Identification of Leishmania species in naturally infected sand flies from refugee camps, Greece

Authors: FOTAKIS, E - AGRICULTURAL UNIVERSITY OF ATHENS; GIANTSIS, I - ARISTOTLE UNIVERSITY OF THESSALONIKI; AVGERINOU, A - ARISTOTLE UNIVERSITY OF THESSALONIKI; KOURTIDIS, S - GENERAL DIRECTORATE OF PUBLIC HEALTH AND SOCIAL WELFARE, REGION OF CENTRAL MACEDONIA; AGATHAGGELIDOU, E - GENERAL DIRECTORATE OF PUBLIC HEALTH AND SOCIAL WELFARE, REGION OF CENTRAL MACEDONIA; KAPOULA, C - GENERAL DIRECTORATE OF PUBLIC HEALTH AND SOCIAL WELFARE, REGION OF CENTRAL MACEDONIA; DADAKOU, G - GENERAL DIRECTORATE OF PUBLIC HEALTH AND SOCIAL WELFARE, REGION OF CENTRAL MACEDONIA; VONTAS, J - AGRICULTURAL UNIVERSITY OF ATHENS; CHASKOPOULOU, ALEXANDRA - EUROPEAN BIOLOGICAL CONTROL LABORATORY (EBCL)

Submitted to: Emerging Infectious Diseases
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/15/2018
Publication Date: 2/1/2019
Citation: Fotakis, E.A., Giantsis, I.A., Avgerinou, A., Kourtidis, S., Agathaggelidou, E., Kapoula, C., Dadakou, G., Vontas, J., Chaskopoulou, A. 2019. Identification of Leishmania species in naturally infected sand flies from refugee camps, Greece. Emerging Infectious Diseases. 25(2):361-364. https://dx.doi.org/10.3201/eid2502.181359.
DOI: https://doi.org/10.3201/eid2502.181359

Interpretive Summary: Leishmaniasis is a parasitic disease caused by protozoans of the genus Leishmania and is transmitted by sand flies of the genus Phlebotomus. Worldwide, 350 million people are at risk of becoming infected, with about 2 million new cases reported every year. Even though leishmaniasis is not common in the United States (occasional cases have been acquired in Oklahoma and Texas), the disease constitutes a major threat to the US military during their overseas operations. An emerging problem regarding leishmaniasis control in Europe is the introduction and establishment of new leishmania species, such as L. donovani and L. tropica, through travellers, refugees and immigrants from countries endemic to non-European species. L. tropica, causes skin lesions that can persist for months or years and L. donovani causes the most severe form of the disease, which affects the internal organs and is associated with high fatality if left untreated. To address this concern a pathogen surveillance program was initiated targeting temporary refugee settlements in Greece. Through this study we a) detected L. tropica and L. donovani in natural populations of sand flies at high frequencies for the first time in Europe, b) provided important new evidence on the vector competence of the European sand fly species and c) validated the concerns for the introduction of exotic Leishmania species in Europe. The timely detection and treatment of the disease in parallel with the establishment of integrated vector management strategies will be a necessary step for the protection of public health and for preventing the spread of these exotic parasites.

Technical Abstract: Two species of Leishmania parasites, L. donovani and L. tropica, were detected in sand flies collected from two refugee camps in Thessaloniki, Greece. All of the pools tested were found positive for either one or both leishmania species. Furthermore, L. donovani and L. tropica, were detected in dissected heads of the 3 prevalent sand fly species (Phlebotomus perfiliewi, P. tobbi, P. simici) indicating late-stage, transmissible infection. This is the first time that these 2 parasites are reported in Europe in naturally occurring sand flies and the high frequency of infection indicates increased levels of pathogen transmission within the refugee accommodation sites. Systematic detection and treatment of the disease, health education of the community and establishment of targeted vector control are essential steps for protecting public health in these settlements and the surrounding communities as well as to avert the colonization of the local sand flies by exotic Leishmania species.