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      Demographic characteristics and prevalence of asymptomatic Leishmania donovani infection in migrant workers working in an endemic area in Northwest Ethiopia

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          Abstract

          Introduction

          Visceral leishmaniasis (VL), a neglected tropical disease that causes substantial morbidity and mortality, is a serious health problem in Ethiopia. Infections are caused by Leishmania ( L.) donovani parasites. Most individuals remain asymptomatic, but some develop VL, which is generally fatal if not treated. We identified the area of Metema-Humera in Northwest Ethiopia as a setting in which we could follow migrant workers when they arrived in an endemic area. The demographic characteristics of this population and factors associated with their risk of asymptomatic infection are poorly characterised.

          Methods

          We divided our cohort into individuals who visited this area for the first time (first comers, FC) and those who had already been in this area (repeat comers, RC). We followed them from the beginning (Time 1, T1) to the end of the agricultural season (Time 2, T2), performing tests for sand fly bite exposure (anti-sand fly saliva antibody ELISA) and serology for Leishmania infection (rK39 rapid diagnostic test and the direct agglutination test) at each time point and collecting information on risk factors for infection.

          Results

          Our results show that most migrant workers come from non-endemic areas, are male, young (median age of 20 years) and are farmers or students. At T1, >80% of them had been already exposed to sand fly bites, as shown by the presence of anti-saliva antibodies. However, due to seasonality of sand flies there was no difference in exposure between FC and RC, or between T1 and T2. The serology data showed that at T1, but not at T2, a significantly higher proportion of RC were asymptomatic. Furthermore, 28.6% of FC became asymptomatic between T1 and T2. Over the duration of this study, one FC and one RC developed VL. In multivariable logistic regression of asymptomatic infection at T1, only age and the number of visits to Metema/Humera were significantly associated with asymptomatic infection.

          Conclusion

          A better understanding of the dynamics of parasite transmission and the risk factors associated with the development of asymptomatic infections and potentially VL will be essential for the development of new strategies to prevent leishmaniasis.

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          Most cited references74

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                Author and article information

                Contributors
                Mulat Yimer: Role: Role: Role:
                Yegnasew Takele: Role: Role: Role: Role:
                Endalew Yizengaw: Role: Role: Role: URI : https://loop.frontiersin.org/people/383890/overview
                Endalkachew Nibret: URI : https://loop.frontiersin.org/people/2291718/overviewRole: Role:
                Petra Sumova: Role: Role: Role: URI : https://loop.frontiersin.org/people/1021092/overview
                Petr Volf: URI : https://loop.frontiersin.org/people/48113/overviewRole: Role: Role: Role:
                Gizachew Yismaw: Role: Role:
                Michael Alehegn: Role: Role:
                Aileen Rowan: URI : https://loop.frontiersin.org/people/859538/overviewRole: Role: Role: Role: Role:
                Ingrid Müller: Role: Role: Role: Role: URI : https://loop.frontiersin.org/people/383629/overview
                James A. Cotton: URI : https://loop.frontiersin.org/people/103722/overviewRole: Role: Role: Role: Role: Role: Role:
                Lloyd A. C. Chapman: URI : https://loop.frontiersin.org/people/1233131/overviewRole: Role: Role: Role: Role: Role: Role:
                Pascale Kropf: URI : https://loop.frontiersin.org/people/229995/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role: Role:
                Journal
                Journal ID (nlm-ta): Front Epidemiol
                Journal ID (iso-abbrev): Front Epidemiol
                Journal ID (publisher-id): Front. Epidemiol.
                Title: Frontiers in Epidemiology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2674-1199
                Publication date (Electronic): 09 April 2024
                Publication date Collection: 2024
                Volume: 4
                Electronic Location Identifier: 1367387
                Affiliations
                [ 1 ]Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University , Bahir Dar, Ethiopia
                [ 2 ]Amhara Public Health Institute , Bahir Dar, Ethiopia
                [ 3 ]Department of Infectious Disease, Imperial College London , London, United Kingdom
                [ 4 ]Institute of Biotechnology, Bahir Dar University , Bahir Dar, Ethiopia
                [ 5 ]Department of Biology, College of Science, Bahir Dar University , Bahir Dar, Ethiopia
                [ 6 ]Department of Parasitology, Faculty of Science, Charles University , Prague, Czechia
                [ 7 ]School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow, United Kingdom
                [ 8 ]Department of Mathematics and Statistics, Lancaster University , Lancaster, United Kingdom
                Author notes

                Edited by: Ruchi Singh, National Institute of Pathology (ICMR), India

                Reviewed by: Sumi Mukhopadhyay, Calcutta School of Tropical Medicine, India

                Jean Limongi, Federal University of Uberlandia, Brazil

                [* ] Correspondence: Lloyd A. C. Chapman l.chapman4@ 123456lancaster.ac.uk Pascale Kropf p.kropf@ 123456imperial.ac.uk
                [ † ]

                These authors have contributed equally to this work and share first authorship

                [ ‡ ]

                These authors share last authorship

                [ § ]

                Present Addresses: Yegnasew Takele, Department of Comprehensive Cancer Centre, King's College London, London, United Kingdom

                Article
                DOI: 10.3389/fepid.2024.1367387
                PMC ID: 11035784
                PubMed ID: 38655403
                SO-VID: 00af4821-b881-4722-bd63-2bfec76f0866
                Copyright © © 2024 Yimer, Takele, Yizengaw, Nibret, Sumova, Volf, Yismaw, Alehegn, Rowan, Müller, Cotton, Chapman and Kropf.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 08 January 2024
                Date accepted : 26 March 2024
                Page count
                Figures: 4, Tables: 8, Equations: 0, References: 77, Pages: 0, Words: 0
                Funding
                Funded by: UK Medical Research Council (MRC) and the Foreign Commonwealth and Development Office (FCDO) under the MRC/FCDO Concordat agreement
                Award ID: MR/R021600/1
                Funded by: ERD funds
                Award ID: 16_019/0000759
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article.
                This research is jointly funded by the UK Medical Research Council (MRC) and the Foreign Commonwealth and Development Office (FCDO) under the MRC/FCDO Concordat agreement (MR/R021600/1) (MY, EY, JAC, LACC, PK). PS and PV were supported by ERD funds, project CeRaViP (16_019/0000759).
                Categories
                Subject: Epidemiology
                Subject: Original Research
                Custom metadata
                section-at-acceptance Infectious Disease Epidemiology

                Keywords: leishmania,asymptomatic,visceral leishmaniasis,rk39,direct agglutination test,pcr,risk factors
                Data availability:
                Keywords: leishmania, asymptomatic, visceral leishmaniasis, rk39, direct agglutination test, pcr, risk factors

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