Abstract
Objectives
To investigate the proportion of asymptomatic infection among blood donors in a region endemic for Leishmania; and to ascertain epidemiological and genetic factors associated with this condition.
Methods
We studied 1260 blood donors in the Province of Granada in the Southern Spain. After obtaining informed consent in each participant, a poll about habits, housing and contact with animals were carried out. Blood samples were obtained for determining antileishmanial antibodies and a PCR assay. HLA typing was performed in a randomly sample among the donors with positive serology.
Results
We have found that L. infantum antibodies were present in 7.9% of blood donors and DNA in blood was detected in 2.5% of donors. There was no concordance between both determinations, except in one patient. Taking into consideration both techniques, 129 participants were considered to have asymptomatic Leishmania infection. No participant in this study developed clinical leishmaniasis during a follow-up period of 2 years. HLA were typed in 51 donors. Asymptomatic Leishmania infection might be associated with certain HLA antigens. A multivariate analysis was done with the variables obtained through the participants’ interview. The contact with livestock (goats, pigs, and sheep), but not dogs, either at home or in the environment, was significantly and independently associated with asymptomatic leishmania infection.
Conclusions
Asymptomatic leishmanial infection among blood donors is frequent in the Granada Province, south of Spain. The presence of livestock in this region is related to this infection, perhaps influencing vector density of this disease. Some HLA genes might be associated with asymptomatic leishmanial state.
Similar content being viewed by others
References
Ready PD. Leishmaniasis emergence in Europe. Euro Surveill. 2010;15:19505.
Alvar J, Vélez ID, Bern C, Herrero M, Desjeux P, Cano J, et al. Leishmaniasis Worldwide and global estimates of its incidence. PLoS One. 2012;7:e35671. https://doi.org/10.1371/journal.pone0035671.
Magill AJ. Leishmania species: visceral (Kala-Azar), cutaneous, and mucosal leishmaniasis. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier/Saunders; 2015. p. 3091–107.e4.
Murray HW, Berman HD, Saravia NG. Advances in leishmaniasis. Lancet. 2005;366:1561–77.
Le Fichoux Y, Quaranta JF, Aufeuvre JP, Lelievre A, Marty P, Suffia I, et al. Occurrence of Leishmania infantum cryptic parasitemia in asymptomatic blood donors living in an area of endemicity in Southern France. J Clin Microbiol. 1999;37:1953–7.
Riera C, Fisa R, Udina M, Gallego M, Portus M. Detection of Leishmania infantum cryptic infection in asymptomatic blood donors living in an endemic area (Eivissa, Balearic Islands, Spain) by different diagnostic methods. Trans R Soc Trop Med Hyg. 2004;98:102–10.
Riera C, Fisa R, López-Chejade P, Serra T, Girona E, Jiménez T, et al. Asymptomatic infection by Leishmania infantum in blood donors from the Balearic Islands (Spain). Transfusion. 2008;48:1383–9.
Pérez-Cutillas P, Goyena E, Chitimia L, De la Rúa P, Bernal LJ, Fisa R, et al. Spatial distribution of human asymptomatic Leishmania infantum infection in southeast Spain: a study of environmental, demographic and social risk factors. Acta Trop. 2015;146:127–34.
Jimenez-Marco T, Riera C, Girona-Llobera E, Guillen C, Iniesta L, Alcover M, et al. Strategies for reducing the risk of transfusion-transmitted leishmaniasis in an area endemic for Leishmania infantum: a patient- and donor-targeted approach. Blood Transfus. 2018;16:130–6.
Singh OP, Hasker E, Sacks D, Boelaert M, Sundar S. Asymptomatic Leishmania infection: A new challenge for Leishmania control. Clin Infect Dis. 2014;58:1424–9.
Merino-Espinosa G, Corpas-López V, Díaz-Sáez V, Morillas-Márquez F, Tercedor-Sánchez J, Azaña-Defez JM, et al. Cutaneous leishmaniasis by Leishmania infantum: behind granulomatous lesions of unknown aetiology. J Eur Acad Dermatol Venereol. 2018;32:117–24.
Martín-Sánchez J, López-López MC, Acedo-Sánchez C, Castro-Fajardo JJ, Pineda JA, Morillas-Márquez F. Diagnosis of infections with Leishmania infantum using PCR-ELISA. Parasitology. 2001;122:607–15.
França AdO, Pompilio MA, Pontes ERJC, De Oliveira MP, Pereira LOR, Lima RB, et al. Leishmania infection in blood donors: a new challenge in leishmaniasis transmission? PLoS One. 2018;13:e0198199.
Martín-Sánchez J, Pineda JA, Morillas-Márquez F, García-García JA, Acedo C, Macías J. Detection of Leishmania infantum kinetoplast DNA in peripheral blood from asymptomatic individuals at risk for parenterally transmitted infections: relationship between polymerase chain reaction results and other Leishmania infection markers. Am J Trop Med Hyg. 2004;70:545–8.
Elmahallawy EK, Cuadros-Moronta E, Liébana-Martos MC, Rodríguez-Granger J, Sampedro-Martínez A, Agil A, et al. Seroprevalence of Leishmania infection among asymptomatic renal transplant recipients from southern Spain. Transpl Infect Dis. 2015;17:795–9.
Moreno EC, Gonçalves AV, Chaves AV, Melo MN, Lambertucci JR, Andrade ASR, et al. Inaccuracy of enzyme-linked immunosorbent assay using soluble and recombinant antigens to detect asymptomatic infection by Leishmania infantum. PLoS Negl Trop Dis. 2009;3:e536.
Michel G, Pomares C, Ferrua B, Marty P. Importance of worldwide asymptomatic carriers of Leishmania infantum (L. chagasi) in human. Acta Trop. 2011;119:69–75.
Maritati M, Trentini A, Michel G, Bellini T, Almugadam S, Hanau S, et al. Subclinical Leishmania infection in patients with rheumatic diseases under biological drugs. Infection. 2018;46:801–9.
Jiménez-Marco T, Fisa R, Girona-Llobera E, Cancino-Faure B, Tomás-Pérez M, Berenguer D, et al. Transfusion-transmitted leishmaniasis: a practical review. Transfusion. 2016;56:45–51.
Singh T, Fakiola M, Oomen J, Singh AP, Singh AK, Smith N, et al. Epitope-binding characteristics for risk versus protective DRB1 alleles for visceral leishmaniasis. J Immunol. 2018;200:2727–37.
Fakiola M, Strange A, Cordell HJ, Miller EN, Pirinen M, Su Z, et al. Common variants in the HLA-DRB1-HLA-DQA1 class II region are associated with susceptibility to visceral leishmaniasis. Nat Genet. 2013;45:208–13.
Bern C, Joshi AB, Jha SN, Das ML, Hightower A, Thakur GD, et al. Factors associated with visceral leishmaniasis in Nepal: bed-net use is strongly protective. Am J Trop Med Hyg. 2000;63:184–8.
Barnett PG, Singh SP, Bern C, Hightower AW, Sundar S. Virgin soil: the spread of visceral leishmaniasis into Uttar Pradesh, India. Am J Trop Med Hyg. 2005;73:720–5.
Bern C, Haque R, Chowdhury R, Ali M, Kurkjiam DM, Vaz L. et. al. The epidemiology of visceral leishmaniasis and asymptomatic leishmanial infection in a highly endemic Bangladeshi village. Am J Trop Med Hyg. 2007;76:129–32.
Gijón-Robles P, Abattouy N, Merino-Espinosa G, El Khalfaoui N, Morillas-Márquez F, Corpas-López V, et al. Risk factors for the expansion of cutaneous leishmaniasis by Leishmania tropica: possible implications for control programmes. Transbound Emerg Dis 2018. https://doi.org/10.1111/tbed.12914.
Jacobson RL. Leishmania tropica (Kinetoplastida: Trypanosomatidae)—a perplexing parasite. Folia Parasitol (Praha). 2003;50:241–50.
Acknowledgements
The authors express their gratitude for the blood donors who kindly agreed to participate in the study and to the Centro Regional de Transfusión Sanguínea de Granada for its invaluable cooperation. We would like to thank Dr. Maite Miranda for her assistance in statistical analysis as well as to Mr Tom Stoelers for his English correction of the manuscript.
Funding
This work was supported by grant from the Fondo de Investigación Sanitaria (FIS) del Instituto de Salud Carlos III (Spain) (Expediente Nº PI14/01024).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they no competing interest.
Rights and permissions
About this article
Cite this article
Aliaga, L., Ceballos, J., Sampedro, A. et al. Asymptomatic Leishmania infection in blood donors from the Southern of Spain. Infection 47, 739–747 (2019). https://doi.org/10.1007/s15010-019-01297-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-019-01297-3