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Human Competence to Transmit Leishmania infantum to Lutzomyia longipalpis and the Influence of Human Immunodeficiency Virus Infection

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  • 1 Graduation Program in Sciences and Health, Federal University of Piauí, Teresina, Brazil;
  • | 2 Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil;
  • | 3 Department of Community Medicine, Federal University of Piauí, Teresina, Brazil;
  • | 4 Maternal and Child Department, Federal University of Piauí, Teresina, Brazil;
  • | 5 Piaui State Central Laboratory of Public Health, Teresina, Brazil;
  • | 6 Animal Sanity Laboratory, Federal University of Piauí, Teresina, Brazil

Visceral leishmaniasis (VL) caused by Leishmania infantum is a lethal disease transmitted by sand flies. Although, considered a zoonosis with dogs held as the main reservoirs, humans are also sources of infection. Therefore, control policies currently focused on dog culling may need to consider that VL and human immunodeficiency virus (HIV)/VL patients may also be infectious, contributing to transmission. Reservoir competence of patients with VL without and with HIV infection and of persons asymptomatically infected with Leishmania was assessed by xenodiagnosis with the vector Lutzomyia longipalpis. Parasites in sand fly’s guts were identified by using optical microscopy and by conventional polymerase chain reaction (PCR). Leishmania infantum blood parasite burden was determined by quantitative PCR. Among the 61 participants, 27 (44%) infected sand flies as seen by microscopy or PCR. When infectiousness was assessed by microscopy, xenodiagnosis was positive in five (25%) patients not infected with HIV, whereas nine (45%) of those harboring HIV were positive. Among the 19 asymptomatic patients four (21%) infected sand flies only demonstrated by PCR. One (50%) asymptomatic patient with HIV had a positive xenodiagnosis by microscopy. 9/372 (2.4%) and 37/398 (9.2%) sand flies were infected when feeding in patients without and with HIV, respectively. Infectiousness was poorly correlated with quantitative PCR. The study shows that asymptomatic humans are capable of transmitting L. infantum, that ill persons with HIV infection are more infectious to sand flies, and that humans are more important reservoirs than previously thought. This fact may be considered when designing control policies for zoonotic VL.

Author Notes

Address correspondence to Carlos Henrique Nery Costa, Instituto de Doenças Tropicais Natan Portella, Rua Artur de Vasconcelos 151 Sul 64001-450 Teresina-PI, Brazil. E-mail: chncosta@gmail.com

Authors’ addresses: Gabriel Reis Ferreira and Jailthon Carlos da Silva, Graduation Program in Sciences and Health, Federal University of Piauí, Teresina, Brazil, and Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil. E-mails: ferreira.rgabriel@gmail.com and jailthonsilva@yahoo.com.br. Antônio Meneses Filho, Teresinha de Jesus Cardoso Farias Pereira, Daniela Moura Parente, Humberto Feitosa Pereira, and Danielle Alves Zacarias, Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil. E-mails: ajfilho87@gmail.com, teresinhafariasgs@hotmail.com, daniela_parente@hotmail.com, hpfeitosa@ig.com.br, and danizacariasbio@yahoo.com.br. Letiano Vieira da Silva and Symonara Karina Medeiros Faustino, Piaui State Central Laboratory of Public Health, Teresina, Brazil. E-mails: letianovieira@hotmail.com and symonara@hotmail.com. Walfrido Salmito Almeida Neto, Department of Community Medicine, Federal University of Piauí, Teresina, Brazil. E-mail: walfridomed@hotmail.com. Dorcas Lamounier Costa, Maternal and Child Department, Graduation program in Sciences and Health, Federal University of Piauí, Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil, Email: dorcas.lc@gmail.com. Ivete Lopes de Mendonça, Animal Sanity Laboratory, Federal University of Piauí, Teresina, Brazil, Email: ivetemendonca@ig.com.br. Carlos Henrique Nery Costa. Department of Community Medicine, Graduation program in Sciences and Health, Federal University of Piauí, Teresina, Brazil, and Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil, E-mail: chncosta@gmail.com.

Financial support: This study was funded by Brazil’s Health Ministry, bid 779/2006, call 2/2006.

Deceased.

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