Does the Plague Still Threaten Us?

Evaluation of a multi-species Protein A-ELISA assay for plague serologic diagnosis in humans and other mammal hosts

Background

The Hemagglutination assay (HA) is widely used in plague diagnosis, however, it has a subjective interpretation and demands high amounts of antigen and other immunobiological supplies. On the other hand, the conventional Anti-IgG ELISA is limited by the need of specific conjugates for multiple plague hosts, which leaves a gap for new diagnostic methods able to cover both the diagnosis of human cases and the epidemiological surveillance of multiple sentinel species.

Methods

We developed an ELISA Protein A-peroxidase method to detect anti-F1 antibodies across several species, including humans. To determine the cut-off and performance rates, HA results from 288 samples (81 rabbits, 64 humans, 66 rodents and 77 dogs) were used as reference. Next, we evaluated the agreement between Protein A-ELISA and Anti-IgG ELISA in an expanded sample set (n = 487).

Results

Optimal conditions were found with 250ng/well of F1 and 1:500 serum dilution. Protein A-ELISA showed high repeatability and reproducibility. We observed good correlation rates between the Protein A and IgG ELISAs optical densities and a higher positive/negative OD ratio for the Protein A-ELISA method. The overall sensitivity, specificity and area under the curve for Protein A-ELISA were 94%, 99% and 0.99, respectively. Similar results were observed for each species separately. In the analysis of the expanded sample set, there was a strong agreement between Protein A and IgG assays (kappa = 0.97). Furthermore, there was no cross-reaction with other common infectious diseases, such as dengue, Zika, Chagas disease, tuberculosis (humans) and ehrlichiosis, anaplasmosis and leishmaniasis (dogs).

Conclusions

Altogether, the Protein A-ELISA showed high performance when compared both to HA and Anti-IgG ELISA, with a polyvalent single protocol that requires reduced amounts of antigen and can be employed to any plague hosts.

Here, we developed and evaluated an ELISA diagnostic test based on the Protein A-peroxidase conjugate that allows the test to be used for plague laboratorial diagnosis not only in humans, but also in a wide range of mammalian species. This particularity is specifically important for plague epidemiological surveillance, given that Yersinia pestis, the causative agent of plague, have a long list of animal reservoirs across distinct ecosystems. Briefly, we first evaluated the best reaction parameters, such as antigen concentration, serum and protein A-conjugate dilutions. Next, we used serum samples from humans, dogs, rodents and rabbits (n = 288) with known results for plague serology by a conventional method, to evaluate the performance of the new Protein A-ELISA test. We observed a good performance of the novel Protein A-ELISA test, with high sensitivity and specificity rates. Evaluation of the coefficient of variation revealed that the test measurements suffer little variation, and therefore, has high repeatability and reproducibility. Next, by evaluating 487 samples, we observed a high degree of concordance between the Protein A-ELISA with a conventional IgG-based ELISA. Furthermore, this test showed no significant cross-reaction with other common infectious diseases. Altogether, the Protein A-ELISA showed high performance when compared both to HA and Anti-IgG ELISA, with a single protocol that requires reduced amounts of antigen and can be employed to several plague hosts.

Spatial and Temporal Distribution of Rodents during the Epizootic and Enzootic Periods of Plague, with a Focus on Exu, Northeastern Brazil

The plague caused by the Yersinia pestis bacterium is primarily a flea-transmitted zoonosis of rodents that can also be conveyed to humans and other mammals. In this work, we analyzed the spatial and temporal distribution of rodent populations during epizootic and enzootic periods of the plague in the municipality of Exu, northeastern Brazil. The geospatial analyses showed that all the rodent species appeared through the whole territory of the municipality, with different occurrence hotspots for the different species. Important fluctuations in the rodent populations were observed, with a reduction in the wild rodent fauna following the end of a plague epizootic period, mostly represented by Necromys lasiurus and an increase in the commensal species Rattus rattus. A higher abundance of rats might lead to an increased exposure of human populations, favoring spillovers of plague and other rodent-borne diseases. Our analysis highlights the role of wild rodent species as amplifier hosts and of commensal rats (R. rattus) as preserver hosts in the enzootic period of a specific transmission infection area.

Spatiotemporal analysis of bubonic plague in Pernambuco, northeast of Brazil: Case study in the municipality of Exu

Along with other countries in America, plague reached Brazil through the sea routes during the third pandemic. A brief ports phase was followed by an urban phase that took place in smaller inland cities and finally, it attained the rural area and established several foci where the ecological conditions were suitable for its continued existence. However, the geographic dispersion of plague in Brazil is still poorly studied. To better understand the disease dynamics, we accessed satellite-based data to trace the spatial occurrence and distribution of human plague cases in Pernambuco, Northeastern Brazil and using the municipality of Exu as study case area. Along with the satellite data, a historical survey using the Plague Control Program files was applied to characterize the spatial and temporal dispersion of cases in the period of 1945-1976. Kernel density estimation, spatial and temporal clusters with statistical significance and maximum entropy modeling were used for spatial data analysis, by means of the spatial analysis software packages. The use of geostatistical tools allowed evidencing the shift of the infection from the urban to the wild-sylvatic areas and the reemergence of cases after a period of quiescence, independent of the reintroduction from other plague areas.

The pests of a pest: A systematic review of ectoparasitic fauna among synanthropic rodents in the 21st century with meta-analysis

Synanthropic rodents are important urban pests that frequently carry hematophagous ectoparasites. These blood-sucking pests are capable of transmitting epizootic and zoonotic pathogens by landing on one host after feeding on an infected animal. This study aimed to estimate the prevalence of ectoparasites carried by synanthropic rodents and discuss the pathogens that are associated with these external parasites. We searched relevant literatures using predefined criteria in the following databases: EMBASE, PUBMED, Web of Science and Scopus from January 2000 to June 2020. Quality of studies was evaluated using Newcastle-Ottawa scale (NOS). Of 35 included studies from 15 countries in Africa, America, Asia, Europe and Oceania, black rats (R. rattus), brown rats (R. norvegicus), pacific rats (R. exulans) and house mice (Mus musculus) were common synanthropic rodents. Mites (Mesostigmata, Sarcoptiformes and Trombidiformes) were the most prevalent (42.6%, 95% CI 26-59.2), followed by ticks (Ixodida) (21.5%, 95% CI 10.5-32.6), lice (Phthiraptera) (17.8%, 95% CI 7.7-27.9) and fleas (Siphonaptera) (14.1%, 95% CI 10.1-18.1). Heterogeneity (I2>96%) across studies was statistically significant. The ectoparasitic fauna was shared considerably by different urban rodent species and appeared to be more diverse in R. rattus and R. norvegicus. Nonetheless, pathogens carried by these ectoparasites were rarely investigated. In conclusion, ectoparasites are ubiquitous in urban-dwelling rodents but our understanding of the epidemiology and the associated pathogens of these parasites remains limited. Further studies are warranted to unravel the pathogen landscape found in rodent-associated ectoparasites.