫。在来自埃塞俄比亚西北部阿姆哈拉地区的四个样本中,通过 ITS-1 HRM PCR 鉴定出杜氏利什曼原虫,其中两个通过 HSP70 序列得到证实。虽然这四个患者都没有 VL 症状,但有两个患者来自已知的 VL 流行地区。
结论:大多数 CL 是由 L. aethiopica 引起的,但不能排除由 L. tropica 和 L. major 引起的 CL。我们的研究是首次证明埃塞俄比亚 CL 患者由 L. donovani 引起。这应该引发未来的研究,以调查这种传播的地点、方式和程度,它在遗传上与引起 VL 的 L. donovani 有何不同,以及是否可以使用现有的工具和药物成功诊断和治疗此类患者。
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