CLIMOS Open Source Publications

Authors: Carla Maia

Abstract
Phlebotomine sand flies (Diptera: Phlebotominae) are vectors of human and animal pathogens, including Leishmania species protozoan parasites and viruses of the genus Phlebovirus. In Europe, visceral zoonotic leishmaniasis caused by Leishmania infantum, a deadly disease when left untreated, is endemic in southern countries, and dogs are the main reservoir hosts for human infection. Most phleboviruses cause asymptomatic infections or flu-like syndromes in humans, but Toscana phlebovirus can cause meningitis and encephalitis. These diseases are likely to re-emerge, posing a growing threat to public and animal health. Potential triggers include the movement of humans and dogs, increasing numbers of immunosuppressive conditions, climate change and other human-mediated environmental changes. An overview of the main epidemiological characteristics of the pathogens transmitted by sand flies in Europe and the potential triggers involved in their emergence and re-emergence are reviewed here. There is a need to implement mandatory notification of human and canine leishmaniases and human phleboviruses and coordinated epidemiological surveillance programmes at a European level, and to raise awareness among healthcare professionals and citizens about sand fly-borne diseases, following a One Health approach.

Published in Journal of Comparative Pathology

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Authors: Ceylan Polat, Nazli Ayhan, Koray Ergünay, Remi N. Charrel

Abstract
Sandfly-borne phleboviruses (SBPs), which cause sandfly fever, aseptic meningitis, encephalitis, and meningoencephalitis, are emerging pathogens of major public health concern. Virus nucleic acid testing is essential for SBP diagnosis, especially in the early stages of infection, and for the discovery of novel SBPs. The efficacy of utilizing generic primers that target conserved nucleotide sequences for the detection of both known and novel SBPs has not been extensively evaluated. We aimed to compare and evaluate the performance of five generic primer sets, widely used to detect S- and L-segments of arthropod-borne phleboviruses and designed as singleplex (n = 3) and nested (n = 2) formats, including both well-known and recently characterized 15 Old World virus strains. Furthermore, we performed in silico analysis to assess the detection capabilities of these generic primer sets. The initial evaluation of previously published generic primer sets for SBP detection yielded two singleplex primer sets with the potential to be adapted for use in real-time or high-throughput detection settings. Studies are ongoing to develop and further optimize a preliminary assay and test various hosts and vectors to assess their capacity to detect known and novel viruses.
IMPORTANCEVirus nucleic acid testing is the primary diagnostic method, particularly in the early stages of illness. Virus-specific or syndromic tests are widely used for this purpose. The use of generic primers has had a considerable impact on the discovery, identification, and detection of Old World sandfly-borne phleboviruses (OWSBP). The study is significant because it is the first to carry out a comparative evaluation of all published OWSBP generic primer sets.

Published in ASM/ Microbiology Spectrum

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Authors: Rafael Rocha, Cláudia Conceição, Luzia Gonçalves, Carla Maia

Abstract

Objective
To compare the current knowledge and practices regarding leishmaniasis among blood donors and health students and professionals, in Portugal.

Material and methods
Data were collected through the application of two questionnaires (one online and one in paper) with similar questions in two distinct cross-sectional independent studies, each targeting one of the groups. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics.

Results
In total, 3763 blood donors, 254 students and 232 professionals were included in the comparative analysis. Over 95% of students and professionals, but only around 70% of blood donors had previously heard of leishmaniasis. Over 90% of participants in each group admitted leishmaniasis affected animals, but only in the professional group over 90% were aware of human leishmaniasis.

Conclusions
Even though canine leishmaniasis is recognized by many blood donors and by most students and professionals, awareness of the disease in humans is less common, highlighting the importance of promoting an approach to this infection through a One Health lens.

Published in One Health

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Authors: Tarcisio de Freitas Milagres, Carla Maia

Abstract

Phlebotomus perniciosus, recognized as the most important phlebotomine sand fly vector in countries of the Western Mediterranean region, is responsible for transmitting the protozoan Leishmania infantum, the causative agent of zoonotic leishmaniasis. This species also serves as a vector for various phleboviruses, with the Toscana virus being the most clinically relevant, associated as one of the main causes of meningitis and encephalitis in this region. Detected in 22 countries, P. perniciosus has a broad distribution in countries located in the Western part of the Mediterranean basin. However, due to global changes, it is expected that it will expand its endemicity to currently non-endemic regions. In endemic areas, this species is usually considered the most abundant and predominant vector, except in colder and more humid regions. It can be found from May to November, with density trends that may vary with each endemic scenario, making its presence temporally heterogeneous.

Published in Trends in Parasitology

Authors: Rafael Rocha1,2,3, Cláudia Conceição1,2, Luzia Gonçalves1,2,4,5, LeishPT group and Carla Maia1,2

Abstract

Background: Leishmania infantum is endemic in the Mediterranean region, presenting mostly as visceral leishmaniasis (VL). In Portugal, reporting of VL cases to public health authorities is mandatory, but significant underreporting is likely. This study aimed to describe the epidemiological and clinical aspects of the VL cases diagnosed in hospitals of the Portuguese National Health Service (NHS), between 2010 and 2020.

Methods: Collaboration was requested to every hospital of the Portuguese NHS in Mainland Portugal. Cases were screened through a search of diagnostic discharge codes or, if not available, by a search of positive laboratory results for Leishmania infection. Sociodemographic and clinical data was retrieved from medical records. Simultaneously, the National Health authority was contacted to request access to data of notified cases of VL between 2010 and 2020. Descriptive, hypothesis testing and multiple binary logistic regression models were performed.

Results: A total of 221 VL cases were identified. A significant increase in estimated national incidence was seen in the years after 2016 (P = 0.030). VL was predominantly diagnosed in people living with HIV (PLWH) and in children (representing around 60% of the new cases), but the outcome was generally poorer in non-HIV patients with associated immunosuppression, with significantly lower rates of clinical improvement at 7 (P = 0.003) and 30 days (P = 0.008) after treatment. Atypical presentations, with gastrointestinal and/or respiratory involvement, were seen in 8.5% of VL cases. Hemophagocytic lymphohistiocytosis was diagnosed in 40.0% of children under 5 years of age. Only 49.7% of incident VL cases were reported. Simultaneous involvement of the skin was confirmed in 5.9% of patients.

Conclusions: VL presents a continuing threat in Portugal, especially to PLWH and children, and an increasing threat to other immunosuppressed groups. Recent increases in incidence should be closely monitored to allow prompt interventions. Programs to control the disease should focus on providing tools for earlier diagnosis and on reducing underreporting and promoting an integrated surveillance of human and animal disease. These data should be combined with asymptomatic infection and vector information, following a One Health approach.

Published in Trends in Parasitology

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Authors: Rafael Rocha, Cláudia Conceição, Luzia Gonçalves, LeishPT group: Ana Cláudia Carvalho, André Maia, André Martins, António Carujo, António Maio, Catarina Forra, Catarina Melita, Daniela Couto, Diana Fernandes, Dulce Pereira, Ema Leal, Helena Sarmento, Inês Sousa, Jean-Pierre Gonçalves, Joana Marinho, Joana Vasconcelos, João Cunha, João Rodrigues, José Miguel Silva, Lídia Caley, Luís Malheiro, Luís Santos, Margarida Garcia, Margarida Prata, Maria Cunha, Maria Lima, Maria Margarida Andrade, Marta Marques, Miguel Alpalhão, Mónica Silva, Rita Ferraz, Rui Soares, Salomão Fernandes, Samuel Llobet, Sofia Cruz, Teresa Guimarães, Tiago Branco, Tomás Robalo-Nunes, Vasco Almeida, Carla Maia

Abstract

Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.

Published in Microorganisms

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Authors: J. Risueño , S. Bersihand , C. Bender , T. Cornen , K. De Boer , A. Ibáñez-Justicia , D. Rey , Y. Rozier , A. Schneider , A. Stroo , A. Vanslembrouck , W. Van Bortel , A. Weigand , D. Zambianchi , P. Pérez Cutillas , S. Oerther , M. Braks , G.R.W. Wint , E. Berriatua , and F. Schaffner

Abstract

Sand flies are vectors of Leishmania spp. protozoa, phleboviruses and Bartonella bacilliformis. In this study we surveyed areas of central-western Europe, encompassing the northern limit of the known sand fly distribution, and investigated the relationship between their presence and environmental variables. In this area, very limited occurrence data exists, none of them recent. Sampling was performed in July and August 2023 using CDC-light traps, sticky traps and human landing captures, at 179 selected sites in 48 municipalities. A total of 55 sand fly specimens were collected at 11% (20/179) of the sites sampled – including 16 sites in France, 2 in Luxembourg and 1 in Germany – comprising the first published records for Luxembourg and the Trier-Saarburg County of Germany. No sand flies were detected in Belgium or in the Netherlands. Two species were captured: Phlebotomus mascittii (37 females, 2 males) and Ph. perniciosus (1 female, 15 males). The latter species was only found in Savoie, the southernmost region sampled in France, while the former species was detected as far north as latitude 50°N. Logistic regression modelling indicated that the probability of sand fly presence gradually decreased with increasing latitude and altitude (P < 0.05), and it was not associated to other analysed landscape features in the proximity of the traps. The study confirms and provides new evidence for the presence of sand flies in areas of Western Europe and highlights the need to be aware of potential autochthonous transmission of sand fly-borne pathogens in these areas.

Published in European Mosquito Control Association

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Authors: Kim R van Daalen, PhD Prof Cathryn Tonne, ScD Prof Jan C Semenza, PhD Prof Joacim Rocklöv, PhD Prof Anil Markandya, PhD Niheer Dasandi, PhD Prof Slava Jankin, PhD Hicham Achebak, PhD Joan Ballester, PhD Hannah Bechara, PhD Thessa M Beck, MSc Max W Callaghan, PhD Bruno M Carvalho, PhD Jonathan Chambers, PhD Marta Cirah Pradas, MSc Orin Courtenay, PhD Shouro Dasgupta, PhD Matthew J Eckelman, PhD Zia Farooq, MSc Peter Fransson, PhD Elisa Gallo, PhD Olga Gasparyan, PhD Nube Gonzalez-Reviriego, PhD Prof Ian Hamilton, PhD Risto Hänninen, DSc Charles Hatfield, MUP Kehan He, PhD Aleksandra Kazmierczak, PhD Vladimir Kendrovski, PhD Harry Kennard, PhD Gregor Kiesewetter, PhD Rostislav Kouznetsov, PhD Hedi Katre Kriit, PhD Alba Llabrés-Brustenga, PhD Simon J Lloyd, PhD Martín Lotto Batista, MSc Carla Maia, PhD Prof Jaime Martinez-Urtaza, PhD Zhifu Mi, PhD Carles Milà, MSc Jan C Minx, PhD Prof Mark Nieuwenhuijsen, PhD Julia Palamarchuk, PhD Dafni Kalatzi Pantera, PhD Marcos Quijal-Zamorano, MSc Peter Rafaj, PhD Prof Elizabeth J Z Robinson, PhD Nacho Sánchez-Valdivia, MSc Daniel Scamman, EngD Oliver Schmoll, Dipl.-Ing Maquins Odhiambo Sewe, PhD Jodi D Sherman, MD Pratik Singh, MSc Elena Sirotkina, MA Henrik Sjödin, PhD Prof Mikhail Sofiev, PhD Balakrishnan Solaraju-Murali, PhD Prof Marco Springmann, PhD Marina Treskova, PhD Joaquin Triñanes, PhD Eline Vanuytrecht, PhD Fabian Wagner, PhD Maria Walawender, PhD Laura Warnecke, PhD Ran Zhang, MSc Marina Romanello, PhD Prof Josep M Antó, PhD Prof Maria Nilsson, PhD Prof Rachel Lowe,

Abstract

Record-breaking temperatures were recorded across the globe in 2023. Without climate action, adverse climate-related health impacts are expected to worsen worldwide, affecting billions of people. Temperatures in Europe are warming at twice the rate of the global average, threatening the health of populations across the continent and leading to unnecessary loss of life. The Lancet Countdown in Europe was established in 2021, to assess the health profile of climate change aiming to stimulate European social and political will to implement rapid health-responsive climate mitigation and adaptation actions. In 2022, the collaboration published its indicator report, tracking progress on health and climate change via 33 indicators and across five domains.
This new report tracks 42 indicators highlighting the negative impacts of climate change on human health, the delayed climate action of European countries, and the missed opportunities to protect or improve health with health-responsive climate action. The methods behind indicators presented in the 2022 report have been improved, and nine new indicators have been added, covering leishmaniasis, ticks, food security, health-care emissions, production and consumption-based emissions, clean energy investment, and scientific, political, and media engagement with climate and health. Considering that negative climate-related health impacts and the responsibility for climate change are not equal at the regional and global levels, this report also endeavours to reflect on aspects of inequality and justice by highlighting at-risk groups within Europe and Europe’s responsibility for the climate crisis.

Published in The Lancet

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Authors:

Bruno M. Carvalho, Carla Maia, Orin Courtenay, Alba Llabrés-Brustenga, Martín Lotto Batista, Giovenale Moirano, Kim R. van Daalen, Jan C. Semenza, Rachel Lowe.

Abstract

Published in The Lancet

Authors:

Abstract

Global changes in climate are contributing to modified Phlebotomine sand fly presence and activity, and the distribution of the pathogens they transmit (e.g., Leishmania and Phlebovirus), and are leading to their possible extension toward northern France. To predict the evolution of these pathogens and control their spread, it is essential to identify and characterize the presence and abundance of potential vectors. However, there are no recent publications describing sand fly species distribution in France. Consequently, we carried out a systematic review to provide distri- bution and abundance maps over time, along with a simplified dichotomous key for species in France. The review adhered to PRISMA guidelines, resulting in 172 relevant capture reports from 168 studies out of the 2646 documents retrieved, of which 552 were read and 228 analyzed. Seven species were recorded and categorized into three groups based on their abundance: low abundance species, abundant but little-studied species, and abundant vector species. Sand flies are certainly present throughout France but there is a greater diversity of species in the Mediterranean region. Phlebotomus perniciosus and Ph. ariasi are the most abundant and widely distributed species, playing a role as vectors of Leishmania. Sergentomyia minuta, though very abundant, remains under-studied, highlighting the need for further research. Phlebotomus papatasi, Ph. perfiliewi, Ph. sergenti, and Ph. mascittii are present in low numbers and are less documented, limiting understanding of their potential role as vectors. This work provides the necessary basis for comparison of field data generated in the future.

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