scieee AI-readable full text Open interactive document viewer

Molecular detection of Leishmania infantum in rats and sand flies in the urban sewers of Barcelona, Spain

Galán Puchades, María Teresa,Solano, Jennifer,González, Gloria,Osuna Carrillo De Albornoz, Antonio

Abstract

Background: Classically, dogs have been considered to be the only reservoir of leishmaniasis in urban areas. However, in a previous study, we found a 33.3% prevalence of Leishmania infantum in the spleens of Norway rats (Rattus norvegicus) sampled in the underground sewer system of the city of Barcelona (Spain). The aim of the present study was to verify, using molecular methods, the potential reservoir role of these rats in the same sewer system. Methods: A sensitive real-time PCR (qPCR) assay, DNA sequencing and phylogenetic analysis were carried out to identify and quantify the presence of L. infantum DNA in sand fly individuals captured in the same underground sewer system of Barcelona as in our previous study and in the spleens and ears of rats captured in the same sewer system. Results: Leishmania infantum DNA was found in 14 of the 27 (51.9%) sand flies identified as Phlebotomus perniciosus, and 10 of the 24 (41.7%) rats studied were infected. Leishmania infantum was found in the spleens (70%) and in the ears (40%) of the infected rats. Quantitative results revealed the presence of high loads of L. infantum in the rats studied (> 3 × 106 parasites/g ear tissue) and among the sand flies (> 34 × 106 parasites in 1 individual). Conclusions: The molecular methods used in this study demonstrated a high prevalence of L. infantum in the undergroundsewer populations of both R. norvegicus and P. perniciosus. These results suggest that sewer rats, in addition to dogs, are likely to act as reservoirs of leishmaniasis in cities, where sewer systems seem to offer the ideal scenario for the transmission of leishmaniasis. Therefore, to achieve the WHO 2030 target on the elimination of leishmaniasis as a public health problem successfully, an efficient control strategy against leishmaniasis in rats and sand flies should be implemented, particularly in the sewer systems of urban areas of endemic countries.

Full text

Galán‑Puchadesetal. Parasites & Vectors (2022) 15:211 https://doi.org/10.1186/s13071‑022‑05309‑4 SHORT REPORT Molecular detection ofLeishmania infantum inrats andsand flies intheurban sewers ofBarcelona, Spain María Teresa Galán‑Puchades1* , Jennifer Solano2, Gloria González2, Antonio Osuna2, Jordi Pascual3, Rubén Bueno‑Marí1,4, Sandra Franco3, Víctor Peracho3, Tomás Montalvo3,5 and Màrius V. Fuentes1 Abstract Background: Classically, dogs have been considered to be the only reservoir of leishmaniasis in urban areas. How‑ ever, in a previous study, we found a 33.3% prevalence of Leishmania infantum in the spleens of Norway rats (Rattus norvegicus) sampled in the underground sewer system of the city of Barcelona (Spain). The aim of the present study was to verify, using molecular methods, the potential reservoir role of these rats in the same sewer system. Methods: A sensitive real‑time PCR (qPCR) assay, DNA sequencing and phylogenetic analysis were carried out to identify and quantify the presence of L. infantum DNA in sand fly individuals captured in the same underground sewer system of Barcelona as in our previous study and in the spleens and ears of rats captured in the same sewer system. Results: Leishmania infantum DNA was found in 14 of the 27 (51.9%) sand flies identified as Phlebotomus perniciosus, and 10 of the 24 (41.7%) rats studied were infected. Leishmania infantum was found in the spleens (70%) and in the ears (40%) of the infected rats. Quantitative results revealed the presence of high loads of L. infantum in the rats stud‑ ied (> 3 × 106 parasites/g ear tissue) and among the sand flies (> 34 × 106 parasites in 1 individual). Conclusions: The molecular methods used in this study demonstrated a high prevalence of L. infantum in the under‑ groundsewer populations of both R. norvegicus and P. perniciosus. These results suggest that sewer rats, in addition to dogs, are likely to act as reservoirs of leishmaniasis in cities, where sewer systems seem to offer the ideal scenario for the transmission of leishmaniasis. Therefore, to achieve the WHO 2030 target on the elimination of leishmaniasis as a public health problem successfully, an efficient control strategy against leishmaniasis in rats and sand flies should be implemented, particularly in the sewer systems of urban areas of endemic countries. Keywords: Leishmania infantum, Phlebotomus perniciosus, Rattus norvegicus, Barcelona sewer system, Underground leishmaniasis © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Background The road map for neglected tropical diseases (NTDs) 2021–2030, elaborated by the WHO and endorsed by the Seventy-third World Health Assembly in November 2020, sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases. These 20 diseases and disease groups, classified as NTDs, have one feature in common: their devastating impact on impoverished communities [1]. Leishmaniasis, a vector-borne Open Access Parasites & Vectors *Correspondence: [email protected] 1 Parasite and Health Research Group, Department of Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, 46100 Burjassot, Valencia, Spain Full list of author information is available at the end of the article Page 2 of 8 Galán‑Puchadesetal. Parasites & Vectors (2022) 15:211 disease transmitted by the bite of phlebotomine females, is caused by 20 Phlebotomus species pathogenic to humans, and the disease ranks among the top ten NTDs worldwide [2]. About 350 million people are at risk of acquiring the disease in 97 endemic countries. In terms of disease burden, in 2019, 277,224 new cases of cutaneous leishmaniasis (CL) and 13,814 of visceral leishmaniasis (VL) (including 491 deaths) were reported in endemic countries [1]. In the Mediterranean basin, of the four Leishmania species present (Leishmania infantum, L. major, L. tropica and L. donovani), L. infantum is predominant and the causative agent of CL, VL and mucocutaneous leishmaniasis [3]. A dozen Phlebotomus species have been implicated in the transmission of Mediterranean L. infantum, of which eight have been implicated as vectors, i.e. Phlebotomus ariasi, P. balcanicus, P. kandelakii, P. langeroni, P. neglectus, P. perfiliewi, P. perniciosus and P. tobbi [4]. In the context of animal reservoirs of L. infantum, dogs are classically considered to be the only vertebrate reservoir of leishmaniasis in urban areas in Mediterranean countries. Consequently, dogs are the only target for disease surveillance and control [5, 6]. Spain is one of the endemic countries of leishmaniasis in the Mediterranean basin [7], with P. perniciosus and P. ariasi being the main vectors of L. infantum, which is endemic in the Iberian Peninsula [4]. Studies in different areas of Spain have reported seroprevalences of canine leishmaniasis (CanL) in dogs varying from 0 to 57.1% [8]. Specifically in Barcelona province, the seroprevalence of CanL has been reported to range from 14.5 to 16.7% [8]. As part of the multifocal project “BCN Rats” program developed in Barcelona (Spain), we investigated and quantified the presence of L. infantum in the spleens of an urban population of the Norway rat (Rattus norvegicus), in a sampled population of 98 individuals, using a highly sensitive real-time PCR (qPCR) method for Leishmania DNA detection. Only one out of 14 (7.1%) rats captured in parks tested positive for L. infantum. However, the prevalence of Leishmania DNA in rats captured from the underground sewage system was 33.3% (28/84 rats) [9]. This was the first time that rats trapped in sewers were analyzed from a parasitological point of view. Thus, when only sewer rats are considered—and not those living above ground—a 0.13 rat-per-person scenario is suspected in Barcelona [10]. Based on this ratio, there could be more than 72,000 L. infantum-positive rats living in the underground sewers in Barcelona, a city with 1,664,182 inhabitants in 2020, representing a major public health concern as a potential reservoir. The criteria to define a reservoir in the case of leishmaniasis were established by WHO in 2010 [11]. Specifically, the reservoir must be abundant and long lived; an intense host-sand fly contact is necessary; Leishmania prevalence should be > 20%; the infection should be non-pathogenic and persistent; and the parasite should be available in blood or skin. Norway rats meet most of these criteria [12]. However, the host-sand fly contact, which can be proved by collecting infected vectors in sewers, and the presence of L. infantum in the skin of the rats, were not proved in our previous study. In the present article, we report evidence showing high levels of L. infantum in sand flies as well as in the skin of the rats by qPCR, in specimens captured in the sewer system of Barcelona. We also demonstrate the presence of high L. infantum loads among sand fly and rat individuals. Methods A total of 609 sand fly individuals were captured with sticky traps in 66 out of the 167 different sections prospected in the underground sewer system of Barcelona (unpublished data). Sampling was mainly carried out at those points in the sewer system where Leishmania parasite prevalences were highest according to our previous study [9]. A total of 25 points was sampled on a weekly basis in August/September 2018. A4-sheets impregnated with castor oil [13] were placed in each sewer section, one at the top of the section and the other at the bottom, in order to capture the maximum number of specimens (Fig.1). Once the traps had been collected, they were kept at 4ºC until treated to separate and identify the phlebotomine sand flies. Individuals separated from the traps by means of a paintbrush were placed in absolute ethanol to remove the castor oil and then stored in 70% ethanol until their subsequent assembly and identification. Twenty-seven randomly selected females of the trapped sand flies were identified by means of morphological keys [14–16]. New individuals of R. norvegicus were also captured with snap traps in the sewage system as part of the rodent surveillance and control program in Barcelona. For the molecular detection of Leishmania spp. in the female sand flies, genomic DNA was extracted from individual phlebotomines by incubation overnight in 500µl of TESCa + pK buffer (30mM Tris–HCl, pH 8, 10mM EDTA, 1% SDS, 5mM CaCl2 and 0.42µg/µl proteinase K). After incubation, an equal volume of a mixture of chloroform:isoamyl alcohol (24:1) was added to the incubation medium, followed by a vortexing step and centrifugation at room temperature for 5min at 14,000rpm. The top aqueous layer was transferred to a different tube and the DNA was precipitated in a 2.5 volume of absolute ethanol. All pellets were dissolved in 10μl of nuclease-free water [17]. The DNA concentration and the absorbance ratio at 260 and 280nm Page 3 of 8 Galán‑Puchadesetal. Parasites & Vectors (2022) 15:211 (A260/280 ratio) were evaluated using a NanoDrop OneC spectrophotometer (Thermo Fisher Scientific, Waltham, MA, USA). DNA extraction quality was evaluated with an internal control PCR, using the primers LCO1490 (5ʹ-GGT CAA CAA ATC ATA AAG ATA TTG G-3ʹ) and HCO2198 (5ʹ-TAA ACT TCA GGG TGA CCA AAA AAT CA-3ʹ), which amplify a cytochrome c oxidase subunit 1 (COI) gene [18]. The presence of a 600- bp band visualized by electrophoresis on a 1% agarose gel confirmed that the extracted DNA was of appropriate PCR amplifiable quality. For the molecular detection of Leishmania spp. in the tissues (ears and spleens) of the Norway rat, total genomic DNA was extracted from approximately 150 mg of ear and 100 mg of spleen samples using the QIAamp Blood and Tissue Kit (QIAGEN, Hilden, Germany), according to the manufacturer’s instructions. Each DNA sample was eluted in 200μl of nuclease-free water and frozen at − 20°C until use. The concentration and quality of the DNA obtained from these tissues were determined on a NanoDrop OneC spectrophotometer (Thermo Fisher Scientific). The primer pair ACTBF 5ʹ-TCC ATC ATG AAG TGT GAC GT-3ʹ and ACTBR 5ʹGAG CAA TGA TCT TG ATC TTC AT-3ʹ was used to detect the beta-actin gene as a system control check; the presence of a 150-bp band confirmed that the extracted DNA was of appropriate PCR amplifiable quality [19]. Leishmania spp. DNA was detected by qPCR using the primers LEISH-1 (5-AAC TTT TCT GGT CCT CCG GGTAG-3), LEISH-2 (5-ACC CCC AGT TTC CCGC C-3) and the TaqMan-MGB probe (FAM-5-AAA AAT GGG TGC AGA AAT -3-non-fluorescent quencher-MGB) [20]. Each PCR reaction volume contained 1µl of template DNA and a reaction master mix [2× SsoAdvanced Universal Probes Supermix (Bio-Rad Laboratories, Hercules, CA, USA), 0.9µM of each primer and 0.2µM of probe]. All qPCR assays were run with appropriate controls, including the non-template control (NTC) and positive control (DNA obtained from L. majorFriedlin strain MHOM/IL/80/Friedlin;V1). Thermocycling conditions included an initial denaturation step of 4min at 94ºC, followed by 40 cycles of 95°C for 15s and 60°C for 1min. The qPCR was carried out in the CFX96 real-time PCR detection system (Bio-Rad Laboratories). Threshold cycle (Ct) values were calculated automatically by CFX Manager 3.1 software (Bio-Rad Laboratories) using default parameters. The number of parasites was calculated using 123-bp fragments amplified by the LEISH 1 and LEISH 2 primers and based on the mass of the Leishmania genome (71.8fg) and the number of copies of the histone H2B gene (1000 copies). Standard curves were constructed in triplicate by serial dilutions of genomic DNA from L. infantum promastigotes (reference strain: MHOM/BR/1974/PP75) with the dilution factor increasing by 10 to 10–7 (1.10 × 107 parasites). The parasite number was determined by interpolating the mean of Ct) values of the samples in the standard curves. Some results were repeated three more times for validation purposes. The mean and standard deviation of Ct values of each standard curve dilution were calculated using the GraphPad Instat software package (GraphPad Software Inc., San Diego, CA, USA). Leishmania species were identified by amplifying the coding region of heat shock protein 70 (HSP70) using the 70-IR-D (5ʹ-CCA AGG TCG AGG AGG TCG AC TA-3ʹ) and 70-IR-M (5’-ACG GGT AGG GGG AGG AAA GA-3ʹ) primers [21]. The PCR products that generated Fig. 1 Sticky traps placed in the Barcelona sewer system Page 4 of 8 Galán‑Puchadesetal. Parasites & Vectors (2022) 15:211 amplification bands of approximately 700bp were examined by electrophoresis in agarose gels and purified using NucleoSpin Gel and PCR Clean-up procedure (MACCHEREY-NAGEL, Düren, Germany), according to the manufacturer’s instructions. DNA sequencing was carried out in the Genomics Unit IPBLN of López Neyra Institute, CSIC, Granada. DNA sequencing of the amplified product was submitted to the BLAST (NIH) database. Results anddiscussion The selected sand fly females were identified as Phlebotomus perniciosus, the most abundant sand fly vector in Spain [8], which, in addition to P. ariasi, has been credited as a competent vector of L. infantum in the Iberian Peninsula [22]. The presence of these two main leishmaniasis vectors is known due to the monitoring of the city of Barcelona by ASPB (Agència de Salut Pública de Barcelona), the institution responsible for vector surveillance and control in the city [23]. The sequence of the 3’-untranslated region (UTR) is shown in Additional file1: (Figure S1). The results of the NCBI BLAST analysis of this sequence verified that the amplicon corresponded to a non-transcribed region of the UTR of HSP70 (700bp) corresponding to chromosome 28 of Leishmania infantum, with a 61% coverage and an E of 2.00E−156 and a percentage of identity of 89.86%. Similar values were obtained for Leishmania chagasi. A phylogenetic tree was created with the same program (Additional file2: Figure S2), showing how the amplified region corresponds to L. infantum /L. chagasi with a high identity. Leishmania infantum DNA was detected in 14 out of the 27 (51.9%) sand fly individuals analyzed. The quantitative results obtained by the qPCR method for the infected P. perniciosus are shown in Table 1. Regarding parasite loads, sand flies captured in a leishmaniasis focus near Madrid (Spain) were classified into different groups [24]. According to our results, most of the sand flies (85.7%) presented moderate loads (between 10 and 1000 parasites) [24]. However, in the Madrid focus, the highest parasite load found, considered to be a very high load, was about 100,000 parasites. In our study, we detected an individual of P. perniciosus with a parasite load of > 1,500,000 and another one with an extraordinary parasite load of > 34,000,000 (Table1) (Additional file3: FiguresS3, S4). Leishmania infantum infection was also investigated in 24 individuals of R. norvegicus. L. infantum wasfound to be present in 10 out of the 24 rats(41.7%) studied. The protozoan was found in the spleens of seven of the sampled rats (i.e. in 70% of the infected rats). Leishmania infantum was also found in the ears of four rats (i.e. 40% of the Leishmania-positive ones). Table 2 shows the respective qPCR quantitative results in R. norvegicus obtained in the spleens and ears of the Leishmaniapositive individuals (Additional file 4: Figures S5, S6; Additional file5: FiguresS7, S8). One of the rats was determined to have an estimated load of > than 430,000 parasites per 150 mg ear tissue (R. norvegicus no. 8 in Table2). In six Norway rats the protozoan was present only in the spleen (rat ID numbers 2–7 in Table2). One rat presented Leishmania in the spleen and the ear (rat number 1 in Table2), and three only in the ears (rat numbers 8–10 in Table2). Despite the limitations of thisstudy, the most important of which are the low number of sand flies/rats analyzed andthe limited period of time in which the sampling was carried out, the results obtained are relevant. Taking into account both the high percentage of L. infantum-infected rats in the Barcelona underground sewer system [9] and the suitability of the sewers as a breeding site for sand flies [4], we expected a positive result for L. infantum in the phlebotomines studied, although not at such a high rate (51.9%). Data on the prevalence of L. infantum in sand flies in urban areas of the Mediterranean basin are scarce. In Spain, entomological surveys carried out in four municipalities in the province of Madrid (considered a focus of human leishmaniasis) revealed a P. perniciosus prevalence Table 1 Real‑time PCR results for the 14 Leishmania infantum‑ positive Phlebotomus perniciosus individuals captured in the Barcelona underground sewer system Cut‑off established for a positive result: Ct values < 36 a Values are the mean of the three replicates of each sample P. perniciosus ID numbers qPCR resultsaEstimated n of parasites Standard deviation Ct 1 32.10 157.18 17.88 2 31.62 220.37 40.32 3 30.81 371.93 24.20 4 32.35 134.98 32.22 5 29.38 979.45 65.34 6 33.97 65.57 28.05 7 18.31 1,528,989.74 446,327.06 8 13.84 34,005,842.84 6,927,767.90 9 32.10 157.18 17.88 10 31.62 220.37 40.32 11 30.81 371.93 24.20 12 32.35 134.98 32.22 13 29.38 979.45 65.34 14 33.97 65.57 28.06 Page 5 of 8 Galán‑Puchadesetal. Parasites & Vectors (2022) 15:211 of 8.9% over a 7-year period, with the highest infection rate, 15.2%, in Leganés, one of the towns included in the study [25]. Likewise, in the cities of Marseille (France) and Catania (Sicily, Italy), a prevalence of 5% and 11% Leishmania DNA was found in 72 and 99 P. perniciosus, respectively [26, 27]. A prevalence of 58.5% was found in P. perniciosus in a peri-urban area of Madrid, related to the human leishmaniasis focus mentioned above [28]. Most of the remaining data on L. infantum prevalences in Phlebotomus spp. in Spain were obtained in rural areas. For example, 12 out of 31 P. perniciosus (38.7%) were found to be infected by L. infantum in a study conducted in Catalonia [29]. A prevalence of 12.5% (8 positive individuals from 64 P. perniciosus analyzed) was found in a recent study in south-eastern Spain [30]. However, these values are notably higher (up to 58.5%) when studies focus on areas of Leishmania outbreaks [22]. Prevalences found in rural areas of other countries of the Mediterranean basin are low, varying between 0.1% and 15% [31–33]. The prevalences are also higher and vary between 37.6% and 60.5% in high endemic areas of leishmaniasis in Tunisia and Italy [34–36]. The high prevalence of L. infantum found in the sand flies from the underground Barcelona sewers in our study is consistent with those found in active leishmaniasis foci in the Mediterranean basin. Regarding the quantitative results, to our knowledge, the highest L. infantum parasite load detected in previous studies in naturally infected sand flies was 2,820,246 ± 106,072 in an individual of Lutzomyia longipalpis in Brazil [37]. We detected a load of 1,528,989.74 ± 446,327.06 in a sand fly (number 7, Table 1) and an astounding parasite load of 34,005,842.84 ± 6,927,767.90 in another P. perniciosus individual (number 8, Table1). Regarding the results obtained in the rats studied, although the leishmaniasis prevalence was higher than that obtained in our previous study, the difference is not statistically significant (41.7 vs. 33.3%; χ2 = 0.262, df = 1, P = 0.4748). It is worth mentioning that, in addition to the spleens, L. infantum was also detected in the ears of 40% of the infected rats. One of the rats studied harbored a load of 3,089,047 ± 579,268 parasites/g ear tissue (number 8, Table2). Ear skin, in addition to blood, is directly accessible to sand flies, which preferentially feed on certain body parts, such as the ears and nose [38]. An experimental infection revealed persistent parasite depots at bite sites in dog skins [38]. The large number of parasites we found in the ear of the rat probably represents one of these depots in a naturally infected R. norvegicus. CanL has always been considered to be a public health problem in endemic countries based on evidence that cases of CanL are known to precede human cases of the disease, and it is well known that dogs act as a reservoir [3, 4]. Therefore, leishmaniasis in dogs undoubtedly plays an important role in the maintenance of transmission levels and the spread of the disease, specifically in urban areas [39, 40]. In fact, culling dogs, although controversial, seems to be the only effective reservoir control method available to date [41]. However, the control measures taken specifically in urban areas that have involved the euthanasia of seropositive dogs [39, 42] did Table 2 Real Time PCR results for the spleens and ears of the 10 Leishmania infantum‑positive Rattus norvegicus captured in the Barcelona sewer system Cut‑off established for a positive result: Ct values < 36 a Mean values of the three replicates of each sample Rattus norvegicus ID numbers qPCR results a R. norvegicus spleens Ct Estimated n of parasites/100 mg Standard deviation 1 35.45 6.71 2.34 2 35.24 8.43 2.22 3 28.06 794.89 74.66 4 35.24 8.43 2.22 5 35.07 29.43 3.49 6 23.10 20,156.21 1,987.96 7 30.06 445.04 38.93 R. norvegicus ears Ct Estimated n of parasites/150 mg tissue Standard deviation 1 29.82 1222.35 242.37 8 18.09 430,119.63 86,890 9 34.87 10.66 2.32 10 33.86 84.33 37.63 Page 6 of 8 Galán‑Puchadesetal. Parasites & Vectors (2022) 15:211 not modify the incidence of leishmaniasis in humans and dogs, suggesting the possible involvement of other reservoirs of infection [43]. Regarding sand flies, urban environments in Spain had previously not been considered suitable for P. perniciosus [22]. Our studies clearly demonstrate the importance of the trapping site for finding a large number of Leishmania-infected sand flies and rats. To our knowledge, the present study is the first and only study to date to assess the presence of L. infantum in rats living in underground sewage systems of urban areas, where intense contacts between rat and sand fly individuals have apparently led to a high prevalence of leishmaniasis, in turn potentiated by the presence of heavy parasite loads in certain hosts. The identification of L. infantum in naturally infected sand flies is important for predicting the risk and expansion of leishmaniasis in endemic areas [29]. The high prevalence of natural L. infantum infection in a small sample of P. perniciosus trapped in sewers, as detailed in the present study, represents a clear risk of transmission, not only to dogs, but also to the human population. It is important to note that sand flies can find suitable ways to move from sewers to urban surfaces, since they are able to use open structures that connect both types of environments, such as catch basins or storm drains, among others. Once sand flies arrive at the surface, they can also bite humans/dogs close to urban green areas, as opportunistic blood feeding patterns have been demonstrated in P. perniciosus, including anthropophilic behavior [25]. Miró and López-Vélez [5] predicted in 2018 that “In the near future, we are likely to find new animal reservoirs to which special attention will have to be paid as these could even further complicate the epidemiological situation of human and animal leishmaniosis”. Recent epidemiological studies of leishmaniasis carried out in the city of Barcelona showed that autochthonous transmission occurs and is even on the increase [4, 44]. According to the results of the present study, the Norway rat R. norvegicus is likely to be this new reservoir, as we already indicated in our previous study [9], and, in addition to dogs, could be sustaining leishmaniasis levels in urban areas. Sewer rat populations are important to humans since they could act both as a reservoir of individuals to recolonize the surface after successful control actions and as reservoirs, not only of leishmaniasis but also of other parasitic zoonoses [10, 45, 46]. In fact, the rat harboring the highest L. infantum load was also infected by three other parasitic zoonotic agents (Hymenolepis nana, H. diminuta and Taenia taeniaeformis larvae) (unpublished data). The obvious complexity of L. infantum control in rats represents a challenge, particularly in the COVID- 19 scenario in which, in addition to a disruption in the leishmaniasis control programs [47, 48], an increase in rat populations has been observed in several cities due to lockdowns and the interruption of control measures [49, 50]. Conclusions This is the first report of high molecular levels of leishmaniasis in sand flies captured in urban sewers and the first time L. infantum has been detected, in addition to in the spleen, also in the ears of infected rats captured in the same underground sewer system of the city of Barcelona. We found, among both sand flies and rats, high parasite loads in certain individuals. As a result, Norway rats, in addition to dogs, are likely to act as reservoirs of leishmaniasis in cities where the sewer systems seem to offer the ideal scenario for leishmaniasis transmission. Therefore, to achieve the WHO 2030 target on the elimination of leishmaniasis as a public health problem successfully, an efficient control strategy against leishmaniasis in rats and sand flies should be implemented, particularly in the sewer systems of urban areas of endemic countries. Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s13071‑ 022‑ 05309‑4. Additional file1: Sequence of the 3’‑UTR region. Figure S1. The 3’‑UTR region of the HSP70 gene was amplified with primers 70‑IR‑D (5’‑ CCA AGG TCG AGG AGG AGG TCGAC TA‑3’) and 70‑IR‑M (5’‑ACG GGT AGG GGG GGA GGA AAGA‑3’). Additional file2: Phylogenetic analysis. Figure S2. Phylogenetic tree using 3’‑UTR sequences of the HSP70 gene. Additional file3: Sand flies. Figure S3. Standard curve of L. infantum DNA. Standard curve obtained from serial dilutions of L. infantum DNA (108 to 101 parasites). Each point was tested in triplicate. Slope = — 3.70; efficacy = 98 %; R2 = 0.991. Figure S4. Amplification curves. The plot showing the dilution of DNA concentrations (8 to 8 × 10‑7 ng). Additional file4: Rat spleens. Figure S5. Standard curve of L. infantum DNA. Standard curve obtained from a series of dilutions of L. infantum DNA (108 to 101 parasites). Each point was tested in triplicate. Slope = ‑3.367; efficacy = 98.2%; R2 = 0.998. Figure S6. Amplification curves. The plot showing the dilution of DNA concentrations (8–8 × 10‑7 ng). Additional file 5: Rat ears. Figure S7. Standard curve of L. infantum DNA. Standard curve obtained from a series of dilutions of L. infantum DNA (108 to 101 parasites). Each point was tested in triplicate. Slope = ‑3.47; efficacy = 94.1%; R2 = 0.998. Figure S8. Amplification curves. The plot showing the dilution of DNA concentrations (8 to 8 × 10‑7 ng). Author contributions MTGP, AO and MVF designed the study. JP, RBM, SF, VP and TM conducted the field work. JS, GG, AO, MVF conducted the laboratory work. MTGP prepared the manuscript. AO, MVF, RBM, JP, VP, TM contributed to the discussion and improvement of the manuscript. All authors read and approved the final manuscript. Availability of data and materials Materials and data supporting our findings and conclusions are included in the article. The GenBank accession number of the submitted nucleotide sequence is ON364134. Page 7 of 8 Galán‑Puchadesetal. Parasites & Vectors (2022) 15:211 Declarations Ethics approval and consent to participate Permission to carry out the study was granted by the Department of Territory and Sustainability of the regional government of Catalonia (reference number: SF/044). Rats were treated according to Directive 2010/63/EU of the European Parliament and Council decision of 22nd September 2010 on the protection of animals used for scientific purposes. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details 1 Parasite and Health Research Group, Department of Pharmacy, Pharmaceuti‑ cal Technology and Parasitology, Faculty of Pharmacy, University of Valencia, 46100 Burjassot, Valencia, Spain. 2 Molecular Biochemistry and Parasitology Research Group, Department of Parasitology, Institute of Biotechnology, Faculty of Sciences, University of Granada, 18071 Granada, Spain. 3 Pest Sur veil‑ lance and Control, Agència de Salut Pública de Barcelona (ASPB), 08023 Bar‑ celona, Spain. 4 Department of Research and Development, Laboratorios Lokímica, 46980 Paterna, Valencia, Spain. 5 BiomedicalResearch Center Network for Epidemiology and Public Health CIBERESP Epidemiology and Public Health, 08023 Barcelona, Spain. Received: 14 December 2021 Accepted: 4 May 2022 References 1. WHO. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. 2021. https:// www. who. int/ publi catio ns/i/ item/ 97892 40010 352. Accessed Nov 2021. 2. Akhoundi M, Kuhls K, Cannet A, Votypka J, Marty P, Delanuy P, et al. A historical overview of the classification, evolution, and dispersion of Leishmania parasites and sandflies. PLoS Negl Trop Dis. 2016;10:1–40. https:// doi. org/ 10. 1371/ journ al. pntd. 00043 49. 3. Alcover MM, Riera MC, Fisa R. Leishmaniosis in rodents caused by Leishmania infantum: a review of studies in the Mediterranean area. Front Vet Sci. 2021;8:702687. https:// doi. org/ 10. 3389/ fvets. 2021. 702687. 4. Palma D, Mercuriali L, Figuerola J, Montalvo T, Bueno‑Marí R, Millet J‑P, et al. Trends in the epidemiology of Leishmaniasis in the City of Barcelona (1996–2019). Front Vet Sci. 2021;8:653999. https:// doi. org/ 10. 3389/ fvets. 2021. 653999. 5. Miró G, López‑Vélez R. Clinical management of canine leishmaniosis versus human leishmaniasis due to Leishmania infantum: Putting “One Health” principles into practice. Vet Parasitol. 2018;154:151–9. https:// doi. org/ 10. 1016/j. vetpar. 2018. 03. 002. 6. Valero NNH, Uriarte M. Environmental and socioeconomic risk factors associated with visceral and cutaneous leishmaniasis: a systematic review. Parasitol Res. 2020;119:365–84. https:// doi. org/ 10. 1007/ s00436‑ 019‑ 06575‑5. 7. WHO. The Global Health Observatory. Leishmaniasis. 2021. https:// www. who. int/ data/ gho/ data/ themes/ topics/ topic‑ detai ls/ GHO/ leish mania sis. Accessed November 2021. 8. Gálvez R, Montoya A, Cruz I, Fernández C, Martín O, Checa R, et al. Latest trends in Leishmania infantum infection in dogs in Spain .Part I: mapped seroprevalence and sand fly distributions. Parasit Vectors. 2020;13:204. https:// doi. org/ 10. 1186/ s13071‑ 020‑ 04081‑7. 9. Galán‑Puchades MT, Gómez‑Samblás M, Suárez‑Morán JM, Osuna A, Sanxis‑Furió J, Pascual J, et al. Leishmaniasis in Norway rats in sewers, Barcelona Spain. Emerg Infect Dis. 2019;25:1222–4. https:// doi. org/ 10. 3201/ eid25 06. 181027. 10. Pascual J, Franco S, Bueno‑Marí R, Peracho V, Montalvo T. Demography and ecology of Norway rats, Rattus norvegicus, in the sewer system of Barcelona (Catalonia, Spain). J Pest Sci. 2020;93:711–22. https:// doi. org/ 10. 1007/ s10340‑ 019‑ 01178‑6. 11. WHO. Control of the Leishmaniases. WHO Technical Report Series no. 949. 2010. https:// apps. who. int/ iris/ bitst ream/ handle/ 10665/ 44412/ WHO_ TRS_ 949_ eng. pdf; jsess ionid= DFE10 7FC21 06DCA 57A9B F8054 3F920 5C? seque nce=1. Accessed Oct 2021. 12. Galán‑Puchades MT, Fuentes MV. On the reservoirs of Leishmania infan‑ tum in urban areas. Vet Parasitol. 2021;293:109408. https:// doi. org/ 10. 1016/j. vetpar. 2021. 109408. 13. Arnedo A, Bellido J, González F, Arias A, Calvo C, Safont L, et al. Leishma‑ niasis en Castellón: Estudio epidemiológico de los casos humanos, vector y reservorio canino. Rev Sanidad Hig Pública. 1994;68:481–91 (in Spanish). 14. Gil Collado J, Morillas F, Sanchís MC. Los flebotomos en España. Rev Sanid Hig Pública. 1989;1989:15–34. 15. Gállego‑Berenguer J, Botet‑Fregola J, Gállego‑Culleré M, Portús‑Vinyeta M. Los flebotomos de la España peninsular e Islas Baleares: identificación y corología: comentarios sobre los métodos de captura. In: Hernández S, editor. In Memoriam al Profesor Dr. D F de P Martínez Gómez. Cordoba: University of Cordoba; 1992. p. 581–600 (in Spanish). 16. Dantas‑Torres F, Tarallo VD, Otranto D. Morphological keys for the identifi‑ cation of Italian phlebotomine sand flies (Diptera: Psychodidae: Phleboto‑ minae). Parasit Vectors. 2014;7:479. https:// doi. org/ 10. 1186/ s13071‑ 014‑ 0479‑ 5,10. 1186/ s13071‑ 020‑ 04081‑7. 17. Caligiuri LG, Sandoval AE, Miranda JC, Pessoa FA, Santini MS, Salomón OD, et al. Optimization of DNA extraction from individual sand flies for PCR amplification. Methods Protoc. 2019;2:36. https:// doi. org/ 10. 3390/ mps20 20036. 18. Folmer O, Black M, Hoeh W, Lutz R, Vrijenhoek R. DNA primers for ampli‑ fication of mitochondrial cytochrome c oxidase subunit I from diverse metazoan invertebrates. Mol Mar Biol Biotechnol. 1994;3:294–9. 19. Yin R, Tian F, Frankenberger B, de Angelis MH, Stoeger T. Selection and evaluation of stable housekeeping genes for gene expression normaliza‑ tion in carbon nanoparticle‑induced acute pulmonary inflammation in mice. Biochem Biophys Res Commun. 2010;399:531–6. https:// doi. org/ 10. 1016/j. bbrc. 2010. 07. 104. 20. Francino O, Altet L, Sánchez‑Robert E, Rodriguez A, Solano‑Gallego L, Alberola J, et al. Advantages of real‑time PCR assay for diagnosis and monitoring of canine leishmaniosis. Vet Parasitol. 2006;137:214–21. 21. Requena JM, Chicharro C, García L, Parrado R, Puerta CJ, Cañavate C. Sequence analysis of the 3’‑untranslated region of HSP70 (type I) genes in the genus Leishmania: its usefulness as a molecular marker for spe‑ cies identification. Parasit Vectors. 2012;5:87. https:// doi. org/ 10. 1186/ 1756‑ 3305‑5‑ 87. 22. Bravo‑Barriga D, Parreira R, Maia C, Alfonso MO, Blanco‑Ciudad J, Serrano FJ, et al. Detection of Leishmania DNA and blood meal sources in phle‑ botomine sand flies (Diptera: Psychodidae) in western of Spain: update on distribution and risk factors associated. Acta Trop. 2016;164:414–24. https:// doi. org/ 10. 1016/j. actat ropica. 2016. 10. 003. 23. Agència de Salut Pública de Barcelona. Memoria d’activitat del Servei deVigilància i Control de Plagues Urbanes. 2018. https:// www. aspb. cat/ arees/ plagu es‑ urban es/ vigil ancia‑i‑ contr ol‑ de‑ plagu esamb ienta ls/. Accessed Sept 2021. 24. González E, Alvarez A, Ruiz S, Molina R, Jimenez M. Detection of high Leishmania infantum loads in Phlebotomus perniciosus captured in the leishmaniasis focus of southwestern Madrid region (Spain) by real time PCR. Acta Trop. 2017;171:68–73. https:// doi. org/ 10. 1016/j. actat ropica. 2017. 03. 023. 25. González E, Molina R, Iriso A, Ruiz S, Aldea I, Tello A, et al. Opportunistic feeding behaviour and Leishmania infantum detection in Phlebotomus perniciosus females collected in the human leishmaniasis focus of Madrid, Spain (2012–2018). PLoS Negl Trop Dis. 2021;15:e0009240. https:// doi. org/ 10. 1371/ journ al. pntd. 00092 40. 26. Faucher B, Piarroux R, Mary C, Bichaud L, Charrel R, Izri A, et al. Presence of sandflies infected with Leishmania infantum and Massilia virus in the Marseille urban area. Clin Microbiol Infect. 2014;20:340–3. https:// doi. org/ 10. 1111/ 1469‑ 0691. 12404. 27. Lisi O, D’Urso V, Vaccalluzzo V, Bongiorno G, Khoury C, Severini F, et al. Persistence of phlebotomine Leishmania vectors in urban sites of Catania (Sicily, Italy). Parasit Vectors. 2014;7:560. https:// doi. org/ 10. 1186/ s13071‑ 014‑ 0560‑0. 28. Jiménez M, González E, Iriso A, Marco E, Alegre A, Fuster F, et al. Detection of Leishmania infantum and identification of blood meals in Phlebotomus Page 8 of 8 Galán‑Puchadesetal. Parasites & Vectors (2022) 15:211 • fast, convenient online submission • thorough peer review by experienced researchers in your field • rapid publication on acceptance • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year • At BMC, research is always in progress. Learn more biomedcentral.com/submissions Ready to submit your research Ready to submit your research ? Choose BMC and benefit from: ? Choose BMC and benefit from: perniciosus from a focus of human leishmaniasis in Madrid Spain. Parasitol Res. 2013;112:2453–9. https:// doi. org/ 10. 1007/ s00436‑ 013‑ 3406‑3. 29. Alcover MM, Gramiccia M, Di Muccio T, Ballart C, Castillejo S, Picado A, et al. Application of molecular techniques in the study of natural infec‑ tion of Leishmania infantum vectors and utility of sandfly blood meal digestion for epidemiological surveys of leishmaniasis. Parasitol Res. 2012;111:515–23. https:// doi. org/ 10. 1007/ s00436‑ 012‑ 2863‑4. 30. Martínez‑Sánchez J, Torres‑Medina N, Morillas‑Márquez F, Corpas‑López V, Díaz‑Sáez. Role of wild rabbits as reservoirs of leishmaniasis in a non‑ epidemic Mediterranean hot spot in Spain. Acta Trop. 2021;222:106036. https:// doi. org/ 10. 1016/j. actat ropica. 2021. 106036. 31. Léger N, Gramiccia M, Gradoni L, Madulo‑Leblond G, Pesson B, Ferté H, et al. Isolation and typing of Leishmania infantum from Phlebotomus neglectus on the island of Corfu, Greece. Trans R Soc Trop Med Hyg. 1988;82:419–20. https:// doi. org/ 10. 1016/ 0035‑ 9203(88) 90145‑9. 32. Maroli M, Gramiccia M, Gradoni L, Troiani M, Ascione R. Natural infection of Phlebotomus perniciosus with MON 72 zymodeme of Leishmania infantum in the Campania region of Italy. Acta Trop. 1994;57:333–5. https:// doi. org/ 10. 1016/ 0001‑ 706X(94) 90079‑5. 33. Velo E, Bongiorno G, Kadriaj P, Myrseli T, Crilly J, Lika A, et al. The current status of phlebotomine sand flies in Albania and incrimination of Phlebotomus neglectus (Diptera, Psychodidae) as the main vector of Leishmania infantum. PLoS ONE. 2017;12:e0179118. https:// doi. org/ 10. 1371/ journ al. pone. 01791 18. 34. Remadi L, Chargui N, Jiménez M, Molina R, Haouas N, González E, et al. Molecular detection and identification of Leishmania DNA and blood meal analysis in Phlebotomus (Larroussius) species. PLoS Negl Trop Dis. 2020;14:e0008077. https:// doi. org/ 10. 1371/ journ al. pntd. 00080 77. 35. Rossi E, Bongiorno G, Ciolli E, Di Muccio T, Scalone A, Gramiccia M, et al. Seasonal phenology, host‑blood feeding preferences and natural Leishmania infection of Phlebotomus perniciosus (Diptera Psychodidae) in a high‑endemic focus of canine leishmaniasis in Rome province Italy. Acta Trop. 2008;105:158–65. https:// doi. org/ 10. 1016/j. actat ropica. 2007. 10. 005. 36. Latrofa MS, Iatta R, Dantas‑Torres F, Annoscia G, Gabrielli S, Pombi M, et al. Detection of Leishmania infantum DNA in phlebotomine sand flies from an area where canine leishmaniosis is endemic in southern Italy. Vet Parasitol. 2018;253:39–42. https:// doi. org/ 10. 1016/j. vetpar. 2018. 02. 006. 37. Rodrigues ACM, Silva RA, Melo LM, Luciano MSC, Bevilaqua CML. Epide‑ miological survey of Lutzomyia longipalpis infected by Leishmania infantum in an endemic area of Brazil. Rev Bras Parasitol Vet. 2014;23:55–62. 38. Aslan H, Oliveira F, Meneses C, Castrovinci P, Gomes R, Teixeira C, et al. New insights into the transmissibility of Leishmania infantum from dogs to sand flies: experimental vector‑transmission reveals persistent parasite depots at bite sites. J Infect Dis. 2016;213:1752–61. https:// doi. org/ 10. 1093/ infdis/ jiw022. 39. Vaz TP, Gama‑Melo MO, Quaresma PF, Gontijo CMF, Barbosa FS, Fontes G. Evaluation of the euthanasia of seropositive dogs for canine visceral leish‑ maniasis as the only method of controlling the disease in the enzootic area in the Midwestern Minas Gerais Brazil. Pesqui Vet Bras. 2020;40:107– 12. https:// doi. org/ 10. 1590/ 1678‑ 5150‑ PVB‑ 6165. 40. Wamai RG, Kahn J, McGloin J, Ziaggi G. Visceral leishmaniasis: a global overview. J Glob Health Sci. 2020;2:e3. https:// doi. org/ 10. 35500/ jghs. 2020.2. e3. 41. Sasidharan S, Saudagar P. Leishmaniasis: where are we and where are we heading. Parasitol Res. 2021;120:1541–54. https:// doi. org/ 10. 1007/ s00436‑ 021‑ 07139‑2. 42. Dietze R, Barros GB, Teixeira L, Harris J, Michelson K, Falqueto A, et al. Effect of eliminating seropositive canines on the transmission of visceral leishmaniasis in Brazil. Clin Infect Dis. 1997;25:1240–2. 43. Palatnik‑de‑Sousa CB, Day MJ. One Health: the global challenge of epi‑ demic and endemic leishmaniasis. Parasit Vectors. 2011;4:197. https:// doi. org/ 10. 1186/ 1756‑ 3305‑4‑ 197. 44. Silgado A, Armas M, Sánchez‑Montalvá A, Goterris L, Ubals M, Temprana‑ Salvador J, et al. Changes in the microbiological diagnosis and epidemiol‑ ogy of cutaneous leishmaniasis in real‑time PCR era: a six‑year experience in a referral center in Barcelona. PLoS Negl Trop Dis. 2021;15:e0009884. https:// doi. org/ 10. 1371/ journ al. pntd. 00098 84. 45. Galán‑Puchades MT, Sanxis‑Furio J, Pascual JM, Bueno‑Marí R, Franco S, Peracho V, et al. First survey on zoonotic helminthiases in urban Norway rats (Rattus norvegicus) in Spain and associated public health considerations. Vet Parasitol. 2018;259:49–52. https:// doi. org/ 10. 1016/j. vetpar. 2018. 06. 023. 46. Galán‑Puchades MT, Trelis M, Sáez‑Durán S, Cifre S, Gosálvez C, Sanxis‑ Furio J, et al. One health approach to zoonotic parasites: molecular detec‑ tion of intestinal protozoans in an urban population of Norway Rats, Rattus norvegicus, in Barcelona Spain. Pathogens. 2021;10:311. https:// doi. org/ 10. 3390/ patho gens1 00303 11. 47. Dahl EH, Hamdan HM, Mabrouk L, Matendechero SH, Mengistie TB, Elhag MS, et al. Control of visceral leishmaniasis in East Africa: fragile progress, new threats. BMJ Glob Health. 2021;6:e006835. https:// doi. org/ 10. 1136/ bmjgh‑ 2021‑ 006835. 48. WHO. Impact of the COVID‑19 pandemic on seven neglected tropical diseases: a model‑based analysis. 2021. https:// apps. who. int/ iris/ handle/ 10665/ 343993. Accessed Nov 2021. 49. Bedoya‑Pérez MA, Ward MP, Loomes M, McGregor IS, Crowther MS. The effect of COVID19 pandemic restrictions on an urban rodent population. Sci Rep. 2021;11:12957. https:// doi. org/ 10. 1038/ s41598‑ 021‑ 92301‑0. 50. Parsons MH, Richardson JL, Kiyokawa Y, Stryjek R, Corrigan RM, Deutsch MA, et al. Rats and the COVID‑19 pandemic: considering the influence of social distancing on a global commensal pest. J Urban Ecol. 2021;7:1–8. https:// doi. org/ 10. 1093/ jue/ juab0 27. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub‑ lished maps and institutional affiliations.