First Report of Anuran Trypanosoma DNA in Flat-Tailed House Geckos (Reptilia: Gekkonidae) Collected from Southern Thailand: No Evidence as a Reservoir for Human Trypanosomatids

Cave-dwelling phlebotomine sand flies (Diptera: Psychodidae: Phlebotominae) in Thailand: population composition and pathogen detection of Bartonella and Trypanosoma

BACKGROUND

Leishmaniasis is an emerging vector-borne disease that occurs in Thailand. Although Leishmania (Mundinia) parasites, the causative agents of the disease have been identified, the vectors of the disease remain unidentified. In the present study, we collected sand flies from three caves located in endemic areas of leishmaniasis, including Lampang and Chiang Rai in northern Thailand, and Songkhla in southern Thailand.

METHODS

Female sand flies were identified on the basis of morphological characteristics and confirmed by cytochrome c oxidase subunit I (COI) sequencing. Sand fly DNA samples were screened for Leishmania, Trypanosoma, and Bartonella DNA by polymerase chain reaction (PCR) on the basis of the ITS1 region of the ribosomal RNA (rRNA), SSU rRNA, and gltA genes, followed by phylogenetic relationships and haplotype diversity analysis.

RESULTS

A total of 557 sand flies were identified, comprising four genera (Sergentomyia, Phlebotomus, Grassomyia, and Idiophlebotomus) and 11 species. Molecular detection of pathogens demonstrated that Leishmania DNA was not detected. However, Trypanosoma DNA was detected in 11 samples of Phlebotomus mascomai from Lampang (7 for T. noyesi), Se. anodontis from Chiang Rai (1 each for T. noyesi and Trypanosoma sp.), and Se. khawi from Songkhla (2 for Trypanosoma sp.). Bartonella DNA was detected in 16 samples of Se. anodontis and Se. barraudi s.l. from Chiang Rai, Se. anodontis from Lampang, and Se. khawi from Songkhla. The novel Bartonella sp. detected in Thai sand flies was phylogenetically related to Bartonella sp. from bats. Genetic diversity analysis showed high haplotype diversity in both Trypanosoma parasites and Bartonella bacteria.

CONCLUSIONS

The data from the present study indicate that phlebotomine sand flies could be potential vectors of zoonotic diseases caused by Trypanosoma sp. and Bartonella sp. To our knowledge, this is the first report of the natural infection of Bartonella associated with bats in Thailand, and the presence of T. noyesi and amphibian trypanosomes. However, further investigation is required to elucidate and enhance the understanding of potential vectors and transmission dynamics of pathogens in Thailand, particularly with regard to different seasonality, habitats, and host ranges.

Trypanosoma infection and bloodmeal analysis in post-feeding sand flies across Thailand

Phlebotomine sand flies are recognized as a primary vector of Leishmania and are also suspected vectors of Trypanosoma. The transmission cycle of these parasites relies on the distribution of sand fly vectors, parasites, and reservoir animals. This study aimed to detect Leishmania and Trypanosoma DNA and identify the sources of bloodmeals in post-feeding sand flies captured across Thailand. A total of 42,911 field female sand flies were collected from 11 provinces across Thailand using CDC light traps. Among these, 253 post-feeding sand flies were selected for analysis. The predominant species in this study was Sergentomyia khawi (33.60 %). The DNA was extracted from individual female sand flies. Polymerase chain reaction (PCR), specific to the internal transcribed spacer 1 (ITS1) and the small subunit ribosomal RNA (SSU rRNA) gene regions were used to detect the presence of Leishmania and Trypanosoma DNA, respectively. Additionally, cytochrome c oxidase subunit I (COI) gene region was utilized to identify the sources of host bloodmeals. Leishmania DNA was not detected in any specimens. The analysis of SSU rRNA sequences revealed the presence of Trypanosoma DNA (11.46 %, 29/253) in sand fly samples. Among these samples, T. noyesi (1.58 %, 4/253) was identified in Idiophlebotomus longiforceps and Phlebotomus asperulus, Trypanosoma Anura01+02/Frog2 (1.18 %, 3/253) in Se. khawi, and Trypanosoma Anura04/Frog1 (8.70 %, 22/253) in Se. khawi, Se. hivernus and Grossomyia indica. Bloodmeal analysis utilizing the COI gene revealed a diverse range of vertebrate hosts' blood, including bird, bat, frog and sun skink. Our findings confirm the presence of Trypanosoma DNA and identify the sources of bloodmeals from vertebrate hosts in various sand fly species, suggesting their potential as possible vectors for Trypanosoma in Thailand. Furthermore, our study is the first to provide molecular evidence using the COI gene to identify frogs as a host blood source for sand flies in Thailand. Further studies focusing on the isolation of live parasites in sand flies to confirm vector potential and examining the role of animal reservoirs will enhance our understanding of the host-parasite relationship and enable more efficient control for disease transmission.

Species diversity of phlebotomine sand flies and sympatric occurrence of Leishmania (Mundinia) martiniquensis, Leishmania (Leishmania) donovani complex, and Trypanosoma spp. in the visceral leishmaniasis focus of southern Thailand

Autochthonous leishmaniasis in Thailand has recently been a public health concern due to an increasing number of new clinical cases. Most indigenous cases were diagnosed with Leishmania (Mundinia) martiniquensis, and Leishmania (Mundinia) orientalis. However, some doubts regarding vector misidentification have arisen and need to be elucidated. Accordingly, we aimed to assess the species composition of sand flies and determine the molecular prevalence of trypanosomatids in the transmission area of leishmaniasis in southern Thailand. In the present study, a total of 569 sand flies were caught from the vicinity of a visceral leishmaniasis patient's house in Na Thawi District, Songkhla Province. Of these, 229 parous and gravid females consisted of Sergentomyia khawi, Se. barraudi, Phlebotomus stantoni, Grassomyia indica, and Se. hivernus, accounting for 31.4%, 30.6%, 29.7%, 7.9%, and 0.4%, respectively. However, Se. gemmea, which has previously been proposed as the most abundant species and putative vector of visceral leishmaniasis, was not found in the present study. Based on ITS1-PCR and sequence analysis, two specimens of Gr. indica and Ph. stantoni showed positive amplification of L. martiniquensis and L. donovani complex, respectively, the first one being presumed indigenous and the second one being not. Anuran Trypanosoma was also molecularly detected using SSU rRNA-PCR and ubiquitously found in sixteen specimens of four dominant sand fly species except for Se. hivernus. The obtained sequences could be phylogenetically categorized into the two major amphibian clades (An04/Frog1 and An01+An02/Frog2). The existence of the monophyletic subgroup and distinct lineage suggests them as novel Trypanosoma species. The TCS network analysis of these anuran Trypanosoma sequences also revealed high haplotype diversity (Hd = 0.925 ± 0.050), but low nucleotide diversity (π = 0.019 ± 0.009). Furthermore, the living anuran trypanosomes were microscopically demonstrated in a single specimen of Gr. indica, supporting the vectorial capacity. Importantly, our data confirmed the scarcity of Se. gemmea and also uncovered, for the first time, the co-circulation of L. martiniquensis, L. donovani complex, and suspected novel anuran Trypanosoma spp. in phlebotomine sand files, implicating their potential role as vectors of trypanosomatid parasites. Therefore, the novel data from this study would greatly facilitate the comprehension of the complexity of trypanosomatid transmission and the establishment of prevention and control measures for this neglected disease more effectively.

Leishmania spp. in indigenous populations: A mini-review

Leishmaniasis, considered a neglected vector-borne disease complex of global concern, has a significant impact on indigenous communities due to daily human and animal exposure in periurban, rural, and naturally preserved areas. This mini-review aims to assess and discuss studies of leishmaniasis in these communities of the New World and Old World, particularly those in the Americas and Asia. Such indigenous communities have been mostly built in poor traditional households with no mosquito-net protection, mostly located in environmentally protected areas, favoring vectors and reservoirs. The presence of leishmaniasis cases surrounding such indigenous areas indicated a high risk of infection, which may have been historically underestimated due to a lack of surveillance, even at present. The absence of studies of indigenous populations in recognized endemic areas may reflect insufficient health services. In conclusion, the persistence of this neglectful scenario may impact tragic outcomes and potential outbreaks in indigenous peoples and surroundings populations worldwide.

Case Report: Autochthonous Disseminated Cutaneous, Mucocutaneous, and Visceral Leishmaniasis Caused by Leishmania martiniquensis in a Patient with HIV/AIDS from Northern Thailand and Literature Review

Autochthonous leishmaniasis cases have been increasing continuously in Thailand over the years. We report multiple presentations of leishmaniasis in a 47-year-old patient with HIV/AIDS from Chiang Rai Province, northern Thailand. Physical examination showed multiple ulcerated papules, nodules, and plaques in a sporotrichoid distribution. Firm mucosal nodules on the hard palate and nasal opening, hepatosplenomegaly, and bilateral inguinal lymphadenopathy were found. Histopathological examination of the biopsies revealed an inflammatory infiltrate containing intramacrophage amastigotes compatible with Leishmania infection. In addition, Leishmania promastigotes were isolated successfully from the palatal biopsy and assigned the code MHOM/TH/2022/CULE6. Using internal transcribed spacer 1 polymerase chain reaction and sequence analysis, the causative parasite was identified as Leishmania martiniquensis. A definitive diagnosis of multiform leishmaniasis with disseminated cutaneous, mucocutaneous, and visceral involvement was established. The patient was administered intravenous amphotericin B 1 mg/kg/d for 2 weeks, followed by oral itraconazole 400 mg daily. At the 2-month follow-up, the cutaneous and mucosal lesions had improved significantly. To our knowledge, this is the first report of mucocutaneous involvement caused by L. martiniquensis in an immunocompromised patient with HIV/AIDS. In addition, we provide a literature review of leishmaniasis cases, reported formally in Thailand, resulting from this autochthonous parasite.

First Evidence of Co-Circulation of Emerging Leishmania martiniquensis, Leishmania orientalis, and Crithidia sp. in Culicoides Biting Midges (Diptera: Ceratopogonidae), the Putative Vectors for Autochthonous Transmission in Southern Thailand

Since 1996, autochthonous cases of emerging leishmaniasis caused by Leishmania (Mundinia) martiniquensis and Leishmania (Mundinia) orientalis have been more frequently reported, especially in the northern and southern parts of Thailand. However, the accurate identification of their natural vectors and reservoirs remains unconfirmed. Previous studies have suggested that these emerging parasites might be transmitted by other non-phlebotomine vectors. Herein, we speculated that Culicoides biting midges might act as the competent vectors responsible for autochthonous leishmaniasis in southern Thailand. In this research, 187 non-engorged, parous and gravid Culicoides females and 47 blood-engorged ones were trapped from the residences of two recently diagnosed visceral leishmaniasis patients in Sadao District and the unaffected site in Rattaphum District, Songkhla Province, southern Thailand. Species diversity and abundance of biting midges varied among the trapping sites. Using ITS1-PCR and BLASTn analysis, L. martiniquensis was predominantly detected in several Culicoides species, including C. peregrinus, C. oxystoma, C. mahasarakhamense, and C. huffi from the vicinity of patients’ houses; and in C. fordae and C. fulvus from the unaffected site. L. orientalis was also co-circulated in C. peregrinus and C. oxystoma caught near the second patient’s house. Additionally, Crithidia sp. were also detected using SSU rRNA-PCR across Culicoides spp. Host blood meal analysis of eight different Culicoides species from the unaffected site also revealed that all trapped Culicoides had fed on cows and goats, indicating the possible role of these mammalian species as reservoir hosts. Essentially, this study is the first entomological investigation, revealing the co-circulation of emerging trypanosomatids among several species of Culicoides biting midges and strongly supporting the potential role of this insect group as the main vectors responsible for the epidemiology of autochthonous leishmaniasis in southern Thailand.