LeishEpiNetSA - Control strategies for visceral leishmaniasis (VL) and mucocutaneous leishmaniasis (MCL) in South America: applications of molecular epidemiology

Background:

Molecular epidemiology and population genetics can resolve the diversity and structure of Leishmania populations, for example the intricate relationships between clinical forms of human infection and mammal reservoirs. Research will involve comparative investigations between endemic areas for VL and MCL in Paraguay, Peru, Brazil and Venezuela and will strengthen local capacities for research and for Latin American-European collaborations. The technical aim is to develop a full range of microsatellite markers and multi-locus sequencing typing (MLST) of housekeeping genes for the Leishmania braziliensis complex and for L guyanensis. We will also establish in South America the procedures for microsatellite and MLST analysis for L. infantum, which have been developed and proven as epidemiological tools by a European network. The practical aims are to encourage the application of these and other molecular epidemiological methods in South America for 1. elucidating parasite-vector-host relationships 2. assessing the epidemiological impact of VL-HIV co-infection (Brazil) 3. assessing the epidemiological importance of recombinant Leishmania genotypes and 4. assessing the spread of resistance against first line treatment (SbV). In addition, we will compare genotypes of a) Leishmania isolated from diverse clinical cases of leishmaniasis and b) drug susceptible and drug-resistant strains. The project will be undertaken in the context of an investigation of present understanding and intervention strategies among health professionals, defining how best to introduce project outputs into improved control. An accessible South American repository for Leishmania will be established, incorporating an existing collection, new isolates and representatives from other endemic regions.

Problem:

The Leishmania are single-celled parasites, which cause diseases of humans and dogs and are transmitted by sand flies. In South America, the subgenus Viannia causes cutaneous (CL) or severe mucocutaneous leishmaniasis (MCL). In Europe and South America, L. (L.) infantum causes fatal visceral leishmaniasis (VL). A full and detailed understanding of the transmission cycles and molecular epidemiology of visceral leishmaniasis (VL) and mucocutaneous leishmaniasis (MCL) is necessary to develop disease control and surveillance.

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