Occurrence of Phlebotomine sand flies (Diptera: Psychodidae) in the northeastern plain of Italy

Meteorological, demographic, and environmental risk factors for Leishmania infantum in wildlife

Leishmania infantum is an important and neglected vector-borne zoonotic protozoa endemic in the Mediterranean basin. Several wild and domestic mammals can contribute to maintaining its circulation but their importance as effective reservoirs is still under discussion and varies depending on local ecological communities. By combining environmental, climatic, and individual information, this study assessed the presence of L. infantum DNA in a set of wild species from Northwestern Italy and the potential ecological factors related to the risk of infection. From 2020 to 2022, 304 free-ranging wild animals were analyzed for the detection of L. infantum DNA in the spleen and popliteal lymph node (when available). The prevalence obtained in wild boar (Sus scrofa) and roe deer (Capreolus capreolus) was higher than those previously reported (% ± confidence interval 95%; 42.9 ± 18.4% and 27 ± 6.6% in wild boar and roe deer, respectively), and this is the first report of this parasite infecting the coypu Myocastor coypus (60 ± 34.7%). L. infantum DNA was detected in all the seasons including those free of adult sandflies and seasonal differences were minimal, suggesting a long course of infection. The models revealed that animals from rainy areas with higher greenness during the summer, highly populated by humans and predominantly covered by water surfaces had a higher risk of L. infantum. This study contributes to confirming previous findings on the existence of a sylvatic cycle for L. infantum in certain regions of Italy, as well as on the potential epidemiological role of roe deer for this parasite given the elevated prevalence found.

Re-emergence of human leishmaniasis in northern Italy, 2004 to 2022: a retrospective analysis

BackgroundHuman leishmaniasis is a protozoan disease transmitted by sand flies and endemic in the Mediterranean region. In Italy, leishmaniasis is present in the south and the western coastal regions, with an epidemic peak detected in northern Italy in the early 1970s.AimTo examine temporal trends, and demographic, clinical, geographical and environmental features of human leishmaniasis cases recorded by the local health unit (LHU) of Bologna, northern Italy.MethodsIn this retrospective observational study, we analysed human leishmaniasis cases recorded from 2004 to 2022 within the Bologna LHU. We also conducted serological investigations for canine leishmaniasis in owned dogs living near the place of infection of human cases.ResultsIn total, 173 cases of human leishmaniasis were detected, and 154 cases were considered autochthonous. An increase of human cases was observed since 2004, with incidence peaks above 2 cases/100,000 inhabitants in 2013, 2018 and 2022; epidemic peaks were preceded by dry summers. Most cases lived in the plain and hilly areas less than 400 m above sea level and many resided in isolated housing, in city outskirts, and/or near uncultivated areas, watercourses and railway sections. The incidence of canine leishmaniasis did not increase in the study period.ConclusionAn epidemic of human leishmaniasis with fluctuating annual numbers of cases, probably related to environmental and climatic factors, was identified in the Bologna LHU. Understanding the risk factors and the environmental characteristics related to places of infection is crucial to evaluate the public health implications of leishmaniasis.

Reconstructing the post-glacial spread of the sand fly Phlebotomus mascittii Grassi, 1908 (Diptera: Psychodidae) in Europe

Phlebotomine sand flies (Diptera: Phlebotominae) are the principal vectors of Leishmania spp. (Kinetoplastida: Trypanosomatidae). In Central Europe, Phlebotomus mascittii is the predominant species, but largely understudied. To better understand factors driving its current distribution, we infer patterns of genetic diversity by testing for signals of population expansion based on two mitochondrial genes and model current and past climate and habitat suitability for seven post-glacial maximum periods, taking 19 climatic variables into account. Consequently, we elucidate their connections by environmental-geographical network analysis. Most analyzed populations share a main haplotype tracing back to a single glacial maximum refuge area on the Mediterranean coasts of South France, which is supported by network analysis. The rapid range expansion of Ph. mascittii likely started in the early mid-Holocene epoch until today and its spread possibly followed two routes. The first one was through northern France to Germany and then Belgium, and the second across the Ligurian coast through present-day Slovenia to Austria, toward the northern Balkans. Here we present a combined approach to reveal glacial refugia and post-glacial spread of Ph. mascittii and observed discrepancies between the modelled and the current known distribution might reveal yet overlooked populations and potential further spread.

FeliLeish: An Update on Feline Leishmaniosis and Factors Associated with Infection in Different Feline Populations from Italy

Feline leishmaniosis is a worldwide infection caused by the parasite of the genus Leishmania transmitted by sandflies. Based on the complexity of epidemiology and diagnosis of this infection, the role of cats in the epidemiology and clinical impact of disease is still under debate. By using serological and molecular methods, this study aimed to update the epidemiology of the infection in different feline populations from various areas of Italy and to study factors associated with the infection. Of 1490 cats tested, 124 (8.3%, 95% CI 6.9-9.9) were infected, 96 had only specific L. infantum IgG, 18 were only positive for parasite DNA and 10 were both IFAT and qPCR positive. Risk factors for infection were sampling in the winter season (OR = 3.2, 95% CI 2.2-4.8), originating from the Sicily region (OR = 2.0, 95% CI 1.3-3.0), male gender (OR = 1.8, 95% CI 1.1-3.2), outdoor lifestyle (OR = 2.3, 95% CI 0.9-5.6) and seropositivity for FIV antibodies (OR = 2.2, 95% CI 1.2-4.2), while sampling in the spring (OR = 0.5, 95% CI 0.3-0.7) and summer (OR = 0.3, 95% CI 0.1-0.7), and originating from the Lazio region (OR = 0.1, 95% CI 0.05-0.4) were protective factors for infection. In endemic areas, Leishmania infection should be investigated by using both serological and molecular methods and cats should be protected from sandfly bites, particularly if they are FIV infected.

Multisectoral Perspectives on Global Warming and Vector-borne Diseases: a Focus on Southern Europe

Purpose of Review

The climate change (CC) or global warming (GW) modifies environment that favors vectors' abundance, growth, and reproduction, and consequently, the rate of development of pathogens within the vectors. This review highlights the threats of GW-induced vector-borne diseases (VBDs) in Southern Europe (SE) and the need for mitigation efforts to prevent potential global health catastrophe.

Recent Findings

Reports showed astronomical surges in the incidences of CC-induced VBDs in the SE. The recently (2022) reported first cases of African swine fever in Northern Italy and West Nile fever in SE are linked to the CC-modified environmental conditions that support vectors and pathogens' growth and development, and disease transmission.

Summary

VBDs endemic to the tropics are increasingly becoming a major health challenge in the SE, a temperate region, due to the favorable environmental conditions caused by CC/GW that support vectors and pathogens' biology in the previously non-endemic temperate regions.

Monitoring of Insecticide Resistance Mutations and Pathogen Circulation in Sand Flies from Emilia-Romagna, a Leishmaniasis Endemic Region of Northern Italy

The continuously expanding distribution of sand flies, proven vectors of Leishmania and of several phleboviruses, is a growing public health issue in Europe. Especially in Italy, visceral leishmaniasis (VL) is occurring with increasing incidence northward, in previously non-endemic provinces. Around the globe, disease elimination efforts largely focus on sand fly vector insecticidal control, often leading to the development of resistance. In Emilia-Romagna (ER), northern Italy, insecticides are heavily applied for agricultural and mosquito control, but not specifically against sand flies. Here, we investigated the sand fly species composition in certain environmental settings in ER provinces and monitored the presence of pyrethroid resistance mutations and pathogen circulation. Phlebotomus perfiliewi, a dominant vector of Leishmania infantum, was detected almost exclusively in the region. No mutations in the voltage-gated sodium channel gene, e.g., knock-down resistance mutations I1011M, L1014F/S, V1016G, or F1020S, were recorded. Pathogen monitoring revealed that almost 40% of the tested sand fly pools were positive for Leishmania, while the presence of Toscana and Fermo phleboviruses was also observed in much lower frequencies (≤3% positive pools). Regular epidemiological and entomological monitoring, alongside resistance surveillance, is highly recommended to ensure the sustainability and efficiency of vector control interventions.

Spatio-Temporal Pattern and Meteo-Climatic Determinants of Visceral Leishmaniasis in Italy

Historically, visceral leishmaniasis (VL) in Italy was constrained to Mediterranean areas. However, in the last 20 years, sand fly vectors and human cases of VL have been detected in northern Italy, traditionally classified as a cold area unsuitable for sand fly survival. We aim to study the spatio-temporal pattern and climatic determinants of VL incidence in Italy. National Hospital Discharge Register records were used to identify incident cases of VL between 2009 and 2016. Incident rates were computed for each year (N = 8) and for each province (N = 110). Data on mean temperature and cumulative precipitation were obtained from the ERA5-Land re-analysis. Age- and sex-standardized incidence rates were modeled with Bayesian spatial and spatio-temporal conditional autoregressive Poisson models in relation to the meteo-climatic parameters. Statistical inference was based on Monte Carlo−Markov chains. We identified 1123 VL cases (incidence rate: 2.4 cases/1,000,000 person-years). The highest incidence rates were observed in southern Italy, even though some areas of northern Italy experienced high incidence rates. Overall, in the spatial analysis, VL incidence rates were positively associated with average air temperatures (β for 1 °C increase in average mean average temperature: 0.14; 95% credible intervals (CrI): 0.01, 0.27) and inversely associated with average precipitation (β for 20 mm increase in average summer cumulative precipitation: −0.28, 95% CrI: −0.42, −0.13). In the spatio-temporal analysis, no association between VL cases and season-year specific temperature and precipitation anomalies was detected. Our findings indicate that VL is endemic in the whole Italian peninsula and that climatic factors, such as air temperature and precipitation, might play a relevant role in shaping the geographical distribution of VL cases. These results support that climate change might affect leishmaniasis distribution in the future.

Distribution of Phlebotomine Sand Flies (Diptera: Psychodidae) in the Lombardy Region, Northern Italy

Simple Summary

Pathogens transmitted to humans and animals by Phlebotomines are relatively neglected, as they cause infectious diseases which represent an underestimated burden in most European countries. Several sand fly species are competent vectors of Leishmaniasis, an endemic disease that has spread widely throughout the Mediterranean region in conjunction with sand flies’ movements. In the Lombardy region, information on sand flies is poor and/or outdated. Therefore, the present study was undertaken to preliminarily ascertain the species composition, distribution, and diversity in representative Lombardy localities. The sampling took advantage of regional surveillance plans namely, West Nile virus and leishmaniasis monitoring plans. A focused sampling was also performed in areas identified as favorable for vector presence. Sampling was conducted using CO₂–CDC traps conducted every two and/or three weeks. From trapping for the West Nile monitoring plan, 21 out of 44 capture sites were positive for sand flies, while for the leishmaniasis monitoring plan, 11 out of the 40 trapping sites detected sand flies’ presence. Specimen identification was conducted by identifying morphological features. Phlebotomus perniciosus was the most abundant species (87.76% of specimens collected). Adequate and well-structured monitoring of sand fly populations is essential to provide information about distribution patterns of vector species present in defined geographical areas, as they could enhance pathogen circulation.

Abstract

This study investigated the species composition and density of sand flies in the Lombardy region (Northern Italy). Sand flies were collected using CDC traps baited with CO₂ (CO₂–CDC traps) between June and August 2021. A total of 670 sand flies were collected. The specimens were identified as seven species belonging to two genera, Phlebotomus and Sergentomyia, namely, S. minuta, Ph. perniciosus, Ph. perfiliewii, Ph. neglectus, Ph. mascitti, Ph. papatasi, and Ph. ariasi. Phlebotomus perniciosus was the most abundant species (87.76%), followed by Ph. perfiliewii (7.31%), Ph. neglectus (3.13%), S. minuta (0.75%), Ph. mascitti (0.6%), Ph. papatasi (0.3%), and Ph. ariasi, for which only one specimen was identified. Among these identified species, five are considered vectors of Leishmania, which causes cutaneous and visceral leishmaniasis. As vector presence increases the risk of vector-borne leishmaniasis, these results suggest that Northern Italy could be a potential area of pathogen circulation over the next few years. These preliminary results suggest that the risk of borne leishmaniasis is high in this region of Northern Italy. Monitoring the distribution of sand fly species in areas suitable for their persistence is important for control programs aimed at reducing the risk of leishmaniasis infection.

Monitoring and detection of new endemic foci of canine leishmaniosis in northern continental Italy: An update from a study involving five regions (2018-2019)

Canine leishmaniosis (CanL) is an emerging zoonosis caused by Leishmania infantum and transmitted in southern Europe by phlebotomine sand flies of the subgenus Phlebotomus (Larroussius). Endemic foci of CanL have been recorded in northern continental Italy since early 1990s and attributed to the northward expansion of vector populations due to climatic changes in association with travelling/relocated infected dogs from the southern Mediterranean littoral. In this study, further spread of endemic Leishmania foci was monitored during 2018-2019 in five regions (Aosta Valley, Piedmont, Lombardy, Veneto and Friuli-Venezia Giulia), with focus to territories where investigations were not performed, or they have been inconclusive. Clinical cases of CanL identified by local veterinary practitioners and confirmed by reference diagnosis centers were regarded as autochthonous if their origin from, or travel to, areas endemic for CanL were excluded in the previous ≥2 years. Around these index cases, i) serosurveys for L infantum were carried out where indicated, ii) sampling from potential autochthonous cases in healthy or clinically-suspected resident dogs was intensified by collaborating veterinary practitioners, and iii) suitable sites were investigated for the presence of competent phlebotomine vectors. Fifty-seven municipalities whose enzootic status of CanL was unreported before 2018, were identified as endemic. The stability of 27 foci recorded over the past decade, was also confirmed. Competent phlebotomine vectors, mainly Phlebotomus perniciosus, were collected for the first time in 23 municipalities. The newly recorded endemic municipalities appear to be distributed over a west-to-east decreasing gradient: 30 in Piedmont, 21 in Lombardy, 4 in Veneto and 2 in Friuli-Venezia Giulia. As regards Veneto, it should be noted that a relatively restricted territory was investigated as several municipalities of the region had already been surveyed and detected as endemic for CanL in the past. Cold climate conditions of the easternmost region of Friuli-Venezia Giulia bordering non-endemic territories of Slovenia, are probably less favorable to L infantum transmission.

Exposure to Major Vector-Borne Diseases in Dogs Subjected to Different Preventative Regimens in Endemic Areas of Italy

Vector-borne diseases (VBDs) are globally widespread arthropod-transmitted diseases with a significant impact on animal and human health. Many drivers have recently spurred the geographic spread of VBDs in dogs. This study has evaluated the exposure to most important VBDs in dogs under different preventative treatments in different regions of Italy, i.e., Veneto, Friuli Venezia-Giulia, Umbria, Giglio Island (Tuscany), Abruzzo and Latium. Serological analyses were performed to detect antibodies against Leishmania infantum, Babesia canis, Anaplasma phagocytophilum/Anaplasma platys, Ehrlichia canis/Ehrlichia ewingii, Borrelia burgdorferi, Rickettsia conorii and the circulating antigen of Dirofilaria immitis. Dogs were categorized according to the treatment schedule usually received, and the association between seropositivity and possible risk factors was statistically evaluated. Overall, 124/242 (51.2%) dogs tested positive for at least one pathogen, while 34 (14.0%) were exposed to two or more pathogens. The most detected seropositivity was against R. conorii, followed by Anaplasma spp., L. infantum, B. canis, and the other pathogens under study. Significant statistical associations were found according to geographical provenance, history of tick infestation, lifestyle and inadequate prophylactic treatments. Random/irregular treatments have been identified as a clear risk factor. These results show that adequate prophylactic treatment protocols are overlooked by dog owners, despite the availability of several effective products, with possible implications in veterinary medicine and on public health.