Metagenomic sequencing for investigation of a national keratoconjunctivitis outbreak, Israel, 2022.

BackgroundEpidemics of keratoconjunctivitis may involve various aetiological agents. Microsporidia are an uncommon difficult-to-diagnose cause of such outbreaks.AimDuring the third quarter of 2022, a keratoconjunctivitis outbreak was reported across Israel, related to common water exposure to the Sea of Galilee. We report a comprehensive diagnostic approach that identified Vittaforma corneae as the aetiology, serving as proof of concept for using real-time metagenomics for outbreak investigation.MethodsCorneal scraping samples from a clinical case were subjected to standard microbiological testing. Samples were tested by calcofluor white staining and metagenomic short-read sequencing. We analysed the metagenome for taxonomical assignment and isolation of metagenome-assembled genome (MAG). Targets for a novel PCR were identified, and the assay was applied to clinical and environmental samples and confirmed by long-read metagenomic sequencing.ResultsFluorescent microscopy was suggestive of microsporidiosis. The most abundant species (96.5%) on metagenomics analysis was V. corneae. Annotation of the MAG confirmed the species assignment. A unique PCR target in the microsporidian rRNA gene was identified and validated against the clinical sample. The assay and metagenomic sequencing confirmed V. corneae in an environmental sludge sample collected at the exposure site.ConclusionsThe real-time utilisation of metagenomics allowed species detection and development of diagnostic tools, which aided in outbreak source tracking and can be applied for future cases. Metagenomics allows a fully culture-independent investigation and is an important modality for public health microbiology.

Plant-feeding phlebotomine sand flies, vectors of leishmaniasis, prefer Cannabis sativa.

Blood-sucking phlebotomine sand flies (Diptera: Psychodidae) transmit leishmaniasis as well as arboviral diseases and bartonellosis. Sand fly females become infected with Leishmania parasites and transmit them while imbibing vertebrates' blood, required as a source of protein for maturation of eggs. In addition, both females and males consume plant-derived sugar meals as a source of energy. Plant meals may comprise sugary solutions such as nectar or honeydew (secreted by plant-sucking homopteran insects), as well as phloem sap that sand flies obtain by piercing leaves and stems with their needle-like mouthparts. Hence, the structure of plant communities can influence the distribution and epidemiology of leishmaniasis. We designed a next-generation sequencing (NGS)-based assay for determining the source of sand fly plant meals, based upon the chloroplast DNA gene ribulose bisphosphate carboxylase large chain (rbcL). Here, we report on the predilection of several sand fly species, vectors of leishmaniasis in different parts of the world, for feeding on Cannabis sativa We infer this preference based on the substantial percentage of sand flies that had fed on C. sativa plants despite the apparent "absence" of these plants from most of the field sites. We discuss the conceivable implications of the affinity of sand flies for C. sativa on their vectorial capacity for Leishmania and the putative exploitation of their attraction to C. sativa for the control of sand fly-borne diseases.

Ecology of Leishmaniasis in an urbanized landscape: Relationship of sand fly densities, and Leishmania tropica infection rates with reservoir host colonies.

Urbanization may influence the transmission of leishmaniasis, which is as a serious public health issue in Palestine. Semi urban environments can provide suitable habitats for the reservoir host species and the vector sand flies to create favorable condition for disease transmission. This study was aimed to evaluating the effect of distance from hyrax (reservoir host) colonies on sand fly (vector) abundance and its relationship to Leishmania infection within a semi urban landscape. In the Aleskan neighborhood the town of Tubas, sand flies were collected in July and September of 2016. Five trapping transects were set running from a rocky area containing hyrax dwelling habitats into an area of inhabited houses. 1051 Phlebotomus sand flies from 9 species were captured. The numbers of Phlebotomus sergenti, the vector species, correlated negatively with the distance from hyrax. Infected, blood engorged female sand flies were captured closer to hyrax colonies than infected, non-fed females. The risk of disease transmission to humans increased with a high density of reservoirs, closer proximity of reservoir hosts, and high densities of sand flies near houses. These results must be taken into account when implementing future interventions to reduce CL in urban environments.

The spatial and temporal distribution, species composition, and host preference of phlebotomine sand flies in the Bethlehem District of Palestine.

In the Palestinian West Bank, leishmaniasis is emerging as a serious public health issue with incidence increasing over time, especially in the western and the northern parts. This study was aimed to evaluating the effect of altitude on sand fly density, temporal and spatial distribution, species composition, and host preference within and between three villages in the Bethlehem District. The three villages occur along an elevation cline, ranging from the disease-free area of Kisan (KIS; 732-782 m ASL), down to the endemic areas of Arab Ar-Rashaiyda (AAR; 522-568 m ASL), and Al'Azazma (AZA; 473-510 m ASL) in the Bethlehem District (southeastern West Bank). Sand flies were trapped monthly from May through October in 2013 in traps located north, south, east, and west of each village. The abundance of sand flies differed among the three villages, with Arab Ar-Rashaiyda (AAR) > Al 'Azazma (AZA) >Kisan (KIS). The sex ratio was even in AAR and AZA, and female biased in KIS. Both male and female Phlebotomus sand fly densities varied with elevation, with greatest densities found at intermediate elevations (AAR). Elevation correlated negatively with the proportion of blood-fed Phlebotomus females. Male Phlebotomus species composition differed among sites, with all the species found in this study present in AZA, while some species were absent from AAR and KIS. The host blood species engorged by P. sergenti were grouped in four categories: human (45.5%), livestock (25%), avian (19.9%), and dog (9.6%). This study provided information about the spatial and temporal distribution, age and species composition, and host preference of sand fly vectors that influence disease transmission. This information will allow us to better target sand flies, to control the disease, and to monitor risk prone areas.