title: Seroepidemiology and molecular diversity of Leishmania donovani complex in Georgia.
abstract: Leishmaniasis includes multiple clinical syndromes, most notably visceral, cutaneous, and mucosal forms. Visceral leishmaniasis (VL), also known as kala-azar, is a potentially fatal disease endemic to large parts of Africa and Asia, and in South-Eastern Europe (Greece, Turkey, Georgia). Visceral leishmaniasis is a parasitic zoonosis caused by species of the L. donovani complex. In the classical epidemiological model the main reservoir for VL are canines.
  
  
  
  The study included a cohort of 513 individuals of both genders (190 males and 323 females) from the ages of 1 to 70 years that were screened in ten villages across two districts in Kakheti using the Kalazar Detect™ rK39 rapid diagnostic test. The phylogenetic diversity patterns of local strains, based on the rDNA internal transcribed spacer (ITS) sequences, were assessed for samples obtained from patients with suspected L. donovani infection, from canine reservoirs and from Phlebotomus sand flies obtained from different geographical areas of Georgia and from Azerbaijan.
  
  
  
  Out of a total of 600 domestic dog blood samples 95 (15.8 %) were positive by rK39 rapid diagnostic tests. For symptomatic domestic dogs, the testing of conjunctival swabs or bone marrow aspirates revealed a higher VL incidence in Kvareli District (Kvareli; 19.4 %, n = 329) compared with that observed for Sagarejo District (Sagarejo; 11.4 %, n = 271). A total of 231 sand flies of both genders were collected during the 2-month period; of the 114 females, 1.75 % were PCR positive for the presence of Leishmania spp.
  
  
  
  VL infection rates remain high in both canines and humans in Georgia, with disease in several known natural foci. The genetic relationships derived from rDNA internal transcribed spacer (ITS) sequence comparisons identified genetic subgroups, revealing preliminary insights into the genetic structure of L. donovani complex members currently circulating in the South Caucasus and demonstrates the utility of ITS-based genotyping in the resource-limited country of Georgia.
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia. gbabuadze@ncdc.ge.|Ilia State University, Tbilisi, Georgia. gbabuadze@ncdc.ge.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Babuadze
authors.affiliation: Farlow Scientific Consulting Company, Lewiston, UT, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Farlow
authors.affiliation: Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G43 2DX, UK.
authors.forename: Harry P
authors.initials: HP
authors.lastname: de Koning
authors.affiliation: Unit of Leishmaniasis and Chagas Disease, WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Institute of Health Carlos III, Madrid, Spain.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Carrillo
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Chakhunashvili
authors.affiliation: Ilia State University, Tbilisi, Georgia.
authors.forename: Mari
authors.initials: M
authors.lastname: Murskvaladze
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Merab
authors.initials: M
authors.lastname: Kekelidze
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Irakli
authors.initials: I
authors.lastname: Karseladze
authors.affiliation: S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia.
authors.forename: Nora
authors.initials: N
authors.lastname: Kokaia
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Irine
authors.initials: I
authors.lastname: Kalandadze
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: David
authors.initials: D
authors.lastname: Tsereteli
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Ivane
authors.initials: I
authors.lastname: Markhvashvili
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Ketevan
authors.initials: K
authors.lastname: Sidamonidze
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Gvantsa
authors.initials: G
authors.lastname: Chanturia
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Ekaterine
authors.initials: E
authors.lastname: Adeishvili
authors.affiliation: National Center for Disease Control and Public Health of Georgia, 9 M. Asatiani Str. 0186, Tbilisi, Georgia.
authors.forename: Paata
authors.initials: P
authors.lastname: Imnadze
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004197:Disease Reservoirs / Q000469:parasitology; D004285:Dogs; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D005846:Georgia (Republic) / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007303:Insect Vectors / Q000469:parasitology*; D007893:Leishmania donovani / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010691:Phlebotomus / Q000469:parasitology*; D010802:Phylogeny; D016036:Seroepidemiologic Studies; D055815:Young Adult
keywords: Epidemiology; Georgia; ITS Sequencing; Phlebotomus; Phylogeny of Leishmania; Visceral leishmaniasis