Macroecological patterns of American Cutaneous Leishmaniasis transmission across the health areas of Panamá (1980-2012)

The effect of El Niño and La Niña episodes on the existing niche and potential distribution of vector and host species of American Cutaneous Leishmaniasis

Leishmaniasis is a zoonotic disease transmitted to humans by a protozoan parasite through sandfly vectors and multiple vertebrate hosts. The Pan American Health Organization reported a declining trend in cases, with Brazil, Colombia, Peru, Nicaragua, and Bolivia having the most cases in 2020. There are still knowledge gaps in transmission and the parasite-host relationship. Ecological niche modeling has been used to study host-vector relationships, disease dynamics, and the impact of climate change. Understanding these aspects can aid in early surveillance and vector control strategies. The potential distribution of five host species associated with the transmission of cutaneous leishmaniasis (CL) was modeled. Occurrence data were collected for each host species, and environmental variables were used to build the models. Climatic data from El Niño, La Niña, and Neutral episodes were used to compare the predicted distributions. Additionally, the potential distributions of four vector species were compared to identify overlaps with host species. Niche analysis was conducted to evaluate changes in vector niches across episodes and to identify host-vector pairs based on niche overlap in geographic and environmental spaces. After spatial thinning, 467 records were obtained, and 1,190 candidate models were evaluated for each species. Results showed the distribution of occurrences in the environmental space, highlighting a high risk of extrapolation beyond the calibration areas. Movement-Oriented Parity analysis revealed distinct distribution patterns under different climate conditions, with areas of environmental similarity identified. Bradypus variegatus exhibited a broad potential distribution, while Dasypus novemcinctus and Didelphis marsupialis had more restricted ranges. Sylvilagus braziliensis covered most of the Neotropics. Our study provides valuable insights into ecological niches and geographic ranges of these species, contributing to the understanding of cutaneous leishmaniasis transmission dynamics.

The bibliometric landscape of infectious disease research in Panama (1990-2019)

Background

This work aims to analyze the landscape of scientific publications on subjects related to One Health and infectious diseases in Panama. The research questions are: How does the One Health research landscape look like in Panama? Are historical research efforts aligned with the One Health concept? What infectious diseases have received more attention from the local scientific community since 1990?

Methods

Boolean searches on the Web of Science, SCOPUS and PubMed were undertaken to evaluate the main trends of publications related to One Health and infectious disease research in the country of Panama, between 1990 and 2019.

Results

4546 publications were identified since 1990, including 3564 peer-reviewed articles interconnected with One Health related descriptors, and 211 articles focused particularly on infectious diseases. A pattern of exponential growth in the number of publications with various contributions from Panamanian institutions was observed. The rate of multidisciplinary research was moderate, whereas those of interinstitutional and intersectoral research ranged from low to very low. Research efforts have centered largely on protozoan, neglected and arthropod-borne diseases with a strong emphasis on malaria, Chagas and leishmaniasis.

Conclusion

Panama has scientific capabilities on One Health to tackle future infectious disease threats, but the official collaboration schemes and strategic investment to develop further competencies need to be conciliated with modern times, aka the pandemics era. The main proposition here, addressed to the government of Panama, is to launch a One Health regional center to promote multidisciplinary, interinstitutional and intersectoral research activities in Panama and beyond.

Insights into the Genetic Diversity of Leishmania (Viannia) panamensis in Panama, Inferred via Multilocus Sequence Typing (MLST)

Leishmaniasis is a disease caused by parasites of the genus Leishmania and transmitted by sand fly vectors. Tegumentary leishmaniasis is the most prevalent clinical outcome in Latin America, afflicting people from 18 countries. In Panama, the annual incidence rate of leishmaniasis is as high as 3000 cases, representing a major public health problem. In endemic regions, L. panamensis is responsible for almost eighty percent of human cases that present different clinical outcomes. These differences in disease outcomes could be the result of the local interplay between L. panamensis variants and human hosts with different genetic backgrounds. The genetic diversity of L. panamensis in Panama has only been partially explored, and the variability reported for this species is based on few studies restricted to small populations and/or with poor resolutive markers at low taxonomic levels. Accordingly, in this study, we explored the genetic diversity of sixty-nine L. panamensis isolates from different endemic regions of Panama, using an MLST approach based on four housekeeping genes (Aconitase, ALAT, GPI and HSP70). Two to seven haplotypes per locus were identified, and regional differences in the genetic diversity of L. panamensis were observed. A genotype analysis evidenced the circulation of thirteen L. panamensis genotypes, a fact that might have important implications for the local control of the disease.

Land reversion and zoonotic spillover risk

Deforestation alters wildlife communities and modifies human-wildlife interactions, often increasing zoonotic spillover potential. When deforested land reverts to forest, species composition differences between primary and regenerating (secondary) forest could alter spillover risk trajectory. We develop a mathematical model of land-use change, where habitats differ in their relative spillover risk, to understand how land reversion influences spillover risk. We apply this framework to scenarios where spillover risk is higher in deforested land than mature forest, reflecting higher relative abundance of highly competent species and/or increased human-wildlife encounters, and where regenerating forest has either very low or high spillover risk. We find the forest regeneration rate, the spillover risk of regenerating forest relative to deforested land, and how rapidly regenerating forest regains attributes of mature forest determine landscape-level spillover risk. When regenerating forest has a much lower spillover risk than deforested land, reversion lowers cumulative spillover risk, but instaneous spillover risk peaks earlier. However, when spillover risk is high in regenerating and cleared habitats, landscape-level spillover risk remains high, especially when cleared land is rapidly abandoned then slowly regenerates to mature forest. These results suggest that proactive wildlife management and awareness of human exposure risk in regenerating forests could be important tools for spillover mitigation.

Determination of the trend of incidence of cutaneous leishmaniasis in Kerman province 2014-2020 and forecasting until 2023. A time series study

Introduction

Cutaneous leishmaniasis (CL) is currently a health problem in several parts of Iran, particularly Kerman. This study was conducted to determine the incidence and trend of CL in Kerman during 2014–2020 and its forecast up to 2023. The effects of meteorological variables on incidence was also evaluated.

Materials and methods

4993 definite cases of CL recorded from January 2014 to December 2020 by the Vice-Chancellor for Health at Kerman University of Medical Sciences were entered. Meteorological variables were obtained from the national meteorological site. The time series SARIMA methods were used to evaluate the effects of meteorological variables on CL.

Results

Monthly rainfall at the lag 0 (β = -0.507, 95% confidence interval:-0.955,-0.058) and monthly sunny hours at the lag 0 (β = -0.214, 95% confidence interval:-0.308,-0.119) negatively associated with the incidence of CL. Based on the Akaike information criterion (AIC) the multivariable model (AIC = 613) was more suitable than univariable model (AIC = 690.66) to estimate the trend and forecast the incidence up to 36 months.

Conclusion

The decreasing pattern of CL in Kerman province highlights the success of preventive, diagnostic and therapeutic interventions during the recent years. However, due to endemicity of disease, extension and continuation of such interventions especially before and during the time periods with higher incidence is essential.

Cutaneous leishmaniasis (CL) is one of the most prevalent tropical diseases and the most common form of leishmaniasis, which is found in different regions. Due to different geographical climates, the transmission pattern and the impact of meteorological variables on CL is different. In this study we evaluated the incidence and trend of CL during 2014–2020 and its forecast up to 2023 in Kerman province, Iran. In addition, the impact of meteorological variables on its incidence was assessed. Our finding showed a decreasing trend of CL during the studied years. There was a negative association between CL and sunny hours per day and rainfall at lag 0.

Potential distribution of four vectors of American Cutaneous Leishmaniasis: The effect of El Niño and La Niña episodes from the perspective of the ecological niche

The potential distribution of four American Cutaneous Leishmaniasis vectors under average conditions during Neutral (in between episodes), El Niño, and La Niña episodes from 2000 to 2018 were constructed through ecological niche modeling. The potential distribution in El Niño and La Niña were compared with the Neutral distribution. The four vector species (Lutzomyia gomezi, Lutzomyia ovallesi, Lutzomyia panamensis, and Lutzomyia trapidoi) decreased the potential distribution with the occurrence of El Niño and La Niña episodes. During El Niño, the reduction was concentrated over the dry ecosystems, while with the occurrence of La Niña, the potential distribution decreased over most of the Neotropic, leaving areas of climatic suitability concentrated in the Andean and Amazon areas, along with some scattered patches. We found evidence that the occurrence of the climatic anomalies has an effect on the potential distribution of this vector species.

Spatiotemporal trends of cutaneous leishmaniasis in Costa Rica

BACKGROUND

Cutaneous leishmaniasis (CL) remains an important neglected tropical disease in Costa Rica, which has one of the largest burdens of this disease in Latin America.

METHODS

We identified district-level hotspots of CL from 2006 to 2017 and conducted temporal analysis to identify where hotspots were increasing across the country.

RESULTS

Clear patterns of CL risk were detected, with persistent hotspots located in the Caribbean region, where risk was also found to be increasing over time in some areas.

CONCLUSIONS

We identify spatiotemporal hotspots, which may be used in support of the leishmaniasis plan of action for the Americas.

Evaluation of cytochrome b sequence to identify Leishmania species and variants: the case of Panama

BACKGROUND

The genetic heterogeneity of Leishmania parasites is a major factor responsible for the wide variety of Leishmania-associated manifestations. Consequently, understanding the genetic make-up of Leishmania species using suitable molecular markers is an important component of realising local and regional scale disease risk. The cytochrome b (cytb) is frequently used to type New World Leishmania species. However, its potential to discriminate Leishmania species and variants requires further evaluation.

OBJECTIVES

To explore the capacity of cytb gene to identify New World Leishmania species and variants and to develop an approach able to type local Leishmania species and variants.

METHODS

We retrieved 360 partial and complete Leishmania cytb gene sequences publicly available in GenBank database to study all single nucleotide polymorphisms (SNPs) across the cytb gene that differentiate New World Leishmania species. This information was used to develop an approach based upon the polymorphisms found in a DNA segment of 948bp. We also compared the typing results found with this technique with the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) profiling obtained using HSP70 gene as target. One hundred Panamanian isolates were used to both typed Leishmania species and assess local genetic variability.

FINDINGS

We found complete agreement between our cytb approach and the PCR-RFLP profiling method based on HSP70 for Leishmania species identification. Ninety-two isolates were identified as L. panamensis, although other Viannia species were found circulating at a lower frequency. Three L. panamensis haplotypes were identified in Panamanian provinces. We also provide an initial report of L. guyanensis haplotypes circulating in Panama.

MAIN CONCLUSIONS

Cytb gene sequence encompasses key main SNPs that aid to identify Leishmania species. The cytb approach developed with this information was able to identify and assess genetic variability of local Leishmania species found in this study.

Diversity, Co-Occurrence, and Nestedness Patterns of Sand Fly Species (Diptera: Psychodidae) in Two Rural Areas of Western Panamá

Simple Summary

Sand flies are insects that can transmit the parasites causing leishmaniasis, a major neglected tropical disease. In the Americas, these insects are highly diverse, and unlike what is observed for other vector-borne diseases, many species co-occur in sites where this disease affects human populations. Here, we present results from a two-year-long study where we study how the number of species changes in two rural areas of Western Panamá with different land use cover and through the dry and wet seasons. We found that species number increased during the wet season and in plots with higher natural forest cover and that species number decreased in both areas in plots when the forest cover decreased, with some species changing through the seasons, and some species disappearing when comparing the sand fly faunas of the most forested with less forested plots. However, our results suggest that seasonality, or the change from a dry to rainy season, can be a more important driver of the number of species locally observed in the studied areas.

Abstract

Cutaneous Leishmaniasis transmission in the New World is observed in areas with rich sand fly species’ faunas. The diversity and composition of sand fly species can change in response to seasonal weather and land use changes. Here, we present results from a two-year-long study where we collected, using Centers for Disease Control (CDC) light traps, sand flies from two rural areas, Las Pavas (LP) and Trinidad de las Minas (T) in western Panamá. Over 710 trap-nights, we collected 16,156 sand flies from 15 genera and 35 species. We identified 34 species in T, and the most abundant species collected was Nyssomyia trapidoi (Fairchild and Hertig, 1952) (n = 2278, 37%), followed by Psychodopygus panamensis (Shannon, 1926) (n = 1112, 18%), and Trichopygomyia triramula (Fairchild and Hertig, 1952) (n = 1063, 17%). In LP, we identified 26 species, and the most abundant species collected were Ty. triramula (n = 4729, 48%), and Ps. panamensis (n = 3444, 35%). We estimated a higher species’ richness in T (Chao2 ± S.E.: 36.58 ± 3.84) than in LP (27.49 ± 2.28). In T, species’ richness was significantly higher in the rainy season, but no seasonal differences were observed in LP. Species’ assemblages were nested in the two areas. Phlebotomine sand fly species’ abundance increased at the two sites during the rainy season. Our data suggest that seasonality is more important than land use as a factor driving sand fly species’ diversity at the studied sites.

Molecular Identification of Parasites Causing Cutaneous Leishmaniasis in Panama

Isolates from 475 cutaneous leishmaniasis (CL) patients from three endemic regions were studied by three typing techniques. The molecular analysis from lesion scrapings based on hsp70 PCR-RFLP showed that 78.1% (371/475) restriction patterns corresponded to Leishmania (Viannia) panamensis, 19% (90/475) to Leishmania (Viannia) guyanensis, and 3.0% (14/475) to Leishmania (Viannia) braziliensis. Promastigotes isolated by culture from lesions of 228 patients (48.0%, 228/475) were identified by multi-locus enzyme electrophoresis. Of them, 95.2% (217/228) were typified as L. (V.) panamensis, 1.3% (3/228) as L. (V.) guyanensis, 2.2% (5/228) as L. (V.) braziliensis, and 1.3% (3/228) as hybrids (L. [V.] braziliensis/L. [V.] panamensis). However, a partial sequencing analysis of the hsp70 gene from 77 selected samples showed 16.9% (13/77) typified as L. (V.) panamensis, 68.8% (53/77) as Leishmania (V.) sp., 1, 3.9% (3/77) as L. (V.) guyanensis, 1.3% (1/77) as L. (V.) braziliensis outlier, 2.6% (2/77) as Leishmania (Viannia) naiffi, 2.6% as (2/77) Leishmania (V.) sp., and 2 and 3.9% (3/77) hybrid isolates of L. (V.) braziliensis/L. (V.) guyanensis. These results confirm L. (V.) panamensis as the predominant species and cause of CL lesions in Panama and that L. (V.) guyanensis, L. (V.) braziliensis, and L. (V.) naiffi are circulating to a lower degree. Furthermore, the determination of parasite isolates belonging to atypical clusters and hybrid isolates suggests the circulation of genetic variants with important implications for the epidemiology and clinical follow-up of CL in Panama. No evidence of the existence of parasites of the Leishmania (Leishmania) mexicana complex in Panamanian territory was found in this study.

Leishmania spp. Infection Rate and Feeding Patterns of Sand Flies (Diptera: Psychodidae) from a Hyperendemic Cutaneous Leishmaniasis Community in Panamá

American cutaneous leishmaniasis (ACL) is a common and important vector-borne parasitic zoonosis in Panamá. Here, we study Leishmania spp. infection rates and blood-feeding patterns among common sand flies in Trinidad de Las Minas, a rural community with hyperendemic ACL transmission, and where a deltamethrin fogging trial was performed. Sand flies were collected from April 2010 to June 2011 with light traps installed inside and in the peridomicile of 24 houses. We restricted our analysis to the most abundant species at the study site: Lutzomyia trapidoi, Lutzomyia gomezi, Lutzomyia panamensis, Lutzomyia triramula, and Lutzomyia dysponeta. We detected Leishmania spp. infection in sand flies by polymerase chain reaction (PCR) amplification of the internal transcribed spacer region 1 (ITS-1) in pooled females (1-10 females per pool). Host species of engorged sand flies were identified using a cytochrome b PCR. From 455 sand fly pools analyzed, 255 pools were positive for Leishmania spp., with an estimated infection rate (confidence interval) of 0.096 [0.080-0.115] before the deltamethrin fogging which slightly, but not significantly (P > 0.05), increased to 0.116 [0.098-0.136] after the deltamethrin fogging. Blood meal analysis suggested that pigs, goats, and birds were the most common sand fly blood sources, followed by humans and domestic dogs. DNA sequencing from a subsample of ITS-1 positive pools suggests that Leishmania panamensis, Leishmania naiffi, and other Leishmania spp. were the parasite species infecting the most common vectors at the study site. Our data confirm an association between sand fly species, humans, domestic dogs, and pigs and Leishmania spp. parasites in rural Panamá.

Socioenvironmental aspects of the Purus Region - Brazilian Amazon: Why relate them to the occurrence of American Tegumentary Leishmaniasis?

This study aims to analyze factors related to the occurrence of American Tegumentary Leishmaniasis in the Purus Region, based on the reporting of cases between 2001 and 2013, correlating them with livelihoods and subsistence farming in the region, and analyzing them in regards to sex, age, clinical form, occupation, diagnostic methods and seasonality. The analysis parameter which was used included all cases of American Tegumentary Leishmaniasis in each sub-region by municipality. The Purus Region, between the states of Amazonas and Acre, consists of three sub-regions: Upper, Middle, and Lower Purus. We observed that socio-environmental impacts influenced the livelihoods of the human population and that the interaction with extractive activities, especially latex and Brazil nut collecting, where the labor regime implies a long stay in the jungle, leads to socio-environmental conditions that are favorable to the contraction of American Tegumentary Leishmaniasis. During the referred period, there were 13,971 cases of American Tegumentary Leishmaniasis distributed among the sub-regions: High (12611 cases = 90.27%), Middle (1225 cases = 8.77%) and Lower (135 cases = 0.96%). Among the 22 municipalities that were studied, Rio Branco stands out with 31.6% of cases, followed by Xapuri with 12.6% and Sena Madureira with 12.5%. In the results, we highlight the high percentage (20.8%) of mucous forms; the age group from 11 to 50 (70.2%), however, 20.2% were in the age group of 1 month to 10 years of age; cases in males were 69.8%, and, in the reports examined, 43.7%. cited their occupation as extractivism. A statistically significant negative association was demonstrated between cutaneous leishmaniasis and rainfall between Purus municipalities. However, in regards to the association of cutaneous leishmaniasis for both, temperature and Municipal Human Development Index-MHDI, no significant associations were found in Purus. We concluded that American Tegumentary Leishmaniasis occurring in the Purus Region is related to two distinct aspects: the development of enterprises that extend the agricultural frontier, and a change in lifestyle, namely the extraction of wood as an occupation, which has, as a consequence, an environmental impact and creates difficulties in accessing treatment.

Environmental and socio-economic determinants associated with the occurrence of cutaneous leishmaniasis in the northeast of Colombia

Background

Cutaneous leishmaniasis (CL) is a vector-borne disease that is widely distributed in most tropical regions. Colombia has experienced an important increase in its incidence during the last decade. There are CL transmission foci in the Colombian departments of Santander and Norte de Santander.

Objectives

To identify environmental and socio-economic variables associated with CL incidence in the municipalities of the northeast of Colombia between 2007 and 2016.

Methods

This was an ecological study of CL cases aggregated by municipality. The cases reported during the study period were analyzed with a negative binomial regression to obtain the adjusted incident rate ratio for environmental and socio-economic variables.

Findings

During the study period, 10 924 cases of CL were reported, and 110 (86.6%) municipalities reported at least one CL case. The coverages of forest (aIRR 1.05, 95% CI 1.03-1.07), heterogeneous agricultural zones (aIRR 1.04, 95% CI 1.02-1.06) and permanent crops (aIRR 1.07, 95% CI 1.02-1.12) were associated with a higher incidence of CL. Conversely, urban functionality (aIRR 0.95, 95% CI 0.92-0.96), minimal-altitude above sea level (aIRR 0.84, 95% CI 0.79-0.90) and shrub coverage (aIRR 0.98, 95% CI 0.95-1.0) were negatively associated with the incidence of CL in the municipality.

Main conclusions

Our results confirm the importance of environmental determinants, such as height above sea level, and coverage of forest, permanent crops and heterogeneous agricultural zones, for the occurrence of CL; these findings also suggest the importance of shrub coverage. Furthermore, urban functionality was a socio-economic determinant independently associated with CL incidence.

Assessing changing weather and the El Niño Southern Oscillation impacts on cattle rabies outbreaks and mortality in Costa Rica (1985-2016)

BACKGROUND

Rabies is a major zoonotic disease affecting humans, domestic and wildlife mammals. Cattle are the most important domestic animals impacted by rabies virus in the New World, leading to thousands of cattle deaths per year and eliciting large economic losses. In the New World, virus transmission in cattle is primarily associated with Desmodus rotundus, the common vampire bat. This study analyses the association of weather fluctuations and the El Niño Southern Oscillation (ENSO), with the occurrence and magnitude, in terms of associated mortality, of cattle rabies outbreaks. Data from the 100 cattle rabies outbreaks recorded between 1985 and 2016 in Costa Rica were analyzed. Periodograms for time series of rabies outbreaks and the El Niño 4 index were estimated. Seasonality was studied using a seasonal boxplot. The association between epidemiological and climatic time series was studied via cross wavelet coherence analysis. Retrospective space-time scan cluster analyses were also performed. Finally, seasonal autoregressive time series models were fitted to study linear associations between monthly number of outbreaks, monthly mortality rates and the El Niño 4 index, temperature, and rainfall.

RESULTS

Large rabies mortality occurred towards the Atlantic basin of the country. Outbreak occurrence and size were not directly associated with ENSO, but were sensitive to weather variables impacted by ENSO. Both, ENSO phases and rabies outbreaks, showed a similar 5 year period in their oscillations. Cattle rabies mortality and outbreak occurrence increased with temperature, whereas outbreak occurrence decreased with rainfall. These results suggest that special weather conditions might favor the occurrence of cattle rabies outbreaks.

CONCLUSIONS

Further efforts are necessary to articulate the mechanisms underpinning the association between weather changes and cattle rabies outbreaks. One hypothesis is that exacerbation of cattle rabies outbreaks might be mediated by impacts of weather conditions on common vampire bat movement and access to food resources on its natural habitats. Further eco-epidemiological field studies could help to understand rabies virus transmission ecology, and to propose sound interventions to control this major veterinary public health problem.

Increased Adult Aedes aegypti and Culex quinquefasciatus (Diptera: Culicidae) Abundance in a Dengue Transmission Hotspot, Compared to a Coldspot, within Kaohsiung City, Taiwan

The assumption that vector abundance differences might drive spatial and temporal heterogeneities in vector-borne disease transmission is common, though data supporting it is scarce. Here, we present data from two common mosquito species Aedes aegypti (Linnaeus) and Culex quinquefasciatus Say, biweekly sampled as adults, from March 2016 through December 2017, with BG-sentinel traps in two neighboring districts of Kaohsiung City (KC), Taiwan. One district has historically been a dengue transmission hotspot (Sanmin), and the other a coldspot (Nanzih). We collected a total 41,027 mosquitoes, and we found that average mosquito abundance (mean ± S.D.) was higher in Sanmin (Ae. aegypti: 9.03 ± 1.46; Cx. quinquefasciatus: 142.57 ± 14.38) than Nanzih (Ae. aegypti: 6.21 ± 0.47; Cx. quinquefasciatus: 63.37 ± 8.71) during the study period. In both districts, Ae. aegypti and Cx. quinquefasciatus population dynamics were sensitive to changes in temperature, the most platykurtic environmental variable at KC during the study period, a pattern predicted by Schmalhausen’s law, which states that organisms are more sensitive to small changes in environmental variables whose average value is more uncertain than its extremes. Our results also suggest that differences in Ae. aegypti abundance might be responsible for spatial differences in dengue transmission at KC. Our comparative approach, where we also observed a significant increment in the abundance of Cx. quinquefasciatus in the dengue transmission hotspot, suggests this area might be more likely to experience outbreaks of other vector borne diseases and should become a primary focus for vector surveillance and control.

Trypanosoma cruzi Infection in Rhodnius pallescens (Heteroptera: Reduviidae) Infesting Coyol Palms in the Dry Arch of Panamá

Ecoepidemiological scenarios for Trypanosoma cruzi Chagas transmission are partially shaped by kissing bug vector ecology. The presence of Attalea butyracea Kunth, the 'royal palm', is a major risk factor for Chagas disease transmission in Panamá given their frequent infestations by Rhodnius pallescens Barber, a major neotropical T. cruzi vector. It was assumed that in Panamá this relationship was very close and unique, limiting the niche of R. pallescens to that of Att. butyracea. However, here we present observations about T. cruzi-infected R. pallescens infesting coyol palms, Acrocomia aculeata Jacquin, in Pedasí district, Los Santos Province, Panamá. Between May 2015 and August 2016, we sampled kissing bugs from 83 coyol palms using mice-baited traps placed at the crown of each palm during the dry and wet season. We collected 62 R. pallescens and one Eratyrus cuspidatus Stål kissing bugs. Using logistic regression, we found that the probability of kissing bug infestation in coyol palms increased during the rainy season, with infructescence number and palm height. We examined adult R. pallescens bugs (n = 30) and found T. cruzi in 67% of the samples. We were able to isolate and characterize T. cruzi from parasites present in the feces from R. pallescens, all parasites belonging to the TC I lineage. We found that green fronds number and house proximity increased T. cruzi infection probability in kissing bugs collected in coyol palms. These results highlight coyol palms as a potential risk factor for Chagas disease transmission in the dry arch of Panamá.

Using Landscape Analysis to Test Hypotheses about Drivers of Tick Abundance and Infection Prevalence with Borrelia burgdorferi

Patterns of vector-borne disease risk are changing globally in space and time and elevated disease risk of vector-borne infection can be driven by anthropogenic modification of the environment. Incidence of Lyme disease, caused by the bacterium Borrelia burgdorferi sensu stricto, has risen in a number of locations in North America and this increase may be driven by spatially or numerically expanding populations of the primary tick vector, Ixodes scapularis. We used a model selection approach to identify habitat fragmentation and land-use/land cover variables to test the hypothesis that the amount and configuration of forest cover at spatial scales relevant to deer, the primary hosts of adult ticks, would be the predominant determinants of tick abundance. We expected that land cover heterogeneity and amount of forest edge, a habitat thought to facilitate deer foraging and survival, would be the strongest driver of tick density and that larger spatial scales (5-10 km) would be more important than smaller scales (1 km). We generated metrics of deciduous and mixed forest fragmentation using Fragstats 4.4 implemented in ArcMap 10.3 and found, after adjusting for multicollinearity, that total forest edge within a 5 km buffer had a significant negative effect on tick density and that the proportion of forested land cover within a 10 km buffer was positively associated with density of I. scapularis nymphs. None of the 1 km fragmentation metrics were found to significantly improve the fit of the model. Elevation, previously associated with increased density of I. scapularis nymphs in Virginia, while significantly predictive in univariate analysis, was not an important driver of nymph density relative to fragmentation metrics. Our results suggest that amount of forest cover (i.e., lack of fragmentation) is the most important driver of I. scapularis density in our study system.

Climatic fluctuations and malaria transmission dynamics, prior to elimination, in Guna Yala, República de Panamá

BACKGROUND

Malaria has historically been entrenched in indigenous populations of the República de Panamá. This scenario occurs despite the fact that successful methods for malaria elimination were developed during the creation of the Panamá Canal. Today, most malaria cases in the República de Panamá affect the Gunas, an indigenous group, which mainly live in autonomous regions of eastern Panamá. Over recent decades several malaria outbreaks have affected the Gunas, and one hypothesis is that such outbreaks could have been exacerbated by climate change, especially by anomalous weather patterns driven by the EL Niño Southern Oscillation (ENSO).

RESULTS

Monthly malaria cases in Guna Yala (1998-2016) were autocorrelated up to 2 months of lag, likely reflecting parasite transmission cycles between humans and mosquitoes, and cyclically for periods of 4 months that might reflect relapses of Plasmodium vivax, the dominant malaria parasite transmitted in Panamá. Moreover, malaria case number was positively associated (P < 0.05) with rainfall (7 months of lag), and negatively with the El Niño 4 index (15 months of lag) and the Normalized Difference Vegetation Index, NDVI (8 months of lag), the sign and magnitude of these associations likely related to the impacts of weather patterns and vegetation on the ecology of Anopheles albimanus, the main malaria vector in Guna Yala. Interannual cycles, of approximately 4-year periods, in monthly malaria case numbers were associated with the El Niño 4 index, a climatic index associated with weather and vegetation dynamics in Guna Yala at seasonal and interannual time scales.

CONCLUSION

The results showed that ENSO, rainfall and NDVI were associated with the number of malaria cases in Guna Yala during the study period. These results highlight the vulnerability of Guna populations to malaria, an infection sensitive to climate change, and call for further studies about weather impacts on malaria vector ecology, as well as the association of malaria vectors with Gunas paying attention to their socio-economic conditions of poverty and cultural differences as an ethnic minority.

Health seeking behavior following snakebites in Sri Lanka: Results of an island wide community based survey

INTRODUCTION

Sri Lanka has a population of 21 million and about 80,000 snakebites occur annually. However, there are limited data on health seeking behavior following bites. We investigated the effects of snakebite and envenoming on health seeking behavior in Sri Lanka.

METHODS

In a community-based island-wide survey conducted in Sri Lanka 44,136 households were sampled using a multistage cluster sampling method. An individual who reported experiencing a snakebite within the preceding 12 months was considered a case. An interviewer-administered questionnaire was used to obtain details of the bite and health seeking behavior among cases.

RESULTS

Among 165,665 individuals surveyed, there were 695 snakebite victims. 682 (98.1%) had sought health care after the bite; 381 (54.8%) sought allopathic treatment and 301 (43.3%) sought traditional treatment. 323 (46.5%) had evidence of probable envenoming, among them 227 (70.3%) sought allopathic treatment, 94 (29.1%) sought traditional treatment and 2 did not seek treatment. There was wide geographic variation in the proportion of seeking allopathic treatment from <20% in the Western province to > 90% in the Northern province. Multiple logistic regression analysis showed that seeking allopathic treatment was independently associated with being systemically envenomed (Odds Ratio = 1.99, 95% CI: 1.36-2.90, P < 0.001), distance to the healthcare facility (OR = 1.13 per kilometer, 95% CI: 1.09 to 1.17, P < 0.001), time duration from the bite (OR = 0.49 per day, 95% CI: 0.29-0.74, P = 0.002), and the local incidence of envenoming (OR = 1.31 for each 50 per 100,000, 95% CI: 1.19-1.46, P < 0.001) and snakebite (OR = 0.90 for each 50 per 100,000, 95% CI: 0.85-0.94, P < 0.001) in the relevant geographic area.

CONCLUSIONS

In Sri Lanka, both allopathic and traditional treatments are sought following snakebite. The presence of probable envenoming was a major contribution to seeking allopathic treatment.

American trypanosomiasis, or Chagas disease, in Panama: a chronological synopsis of ecological and epidemiological research

American trypanosomiasis, or Chagas disease, is a growing public health problem in Panama, and further forest degradation due to human population growth is expected to worsen the situation. Most people infected with the parasite Trypanosoma cruzi are silently ill, and their life expectancy is severely compromised, which contributes to further deterioration of living conditions in endemic regions. Here, we review the outcomes of nearly 100 years of ecological and epidemiological investigation about Chagas disease in Panama, in an attempt to highlight progress, identify needs, and re-orient future efforts. Rhodnius pallescens and Triatoma dimidiata are both primary vectors of T. cruzi in Panama, but R. pallescens seems more efficient in human-altered forest ecosystems due to a greater degree of association with Attalea butyracea. In contrast, T. dimidiata transmits T. cruzi efficiently under more sylvatic conditions (e.g. settlements inside old-growth or secondary forest patches), where its populations reach considerable numbers irrespective of the absence of A. butyracea. A trend of increasing forest degradation, suburbanization, and development of tourism in Panama favoring the establishment of A. butyracea and other palm tree species (Acrocomia sp.) suggests that a colonist species like R. pallescens will continue to play a more prominent role in the transmission of T. cruzi than a forest specialist like T. dimidiata. However, studies about the taxonomic status and ecology of these vectors are still needed in Panama to address their transmission potential fully. The implementation of an active surveillance system and education programs could greatly minimize the risk of Chagas disease transmission in Panama, preventing fatal infections in children from endemic areas.