Publication: Association of Phlebotomus guggisbergi with Leishmania major and Leishmania tropica in a complex transmission setting for cutaneous leishmaniasis in Gilgil, Nakuru county, Kenya
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2019-10-18
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NRF
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PLOSNeglectedTropical Diseases
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Abstract
Background
Phlebotomus (Larroussius) guggisbergi is among the confirmed vectors for cutaneous leish
maniasis (CL) transmission in Kenya. This scarring and stigmatizing form of leishmaniasis
accounts for over one million annual cases worldwide. Most recent CL epidemics in Kenya
have beenreported in Gilgil, Nakuru County, where the disease has become a public health
issue. However, little is known about the factors that drive its transmission. Here, we sought
to determine the occurrence, distribution and host blood feeding preference of the vectors,
andto identify Leishmania species and infection rates in sandflies using molecular tech
niques. This information could lead to a better understanding of the disease transmission
andimprovement of control strategies in the area.
Methodology/ Principal findings
Anentomological survey of sandflies using CDC light traps was conducted for one week per
month in April 2016, and in June and July 2017 from five villages of Gilgil, Nakuru county;
Jaica, Sogonoi, Utut, Gitare and Njeru. Sandflies were identified to species level using mor
phological keys and further verified by PCR analysis of cytochrome c oxidase subunit I
(COI) gene. Midguts of female sandflies found to harbour Leishmania were ruptured and the
isolated parasites cultured in Novy-MacNeal-Nicolle (NNN) media overlaid with Schneider’s
insect media to identify the species. Leishmania parasite screening and identification in 198
randomly selected Phlebotomus females and parasite cultures was done by PCR-RFLP
analysis of ITS1 gene, nested kDNA-PCR and real-time PCR-HRM followed by sequencing.
Bloodmeal source identification was done by real-time PCR-HRM of the vertebrate cyto
chrome-b gene. Atotal of 729 sandflies (males: n = 310; females: n = 419) were collected
from Utut (36.6%), Jaica (24.3%), Sogonoi (34.4%), Njeru (4.5%), and Gitare (0.1%). These
were found to consist of nine species: three Phlebotomus spp. and six Sergentomyia spp.
Ph. guggisbergi was the most abundant species (75.4%, n = 550) followed by Ph. saevus
sensu lato (11.3%, n = 82). Sandfly species distribution across the villages was found to be
significantly different (p<0.001) with Jaica recording the highest diversity. The overall Leish
mania infection rate in sandflies was estimated at 7.07% (14/198). Infection rates in Ph. gug
gisbergi and Ph. saevus s.l. were 9.09% (12/132) and 3.57% (2/56) respectively. L. tropica
wasfound tobethepredominant parasite in Gilgil with an overall infection rate of 6.91% (13/
188) in Ph. guggisbergi (n = 11) and Ph. saevus s.l. (n = 2) sandflies. However, PCR analy
sis also revealed L. major infection in one Ph. guggisbergi specimen. Bloodmeal analysis in
the 74 blood-fed sandflies disclosed a diverse range of vertebrate hosts in Ph. guggisbergi
bloodmeals, while Ph. saevus s.l. fed mainly on humans.
Conclusions/ Significance
Thehigh infection rates of L. tropica and abundance of Ph. guggisbergi in this study con
firms this sandfly as a vector of L. tropica in Kenya. Furthermore, isolation of live L. tropica
parasites from Ph. saevus s.l. suggest that there are at least three potential vectors of this
parasite species in Gilgil; Ph. guggisbergi, Ph. aculeatus and Ph. saevus s.l. Molecular iden
tification of L. major infections in Ph. guggisbergi suggested this sandfly species as a poten
tial permissive vector of L. major, which needs to be investigated further. Sandfly host
preference analysis revealed the possibility of zoonotic transmissions of L. tropica in Gilgil
since the main vector (Ph. guggisbergi) does not feed exclusively on humans but also other
vertebrate species. Further investigations are needed to determine the potential role of
these vertebrate species in L. tropica and L. major transmission in the area.