The risk of imported malaria in security forces personnel returning from overseas missions in the context of prevention of re-introduction of malaria to Sri Lanka

Fernando, Sumadhya Deepika; Dharmawardana, Priyani; Semege, Saveen; Epasinghe, Geetha; Senanayake, Niroshana; Rodrigo, Chaturaka; Premaratne, Risintha

doi:10.1186/s12936-016-1204-y

Cited by 22 publications

(25 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 99%

“…Sri Lankan military personnel are routinely deployed in Leishmania -endemic countries as part of UN peace keeping missions and returning soldiers are a known risk factor for importing parasitic diseases 47 . Indeed, chemoprophylaxis and screening against Malaria upon returning from a mission is routine as part of Sri Lanka personnel deployments in countries such as Sudan 47 . As argued within this and other studies 24–26 , the genetic evidence argues there have been multiple sources of L. donovani entry into Sri Lanka, yet there is no visceral disease and atypical cutaneous leishmaniasis has successfully propagated 20 .…”

Section: Discussionmentioning

confidence: 99%

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Evidence that interspecies Leishmania hybrids contribute to changes in disease pathology

Lypaczewski

Matlashewski

2020

Preprint

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AbstractBackgroundLeishmaniasis is a widespread neglected tropical disease present in over 90 countries with diverse pathologies associated with different species of Leishmania parasites transmitted by infected sand flies. Leishmania donovani causes visceral leishmaniasis, a highly virulent fatal infection of the visceral organs. Leishmania major and Leishmania tropica cause less virulent cutaneous leishmaniasis where the infection remains in the skin at the site of the sandfly bite. A major molecular epidemiological question is why some variants of L. donovani in Sri Lanka cause cutaneous disease rather than the typical visceral disease.MethodsWhole genome sequencing data for 684 L. donovani samples was used to perform sequence alignments and worldwide phylogenetic analyses to determine the source of the atypical L. donovani strains from Sri Lanka. L. donovani genome sequences originating from Sri Lanka were further analyzed for evidence of hybridization with other Leishmania species by determining the density of heterozygous alleles. Polymorphisms from potential Leishmania hybrids were used to reconstruct the parental genetic sequences to identify the potential parental species and quantify their genetic contribution through sequence comparison of the reconstructed parental sequences with all Old World Leishmania genomes.FindingsHere we show that L. donovani in Sri Lanka contains genes with widespread gene polymorphisms derived from African L. major and L. tropica genomes that were likely obtained as a result of diploid genome hybridization and recombination resulting in progeny with mosaic genomes. Furthermore, evidence is presented that multiple L. donovani hybrid parasites originating from visceral leishmaniasis endemic Africa have entered Sri Lanka yet visceral leishmaniasis remains non-existent raising the possibility that environmental factors favour the establishment of atypical L. donovani strains in Sri Lanka.InterpretationThe discovery of L. major and L. tropica genome sequences in L. donovani provides a compelling rationale how some L. donovani strains in Sri Lanka may be able to cause cutaneous rather than visceral leishmaniasis. The identification of L. donovani hybrid parasites in cutaneous leishmaniasis lesions provides a unique opportunity to investigate environmental and parasite genetic factors controlling disease epidemiology and pathogenesis.FundingCanadian Institutes of Health Research and Fonds de recherche du Québec – SantéResearch in contextEvidence before this studyDifferent Leishmania species parasites cause either benign cutaneous leishmaniasis or fatal visceral leishmaniasis. It is unknown why some variants of Leishmania donovani that typically causes visceral leishmaniasis in Asia and Africa can cause cutaneous leishmaniasis in specific geographic locations including Sri Lanka. Leishmania has a diploid genome and hybrid parasites have been identified in nature and generated experimentally. In the context of this study, hybrids are considered to be progeny derived from a single outcross event between two diverse parents. Uncertainty remains whether interspecies hybrids with visceral and cutaneous leishmaniasis causing species in nature are associated with different disease outcomes.Added value of this studyEvidence for genetic hybridization between visceral and cutaneous disease causing Leishmania species is described from Sri Lanka where cutaneous leishmaniasis is highly endemic yet there is no ongoing visceral leishmaniasis transmission. This provides a potential explanation how L. donovani can become attenuated for visceral disease and could help to identify geographic environmental factors associated with selection for parasite attenuation.Implications of all the available evidenceHybrid Leishmania parasites may be one source of atypical cutaneous leishmaniasis. Epidemiological studies are needed to determine why diverse L. donovani hybrid parasites have become ubiquitous in specific geographic locations where the incidence of cutaneous leishmaniasis is increasing. This has implications for understanding the genetic control of disease pathogenesis and for the prevention of cutaneous or visceral leishmaniasis locally and in neighboring countries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evidence that interspecies Leishmania hybrids contribute to changes in disease pathology

Lypaczewski

Matlashewski

2020

Preprint

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“…These surveys should be conducted in conjunction with entomological surveys to assess vector-specific risk behaviours. Additionally, targeted sentinel surveillance—i.e., data collection at existing services or programmes where a target population can be conveniently accessed—could be implemented at locations that serve or employ high-risk populations, such as clinics at military bases, logging and mining camps, or by screening returning foreign workers and migrant laborers at border checkpoints and agricultural and other worksites, as has been piloted in some settings [41, 57]. …”

Section: Introductionmentioning

confidence: 99%

Surveillance and response for high-risk populations: what can malaria elimination programmes learn from the experience of HIV?

Jacobson

Cueto

Smith

et al. 2017

Malar J

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To eliminate malaria, malaria programmes need to develop new strategies for surveillance and response appropriate for the changing epidemiology that accompanies transmission decline, in which transmission is increasingly driven by population subgroups whose behaviours place them at increased exposure. Conventional tools of malaria surveillance and response are likely not sufficient in many elimination settings for accessing high-risk population subgroups, such as mobile and migrant populations (MMPs), given their greater likelihood of asymptomatic infections, illegal risk behaviours, limited access to public health facilities, and high mobility including extended periods travelling away from home. More adaptive, targeted strategies are needed to monitor transmission and intervention coverage effectively in these groups. Much can be learned from HIV programmes’ experience with “second generation surveillance”, including how to rapidly adapt surveillance and response strategies to changing transmission patterns, biological and behavioural surveys that utilize targeted sampling methods for specific behavioural subgroups, and methods for population size estimation. This paper reviews the strategies employed effectively for HIV programmes and offers considerations and recommendations for adapting them to the malaria elimination context.

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“…21,22 In the era of malaria elimination, the knowledge and practices of health professionals and travelers regarding chemoprophylaxis are important for preventing the reintroduction of malaria. 23 Travel to malaria-endemic regions requires specific preparation to avoid illness. A primary care doctor might serve the aforementioned task, but constantly changing and highly specialized information renders a dedicated travel medicine expert more likely to succeed in handling the individual needs of different travelers as well as their unique travel itineraries.…”

mentioning

confidence: 99%

Malaria Chemoprophylaxis for Travelers: The Knowledge of Physicians in the State of Qatar, 2017

Bawazir

Bansal

Chehab

et al. 2018

Int J Travel Med Glob Health

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Introduction Malaria is the world's most widely spread febrile illness. Globally, around 302 million people are at risk of malaria, with 216 million new cases and 445 000 deaths (compared to 446,000 deaths in 2015) attributed to malaria annually. The African region contributed 91% of global malaria cases followed by the Southeast Asian (6%) and Eastern Mediterranean regions (2%). The majority of deaths occur among young children, pregnant women, non-immune travelers, refugees, displaced persons, and laborers traveling to endemic areas. 1 Moreover, it is well known that those visiting friends and relatives (VFR) are at high risk of malaria as they are less likely to use chemoprophylaxis. 2 Imported malaria is currently one of the major threats to the significant achievement of global malaria control, 3 which has led to a substantial reduction in morbidity and mortality in high transmission areas and interruption of transmission in low transmission areas. Though indigenous transmission of malaria has been eliminated in most of the Gulf Cooperation Council (GCC) countries, a large number of imported malaria cases occur, especially among the sizeable migrant workforces in these countries. 4 The majority of these workers come from the Indian subcontinent, while the remaining cases are from sub-Saharan African countries, including Sudan, Ethiopia, http://ijtmgh.com

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The risk of imported malaria in security forces personnel returning from overseas missions in the context of prevention of re-introduction of malaria to Sri Lanka

Cited by 22 publications

References 22 publications

Evidence that interspecies Leishmania hybrids contribute to changes in disease pathology

Evidence that interspecies Leishmania hybrids contribute to changes in disease pathology

Surveillance and response for high-risk populations: what can malaria elimination programmes learn from the experience of HIV?

Malaria Chemoprophylaxis for Travelers: The Knowledge of Physicians in the State of Qatar, 2017

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